Beautiful women feet isolated on white closeup (Gout)

Article by: Consultant Dietitian Megan Ang


Gout is a common form of inflammatory arthritis that affects our joints. In fact, it is one of the most common forms of arthritis in Malaysia.[1] For many, the symptoms (pain and swelling) often begins in the big toe but may also affect other joints in the lower limb[2,3]

There are three stages of gout[4,5]:

  • Asymptomatic hyperuricemia (high uric acid level without any symptoms)
  • Acute gout (sudden and severe gout attack causing intense pain within 24 hours of onset)
  • Chronic tophaceous gout (formation of densely packed crystals called tophi when frequency of gout attack increases, causing permanent joint damage)

This condition can cause extreme pain and affect our daily activities especially as it progresses.

How do I get gout?

Gout occurs when there is a build up of a substance known as uric acid in the body. Although having some uric acid is essential as it acts as a powerful antioxidant in our bodies, too much of it may cause accumulation.[7] This build up is due to excessive production or inadequate excretion which causes crystals to form in our joints, resulting in pain and swelling. 

What is uric acid?

Uric acid is a by-product formed when the body breaks down purine.[5,6,7] This may be naturally produced by our bodies or from purine rich foods in our diets. Therefore, the more purine rich foods we consume, the more uric acid is made.

As mentioned earlier, uric acid itself is not a problem. It only becomes a problem when there is too much of it. Persistently high uric acid levels then lead to increased formation and accumulation of these crystals in our joints.[1] However, not everyone with high levels of uric acid will develop gout.

Am I at risk of getting gout?[1,2,3]

Risk factors for gout include:

  • Gender (more common in men)
  • Age (risk increases with age)
  • Family history of gout
  • Some health conditions (obesity, high blood pressure, congestive heart failure, diabetes, kidney disease, kidney stones)
  • Diet high in purines, alcohol and fructose
  • Some medications (diuretics or water pill, low dose aspirin, excessive B3 vitamin, cyclosporine (immunosuppressant))

How can I manage it?[6,9]

Medical management includes medications to reduce pain of gout flares and lower uric acid.
Medications taken during gout attacks:

  • Non-steroidal Anti-inflammatory Drugs (NSAIDs)
  • Colchicine

Medications to help lower uric acid levels:

  • Allopurinol
  • Febuxostat
  • Probenecid

*Be mindful that some of these medications may have side effects, consult your doctor to find the treatment best suited for you.

Dietary and lifestyle modifications

Through diet and lifestyle changes, future gout attacks may be prevented by reducing uric acid levels in the body.

Maintaining a healthy weight

By maintaining a healthy weight, the risk of developing gout may be reduced.[2,3,5,6] BMI may be used as a general guideline to help you determine if you are in a healthy weight range. 

If you are overweight, losing weight through sustainable healthy eating and exercise may lower your uric acid levels and will also put less stress on your joints especially on your lower limb.

Physical activity

Exercising 30 minutes a day or 150 minutes a week is beneficial to help maintain a healthy weight, which in turn reduces the risk of developing gout.[2,6]

You may start with some low intensity exercise such as walking and slowly increase the intensity as you see fit. Exercising or playing sports with friends and family may also be a good idea. Just try to get your body moving!

Diet

Choose lower purine containing foods!

What should I eat?[3,5,7,8,9]

  • Tart cherries (fresh, frozen, juice or powdered)
  • Low fat dairy products – milk, yogurt, cheese
  • Fruits and vegetables
  • Eggs 
  • Grains and cereals – noodles, rice, bread

What should I reduce?[3,5,7,8,9]

  • Organ meat – liver, kidney
  • Red meat such as beef and lamb, poultry such as chicken
  • Some seafood – sardines, anchovies, tuna, mackerel, muscles, cockles
  • Alcohol – all types, limit to 1-2 standard drinks 
  • High fructose beverages

Some vegetables such as mushroom, asparagus, cauliflower and spinach are higher in purines but studies have shown that they may not have a significant effect on raising uric acid levels. Thus, it is more important to focus on reducing animal sources of high purine foods as there is no strong evidence encouraging avoidance of these plant-based foods.[5,8]

Another important factor is hydration. By drinking plenty of fluids (preferably water), it may promote excretion of uric acid through our urine.[5]

Summary

Much research has been done and gout is a condition that is very well understood. This has allowed for effective strategies to be developed for the prevention and management of gout. With medications, dietary and lifestyle modifications or a combination of both, this painful condition can be well controlled and thus people with gout are able to live without constant pain in their joints.


References:

  1. Wan Rohani WT, Mahfudzah A, Nazihah MY, Tan HL, Wan Syamimee WG, Amanda Jane PG, et al. Association of solute carrier family 2, member 9 (SLC2A9) genetic variant rs3733591 with gout in a Malay sample set. Med J Malaysia. 2018;73(5):307-10.
  2. Gout [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2020 [cited 2022Nov5]. Available from: https://www.cdc.gov/arthritis/basics/gout.html#:~:text=quality%20of%20life%3F-,What%20is%20gout%3F,no%20symptoms%2C%20known%20as%20remission. 
  3. Gout [Internet]. National Institute of Arthritis and Musculoskeletal and Skin Diseases. U.S. Department of Health and Human Services; 2021 [cited 2022Nov5]. Available from: https://www.niams.nih.gov/health-topics/gout 
  4. Doherty M, Jansen TL, Nuki G, Pascual E, Perez-Ruiz F, Punzi L, et al. Gout: why is this curable disease so seldom cured? Ann Rheum Dis. 2012;71(11):1765-70.
  5. Gandy J. Manual of Dietetic Practice. Chichester: Wiley Blackwell; 2019.  
  6. Department of Health & Human Services. Gout [Internet]. Better Health Channel. Department of Health & Human Services; 2000 [cited 2022Nov5]. Available from: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/gout 
  7. Jakše B, Jakše B, Pajek M, Pajek J. Uric Acid and Plant-Based Nutrition. Nutrients. 2019;11(8).
  8. Aihemaitijiang S, Zhang Y, Zhang L, Yang J, Ye C, Halimulati M, et al. The Association between Purine-Rich Food Intake and Hyperuricemia: A Cross-Sectional Study in Chinese Adult Residents. Nutrients. 2020;12(12).
  9. Pillinger MH, Mandell BF. Therapeutic approaches in the treatment of gout. Seminars in Arthritis and Rheumatism. 2020;50(3, Supplement):S24-S30.

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