By Dr. Winnie Chui and Dr. Keith Hariman
Gout is a form of inflammatory arthritis that leads to sudden and intense joint pain. It most commonly affects the smaller joints like the big toe, as well as the joints in your feet, hands, wrists, elbows, and knees. Cases of gout have been on the rise in Hong Kong for the past ten years, affecting 2.9% of the population in 2016, which is similar to the average rates in Western developed countries1.
While there is no cure for gout yet, you can effectively manage the condition and prevent gout attacks with lifestyle modifications and/or medication.
What Causes Gout?
Gout is caused by hyperuricemia, a condition that develops when you have too much uric acid in your blood. Uric acid is produced when the body breaks down purines found in the body and from the food you eat. When too much uric acid accumulates, uric acid crystals build up in the joints, leading to inflammation and pain2.
What are the Symptoms of Gout?
Gout flares, or ‘gout attacks’ are intense bouts of joint pain accompanied by redness, swelling, and tenderness. While a gout flare usually affects only one joint, you can experience multiple inflamed joints at once2. The flares generally happen at night or early in the morning3.
Gout attacks typically resolve in one to two weeks1. If you are experiencing sudden intense pain in a joint, you should see your general practitioner for diagnosis and treatment.
Gout Risk Factors
A variety of factors can increase uric acid levels in the blood and lead to gout attacks. Some risk factors are hereditary and non-modifiable. However, lifestyle and diet-related risk factors, such as excessive intake of purine-rich foods and beverages are modifiable and changes in these factors can help prevent future attacks3.
Non-Modifiable Risk Factors
- Age - Older adults are more likely to experience gout. As people grow older, their chances of developing gout increase4.
- Sex - Gout is more common in men between the ages of 40 and 604.
- Family History - Individuals with an affected first-degree parent have double the chance of developing gout than the general population5.
Modifiable Risk Factors
- Alcohol - Purines are abundant in beer and other alcoholic drinks. The dehydrating effect of alcohol will also impair kidney function, making it difficult to excrete uric acids3.
- Drinks high in fructose - As fructose metabolises in the body, it releases purines and stimulates the development of uric acid. Studies have shown that the consumption of fructose results in a 62% increased risk of gout6.
- Diet - Excessive red meat, organ meat such as liver, or seafood intake increases your risk of gout attacks as they are purine-rich foods7.
- Overweight or obesity - A high body mass index (BMI) of more than 25 increases the risk of gout by 78%. A BMI of more than 35 increases this risk even further to 262%8.
- Use of certain medications - Certain diuretics and anti-hypertensive medications can impair kidney function and thereby prevent uric acid removal from the body9.
- Medical conditions - Certain diseases such as poorly controlled hypertension or diabetes, and kidney disease.
How to Prevent and Manage Gout
Gout affects many facets of everyday life, including work and recreation. Fortunately, there are some methods that have shown to reduce attacks and enhance quality of life.
1. Follow a low purine diet
Follow a purine-restricted diet to avoid foods that may trigger a gout flare. According to the UK Gout Society10, foods can be categorised into high, and low purine types:
|High Purine||Low Purine|
2. Be physically active
Exercise regularly and maintain an optimal body weight. If you are unsure about what intensity of physical activity will best benefit your symptoms and lifestyle, consult with your general practitioner for a customised exercise plan3.
3. Stay hydrated
Drink plenty of fluids to avoid dehydration. To facilitate uric acid excretion, we recommend adults should drink 6 to 8 glasses of water a day.
4. Prescribed medication
Certain medications can increase your risk of gout. If you are already taking medication, speak to your doctor to determine if your medications could be contributing to gout flares3.
Medical Treatment for Gout
There are several short-term and long-term medical treatments that can also treat gout. Talk to your doctor about the medications necessary for your symptoms.
- Non-steroidal anti-inflammatory drugs (NSAIDs) - Reduce swelling and pain in the affected joint. NSAIDs are recommended for people under 65 with no history of stomach ulcers, kidney or liver disease9. Side effects are usually minimal but may include gastrointestinal intolerance and impact on renal function in particular cases.
- Colchicine - An alternative option for a gout flare. The most common side effect is diarrhoea9.
- Glucocorticoids - Also known as steroid medications9, acts as a second line of medication for acute flares when contraindicated to both NSAID and colchicine.
- Allopurinol - Lowers urate levels in people with frequent gout attacks (more than once a year). Allopurinol can be started during an acute attack and is taken for life to reduce the recurrence rate.
Choice of medical treatment depends on your circumstances and symptoms. Please consult with your general practitioner about the best management option for you.
If you are experiencing episodes of gout, you should consult with your general practitioner who will be able to provide a personalised treatment plan. Gout is not a curable condition, but with the adequate management of modifiable risk factors, and proper medical treatment, you can reduce your chances of an attack.
1. Centre for Health Protection Hong Kong. (2019). ‘Gout: No Longer the Disease of the Kings.’ Non-Communicable Diseases Watch. April 2019. Available at: <https://www.chp.gov.hk/files/pdf/ncd_watch_april_2019.pdf> [Accessed 18 May 2021].
2. National Health Service. (2020). ‘Gout.’ NHS. 9 October 2020. Available at: <https://www.nhs.uk/conditions/gout/> [Accessed 21 May 2021].
3. Choi HK, Niu J, Neogi, T, et al (2015). ‘Epidemiology, risk factors, and lifestyle modifications for gout.’ National Institutes of Health. February 2015. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4360969/> [Accessed 21 May 2021].
4. Saag, KG. (2006). ‘Epidemiology, risk factors, and lifestyle modifications for gout.’ PubMed. 12 April 2006. Available at: <https://pubmed.ncbi.nlm.nih.gov/16820041/> [Accessed 18 May 2021].
5. Kuo CF, Grainge MJ, See LC, et al. (2013). ‘Familial aggregation of gout and relative genetic and environmental contributions: a nationwide population study in Taiwan.’ PubMed. 21 November 2013. Available at: <https://pubmed.ncbi.nlm.nih.gov/24265412/> [Accessed 18 May 2021].
6. Jamnik J, Rehman S, Blanco Mejia S, et al. (2016). ‘Fructose intake and risk of gout and hyperuricemia: a systematic review and meta-analysis of prospective cohort studies.’ PubMed. 3 October 2016. Available at: <https://pubmed.ncbi.nlm.nih.gov/27697882/> [Accessed on 18 May 2021].
7. Choi HK, Atkinson K, Karlson EW, et al. (2004). ‘Purine-rich foods, dairy and protein intake, and the risk of gout in men.’ PubMed. 11 March 2004. Available at: <https://pubmed.ncbi.nlm.nih.gov/15014182/> [Accessed on 18 May 2021].
8. Aune D, Norat T, Vatten LJ. (2014). ‘Body mass index and the risk of gout: a systematic review and dose-response meta-analysis of prospective studies.’ PubMed. 11 September 2014. Available at: <https://pubmed.ncbi.nlm.nih.gov/25209031/> [Accessed 18 May 2021].
9. UpToDate. (2021). ‘Patient Education: Gout (Beyond The Basics).’ April 2021. Available at: <https://www.uptodate.com/contents/gout-beyond-the-basics?csi=bfa2e344-5689-460b-8535-34d2ef71274a&source=contentShare> [Accessed 16 May 2020].
10. UK Gout Society. ‘All about gout and diet.’ Available at: <http://www.ukgoutsociety.org/PDFs/goutsociety-allaboutgoutanddiet-0917.pdf> [Accessed 16 May 2020].