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Inflamed joints after a seafood dinner? Syida Lizta Amirul Ihsan gets the lowdown on the disease linked to high uric acid levels in the blood
FOR everyone suffering from gout, the excruciating pain he or she feels from the inflammation could be serious enough to cause moving difficulty and even painful, sleepless nights.
Here’s a guide to the disease, which includes lifestyle changes, exercise and most importantly, medication from Pantai Hospital Kuala Lumpur consultant nephrologist and general physician Dr Foo Siu Mei, to help patients manage their condition better.
Gout is characterised by pain, swelling and inflammation in the joints, especially the big toe, ankle and knee due to accumulation of uric acid there. “Elevated uric acid in a person’s blood test without joint inflammation is not gout,” Dr Foo says. “Many people make the wrong assumption that they have gout if their blood tests show high uric acid level.”
For some, the excruciating pain may be short-lived, others may take days for it to subside.
WHAT CAUSES IT?
“Increased uric acid production in the body and reduced excretion in the urine and intestine,” Dr Foo says. The medication, therefore, is three-pronged: Allopurinol is used to reduce uric acid production, probenecid and benzbromarone are used to increase uric acid excretion, and colchicine is a gout-specific medication to relieve pain and inflammation when there is an attack.
Allopurinol and probenecid are generally safe for long-term use and serious side effects are rare. Their most frequent side effects are allergic rash and diarrhoea. “Colchicine may cause diarrhoea and nausea when used in high dosage,” Dr Foo says.
Also, those with uric acid stones are advised not to take medication to increase excretion of uric acid because the stones may get bigger or new stones form. “They should only take medication to decrease uric acid production.”
Colchicine, meanwhile, should be taken as soon as patients feel like a gout flare is starting, in order to abort the attack and reduce the amount of medicine they need to take to bring the inflammation down.
In developed countries like United Kingdom and the United States, one to five per cent of the population suffers from this disease.
The prevalence is increasing, in line with the increase in obesity and high blood pressure. “Research shows that individuals who are obese and with high blood
pressure have a higher chance of developing gout,” she says.
It affects more men than women. There are some theories on this gender difference, including the effect of sex hormones. “After menopause, there is a higher incidence of gout among women, suggesting that they may no longer be protected by the hormone oestrogen,” Dr Foo says.
WORST CASE SCENARIOS
For patients with longstanding chronic gout, the accumulation of uric acid crystals can form in and around joints. “Called tophi, in the long run if gout is not managed well, this can cause deformity and eventually destroy soft tissues, bones and joints.” “Patients also face the risk of kidney failure due to frequent intake of strong painkillers. Deposition of uric acid crystals in the kidneys can damage the kidney too,” Dr Foo says.
Persistently high uric acid levels in the urine can lead to kidney stone and predispose patients to urinary tract infection or obstruction of the urinary tract.
CAN TOPHI BE OPERATED ON?
“Yes, if it causes severe deformity and depending on the location, and other factors, but tophi doesn’t just happen on one part of the body.
There is no point removing it if you do not treat the root cause of gout,” Dr Foo says.
DIET AND GOUT
Gout patients, Dr Foo says, have to watch their food diligently and must avoid or at least reduce food with high purine content. “Different people have different triggers so you have to know what you need to avoid. If you don’t know, try keeping a food journal.
“Limit your intake of protein to one to two pieces of chicken or fish each meal. Soy is believed to have anti- inflammatory properties although there is no scientific proof so it may be good to take it despite it being a bean.”
IS APPLE CIDER VINEGAR GOOD FOR GOUT?
“This is a grandmother’s story and there are no scientific studies, but it may be true,” Dr Foo says.
She says, based on logic, apple cider vinegar has an alkaline effect on the body. It may be sour, but once it is metabolised, it increases the pH level and may be helpful in excreting uric acid.
Another food that has an alkaline effect on the body is berries. High doses of vitamin C can also increase uric acid excretion.
EXERCISE AND GOUT
For patients with severe gout, exercises should be done in moderation. Rigorous exercise results in muscle breakdown, which further increases uric acid production. “That’s why we experience a heavy ‘sour’ sensation in muscles during rigorous activities,” she says. “So no strenuous exercise, like a marathon, for them.”
Gout patients also should not get dehydrated so make sure there is adequate water intake during and after exercise.
“However, exercise is important as it helps patients maintain their weight, since research shows that obese individuals have a higher tendency to develop gout compared with those who are trim.”
IMPORTANT NOTE ON MEDICATION
Many patients, Dr Foo says, overlook the possibility that many painkillers can damage kidneys when taken long-term and frequently.
“Some high blood pressure medications also raise uric acid level and patients should be aware of this. Tell your doctor if you have gout,” she says.
Those suffering from severe and frequent gout attacks should see a doctor for a proper medical check-up to make sure there are no serious illnesses, like severe renal failure or blood cancers causing the gout
attacks, Dr Foo says.
See a General Physician for a thorough check-up. Then, if the doctor finds an underlying illness causing the gout, the patient will be referred to the relevant specialists, she says.