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Gout

What is Gout?

Gout is a type of inflammatory arthritis in Singapore. It occurs when urate crystals build up in the joints, leading to inflammation, pain, and swelling. Gout commonly affects the big toe but can also affect other joints, such as feet, ankles, knees, elbows, wrists, and fingers. Gout is typically characterised by sudden, severe attacks of pain, redness, swelling, and joint tenderness. These attacks come and go, but when they occur, it is painful enough to wake an individual up from their sleep.

Gout pain toe
Gout is often characterised by a swollen and painful big toe.

What causes Gout?

Gout is primarily caused by an elevated uric acid level in the blood, a condition known as hyperuricaemia.

Uric acid is a waste product that forms when the body breaks down purines –  naturally occurring substances present in certain foods and the body’s cells. It is passed out of your body in urine. However, when too little is removed, or the body produces too much uric acid, uric acid builds up and forms urate crystals in joints and other tissues, causing inflammation of the joints known as gout attacks. However, not everyone with a high uric acid level develops gout.

In severe chronic cases, collections of solid urate known as tophi can form, which causes damage to joints. These can be found in the joints and soft tissues, often visible on the ears, joints, or tendons.

Tophi, accumulation of solid urate crystals can occur in severe cases of gout.

What are the symptoms of Gout?

The symptoms of gout include:

  • Sudden and severe pain: gout attacks often begin with a sudden and intense pain in the affected joint. The pain is usually described as a throbbing, burning, or excruciating sensation. It can be so severe that even the slightest touch or movement of the joint can be unbearable.
  • Swelling: the affected joint becomes swollen and may appear red and inflamed.
  • Warmth: the affected joint may feel warm to the touch due to increased blood flow and inflammation.
  • Tenderness: the affected joint becomes extremely tender, where even a light touch is excruciating.
  • Limited range of motion: pain and swelling of the affected joint can restrict the range of motion.
  • Fever: some individuals with gout may develop a low-grade fever during an acute attack, along with other systemic symptoms like fatigue and malaise.

If you suspect you have gout or are experiencing any of the symptoms mentioned above, make an appointment with Asia Arthritis Rheumatology Clinic today.

inflamed joint - gout
Gout causes pain, swelling, and inflammation of the affected joint.

Is Gout painful?

Yes, gout is commonly associated with severe pain, but not all individuals with gout encounter this level of pain. Gout attacks are sudden and cause severe pain in the affected joint. The pain is typically intense and can wake a person from sleep or cause extreme discomfort.

The pain associated with gout is usually at its worst during the first 24 hours of an acute attack and gradually subsides over several days to weeks.

Who is at risk of Gout?

Several factors can increase the risk of developing gout, such as:

  • Gender and age: gout is more common in men than in women. Men are generally at a higher risk, especially as they age. Women's risk of gout increases after menopause.
  • Genetics: family history and genetics play a role in gout risk. If you have a family member with gout, you may be more likely to develop the condition.
  • Diet: a diet high in purines, found in certain foods like red meat, organ meats, shellfish, and some types of fish, can increase uric acid levels and the risk of gout. Excessive alcohol intake can contribute to gout risk because alcohol interferes with the body's ability to remove uric acid.
  • Medical conditions: certain medical conditions may also increase the risk of gout. These conditions include obesity, diabetes, high blood pressure, kidney disease, and metabolic syndrome.
  • Medications: some medicines used to treat hypertension, like diuretics, can raise uric acid levels, increasing the risk of gout. Additionally, hypertension and gout share common risk factors, such as obesity and a high-purine diet.
  • Joint injuries or surgery: physical trauma, joint injuries, or surgery can sometimes trigger gout attacks in susceptible individuals.

How is Gout diagnosed?

Gout is diagnosed in the following ways:

  • Medical history and symptoms: your medical history and symptoms will be discussed. This includes the pattern of joint pain, the location of the pain, how long the symptoms have been present, and the occurrence of previous gout attacks.
  • Physical examination: a physical exam focusing on the affected joint will be performed to assess the joint for signs of inflammation.
  • Joint aspiration (synovial fluid analysis): a joint aspiration, also known as arthrocentesis, may be performed to confirm the diagnosis of gout. During this procedure, a small needle is inserted into the affected joint to withdraw a sample of synovial fluid, which is the fluid that lubricates the joint. The synovial fluid is examined under a microscope to look for urate crystals.
  • Blood tests: the uric acid level in your blood will be measured.
  • Imaging studies: X-rays or other imaging tests may be performed to assess the joint damage caused by chronic gout. These tests can help determine the extent of joint involvement and any joint damage that has occurred over time.
Gout diagnosis
A physical examination will be conducted to diagnose gout.

What are the treatment options for Gout in Singapore?

The treatment of gout typically involves a combination of lifestyle changes and medications. The treatment goal for gout is to manage pain, reduce inflammation, and lower uric acid levels; here are the treatment options for gout:

  • Medications: medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), anti-inflammatory drugs (colchicine), or corticosteroids like prednisone can provide quick relief from pain and inflammation. Other medications, such as allopurinol or febuxostat, lower uric acid levels in the blood, thus reducing the risk of future gout attacks.
  • Lifestyle modifications: these involve dietary changes, limiting intake of high-purine foods such as seafood, red meat, organ meats, and drinks which contain high fructose corn syrup or alcohol. Keep a balanced diet, maintain a healthy weight, and stay well-hydrated.
  • Joint aspiration and injection: joint aspiration may be performed to relieve pain and remove excess fluid from the affected joint. Joint injections with corticosteroids can quickly relieve pain and inflammation.
  • Management of coexisting conditions: managing other medical conditions, such as diabetes, hypertension, or kidney disease that may contribute to gout is essential for comprehensive care.
 Joint injections gout
Corticosteroid injections can alleviate pain in the affected joint

Make an appointment with Asia Arthritis Rheumatology Centre where we prioritise our patient’s health by ensuring accurate diagnosis and personalised treatment.

Frequently Asked Questions

What is the quickest way to alleviate gout symptoms?

The fastest way to relieve gout symptoms is to take anti-inflammatory medications like NSAIDs, colchicine, or corticosteroids. However, managing the underlying cause of gout – elevated uric acid levels, requires longer-term treatment with urate-lowering medicines and lifestyle changes.

Is gout a permanent condition?

Gout is not necessarily permanent. With proper treatment, lifestyle modifications, and management of uric acid levels, gout can be controlled, and the frequency of gout attacks can be reduced significantly.

Can gout be prevented with dietary changes alone?

Dietary changes, such as reducing high-purine foods and alcohol intake, can help lower the risk of gout attacks.

How long does a typical gout attack last?

Gout attacks usually peak within 24 hours, but the pain and swelling can last from a few days to several weeks. Timely treatment with anti-inflammatory medications can shorten the duration and severity of an attack.

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Dr Annie Law

Senior Consultant Rheumatologist
MB BCh BAO, MRCP (UK), MMed,
FAMS (Rheumatology)

Dr Annie Law is an experienced Senior Consultant Rheumatologist and Medical Director at Asia Arthritis & Rheumatology Centre.

She leads subspecialty SLE clinics, showcasing her dedication to lupus care. Dr Annie Law has been duly recognised for patient-oriented care, earning multiple awards. Her extensive education includes FAMS (Rheumatology) and MRCP (General Medicine). Actively involved in lupus research, she established a lupus database and contributed to paramount protein therapy discoveries. Dr Law is a committed medical educator, holding faculty positions and receiving accolades for her teaching. Her impactful contributions extend to the professional organisation for rheumatology in Singapore exemplifying deep commitment to advancing rheumatology knowledge.

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