Gout

Gout is a form of inflammatory arthritis that resulted from an excess of uric acid in blood.​
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The symptoms of gout are due to the formation of uric acid crystals in the joints and the body’s response to them. Gout usually affects the joint in the base of the big toe.​
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Repeated bouts of gout can lead to gouty arthritis, a worsening form of arthritis.​
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There is no cure for gout, but you can effectively treat and manage the condition with medication and self-management strategies.​

What is Uric Acid

Uric acid is a metabolite of purine. Purine can be found in foods. High levels occur in the blood when the body produces too much uric acid and the kidneys cannot eliminate through of it. Uric acid levels also increase when a person is fasting.​

Uric acid is not very soluble in water and can crystalize in the joints causing inflammation and gout. Gout is more likely to occur at uric acid levels greater than this. However, a person may have  normal uric acid levels and still develop gout.​

What is the normal level of blood uric acid?

Men  = 300-500mmol ( 5-8.3mg/L)

Women =150-380 mmol ( 2.5-6.3mg/L)

Signs and symptoms of Gout

Patients present with :-

Swelling

Pain

Skin bruising or color change

Extreme pain while putting weight or pressure on the forearm

Crooked appearance 

Popping or snapping heard during the injury

Unable to move the arm normally

Causes of Gout

Gout is caused by a condition known as hyperuricaemia, where there is too much uric acid in the body. The body makes uric acid when it breaks down purine, which are found in your body and the foods you eat. 

Excessive amount of uric acid  causes the build up of monosodium crystals in the joints, fluids and tissue within the body. This results in the inflammation, pain and deformity observed in gouty arthritis.

Risk Factors for Gout

• Being male​
• Being obese​
• Having certain health conditions including:​

– congestive heart failure​

– hypertension (high blood pressure)​

– insulin resistance​

– metabolic syndrome​

– diabetes​

– poor kidney function​

• Using certain medications such as duretics (water pills)​
• Drinking alcohol. The risk of gout is greater as alcohol intake goes up​
• Eating or drinking food and drinks high in fructose (a type of sugar)​
• Having a diet high in purines 

– Purine rich foods include red meat, organ meat and some kind of seafood such as anchovies, sardines, mussels, scallops, trout and tuna

Food High in Purine and Suitable Alternatives

Avoid:-

1. Yeast extracts (eg Marmite, Vegemite and Bovril)
2. Animal internal organs such as liver, kidney, heart, brains, beef, mutton, fish roe and cured meat
3. small fish (eg ikan billis, sardines, herring, trout, tuna, canned fish)
4. Soy bean and related products (eg beancurd, bean paste, soya bean milk, tempeh)
5. Broths, meat stocks (eg chicken essence, bak kut teh soup, gravies and stock cubes)

​Alternatives:-

1. Trans-fat free margarine or jam (spread thinly)
2. Lean meat, chicken or fish (limit to one serving or one palm size)
3. Fresh fish (limit to one serving or one palm size daily)
4. Low-fat milk or yoghurt and cheese, lean meat or chicken and poultry, eggs, nuts and other legumes​
5. Fresh herbs and vegetables (onions, carrots, tomatoes) to prepare broths / soups​

How is Gout Diagnosed?

In many cases, gout is a clinical diagnosis. Patients typically present with a flare of the affected joint. The doctor will assess the symptoms and outcomes of  physical examination including blood results and x-rays. Fluid may also be aspirated from the joint and placed under microscopy to confirm the diagnosis

How is gout treated?

Conservative Option

Manage pain using prescription meds like NSAIDS ( non- steroidal anti-inflammatory medications as well as colchcine

Prevent future flare like making changes to lifestyle, losing weight, limiting alcohol

Prevent Tophi and lower uric acid levels in the body and long term close monitoring

Eat a healthy diet

Get physically active

Lose weight

Conclusion

If you suspect that you might have a out issue that you wish to consult, please do not hesitate to contact our team at Spire Orthopaedics. Book a consultation session with us if you have any questions for our Doctor.

Consultation