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  2. Overview
  3. Allergy-Immunology-Rheumatology
[Major Points] 
  1. Gout is a disease caused by abnormal purine metabolism or reduced uric acid excretion. 
  2. The primary symptom is joint pain. 
  3. Common medications for treatment include pain relievers and uric acid-lowering drugs. 
  4. Please follow your doctor's instructions and take your medication on time. Do not stop taking it on your own.
What is "Gout"? 
Gout is a condition caused by abnormal purine metabolism or reduced uric acid excretion, resulting in hyperuricemia (high uric acid levels). When uric acid concentration becomes too high, it forms crystals that deposit within the joint, leading to redness, swelling, heat, and pain in the joint. This condition is known as gout. It is a form of acute arthritis that often occurs suddenly, typically at night or in the early morning. The pain comes on rapidly and can resolve quickly, earning it the name "gout." 
 
What are the common symptoms?
Approximately nine out of ten people experience their first gout attack in the big toe joint. However, it can also occur in other joints such as the top of the foot, ankle, knee, and wrist.
  1. Abnormal blood uric acid levels: In most adults, gout is primarily caused by reduced uric acid excretion, while only a very small number of cases result from overproduction of uric acid. In children, gout is often caused by congenital metabolic gene abnormalities.
  2. Acute gouty arthritis: This commonly affects men between the ages of 30 and 50 who are obese and consume excessive alcohol. Symptoms include sudden redness, swelling, heat, and severe pain in the big toe joint, making it difficult to walk. Other toes or knee joints can also be affected. 
  3. Chronic tophaceous gout: If not well controlled, uric acid crystals can deposit in joints, subcutaneous tissues, the earlobes, internal organs, etc., forming tophi . This can cause joint swelling, permanent damage, and even impair kidney function. 
Experiencing the above-mentioned symptoms does not necessarily indicate gout. If you have these symptoms, please seek medical attention at the Allergy, Immunology and Rheumatology Clinic.
 
What are the common treatment methods?
  1. Medications for acute gouty attacks: 
    1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Medications like Naproxen, Ibuprofen, and Celebrex can reduce inflammation and effectively relieve symptoms. 
    2. Steroids: Steroids have anti-inflammatory effects and can alleviate the discomfort associated with acute gout. They are suitable for patients with peptic ulcers or poor kidney function. 
    3. Colchicine: Used for relieving acute symptoms and prevention. 
  2. When uric acid levels are above 10 mg/dL (uric acid levels in the blood exceeding 10 milligrams per 100 milliliters), and the 24-hour urine uric acid excretion is higher than 1000 milligrams, the consideration of uric acid-lowering medications becomes necessary. 
  3. In the chronic phase, uric acid control is crucial. Common uric acid-lowering medications include Allopurinol, Feburic, Euricon, etc.
Principles of care: 
  1. Maintain healthy weight and waist circumference: If you are overweight, it's advisable to gradually lose weight, aiming for a monthly weight loss of around one kilogram. Rapid weight loss or extreme fasting should be avoided to prevent the triggering of gout attacks due to elevated uric acid levels. Additionally, regular monitoring of waist circumference within the standard range ( National Health Administration:  ≤90 cm for males,  ≤80 cm for females). 
  2. Increase physical activity: Research indicates that physical activity can lower mortality rates in hyperuricemia patients. Therefore, it is advisable to incorporate regular exercise into your routine. 
  3. Maintain proper hydration: Ensure adequate hydration by consuming 2000 ml of water daily. Dehydration can potentially trigger gout attacks, so maintaining proper hydration can reduce the occurrence of gout attacks and the formation of uric acid stones. 
  4. Maintain a balanced diet and avoid high-purine foods:
    1. Carbohydrates: All grains and tubers can be consumed. 
    2. Vegetables and fruits: Most vegetables are allowed, except for heavily dried shiitake mushrooms and seaweed, which should not be consumed in large quantities. There are no restrictions on fruit consumption. 
    3. Protein: Reduce the intake of organ meats and seafood (except for sea cucumbers and jellyfish skins). 
    4. Dairy: Adequate dairy consumption has been shown to lower uric acid levels and reduce the risk of gout.
    5. Fats: High-fat foods can inhibit uric acid excretion, so they should be avoided during acute gout attacks. 
  5. Alcohol and sugary beverages: Alcohol and sugar are metabolized into lactate in the body, which can affect uric acid excretion and accelerate uric acid formation. Therefore, it's important to avoid alcohol and sugary drinks (carbonated beverages, orange juice, etc.), with beer being the most likely to trigger gout attacks.
 
References
  1. Dehlin, M., Jacobsson, L., & Roddy, E. (2020). Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nature Reviews Rheumatology, 16(7), 380-390. https://doi.org/10.1038/s41584-020-0441-1
  2. Pillinger, M. H., & Mandell, B. F. (2020). Therapeutic approaches in the treatment of gout. Seminars in Arthritis and Rheumatism 50(3), 24-30. https://doi.org/10.1016/j.semarthrit.2020.04.010
  3. Shen, M. Z. (2022). Diagnosis and treatment of gout and dietary control. Journal of the Taipei Medical Doctors Association, 66(10), 50-60.
  4. Xu, Y., Li, W., Xu, J., Lin, X., (2022). Comparison of the latest national guidelines for gout and hyperuricemia. Journal of Internal Medicine, 33(5), 365-377. https://doi.org/10.6314/JIMT.202210_33(5).05
     
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    Taipei Veterans General Hospital 
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    • Smoking and chewing betel nut significantly induce oral cancer. Obesity will potentially increase the risk of breast cancer and colorectal cancer. Please control body weight and keep away from tobacco and betel nut.
    • Information provided above can’t overcome physician's treatment and replace physician patient relationship.
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