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What is gout?

Gout is an inflammatory arthritis caused by the uric acid crystallization within the joints. It is highly associated with hyperuricemia. It affects more on male than female (9:1). The first gout attack always occurs at age 40 to 60 years in men.

What are the symptoms and clinical course of gout?

There are four clinical stages of gout:

1. Asymptomatic hyperuricemia:

a status with hyperuricemia but without gout attack yet

2. Acute gouty arthritis:

• acute single joint swelling pain with erythema
• first metatarsophalangeal joint is mostly affected
• ankle, foot and knee joints could also be involved
• acute gout is always self-limited within 1-2 weeks

3. Intercritical gout:

the periods without arthritis between gout attacks

4. Chronic tophaceous gout

a phase of chronic polyarticular gout with multiple tophi deposition which may lead to joint destruction and deformity

What are the management and treatment for gout?

1. Medication: non-steroid anti-inflammation drugs (NSAIDs) and colchicine are prescribed during acute gout attacks. Urate lowering drugs would be used while gout attack more than twice yearly, tophi deposition, urolithiasis, etc.  
2. Exercise: patients should avoid violent sports because it promotes sweating and reduces the amount of serum urine acid excretion.
3. Drink more water: drinking more than 2000 ml water a day to help excrete uric acid.
4. Avoid high purine diet: read the chart below and locate group three for purine rich food. Patients should consume food containing less purine to reduce formation of uric acid.
5. Avoid drinking liquor: once patients consume liquor, it affects uric acid execration and would lead to hyperuricemia.
6. Maintain ideal body weight: overweight and obesity may result in hyperuricemia and gout attack.