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Gout

Rheumatology

Gout is a type of inflammatory arthritis caused by the accumulation of urate crystals in the joints, characterized by sudden, severe joint pain and swelling. In Hong Kong, gout is a common rheumatic disease, affecting about 3 out of every 100 people.

Symptoms

Typical symptoms of gout include:

Acute Joint Pain: Usually starts suddenly at night, most commonly affecting the big toe joint, but can also involve the ankles, knees, fingers, and wrists.
Joint Redness, Swelling, and Warmth: The affected joint becomes red, swollen, and warm, with severe pain that can be triggered by even a light touch or a breeze.
Tophi: Repeated attacks can lead to the formation of urate crystal nodules called tophi around the joints, which can cause joint deformity and damage over time.

Causes and Factors

Causes
Gout results from abnormalities in purine metabolism, leading to high levels of uric acid. Main causes include:

Diet: Excessive intake of high-purine foods such as red meat, organ meats, seafood, and alcohol.
Genetics: Genetic factors influencing uric acid metabolism.
Medical Conditions: Kidney disease, obesity, diabetes, etc.
Medications: Certain medications can affect uric acid excretion.

Risk Factors

Gender: Men are at higher risk; the risk increases for women after menopause.
Age: Most common in middle-aged and older individuals.
Dietary Habits: High-purine diets and excessive alcohol consumption increase the risk.
Other Health Conditions: Hypertension, diabetes, and obesity.

Diagnosis

Diagnosis of Gout involves several tests:

Medical History and Clinical Examination: The doctor will take a detailed history and perform a physical exam.
Blood Tests: Measure uric acid levels in the blood, but high uric acid alone is not sufficient for diagnosis.
Joint Fluid Analysis: The most accurate method involves extracting fluid from the inflamed joint and using polarized light microscopy to observe urate crystals.

Treatments

Gout treatment includes medication and lifestyle changes:

Acute Gout Attacks:
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Such as ibuprofen, to relieve pain and inflammation.
- Colchicine: To alleviate symptoms of acute attacks.
- Steroids: Oral or joint injections to reduce severe pain.
Long-Term Management:
- Urate-lowering medications, Such as allopurinol and probenecid, to lower uric acid levels and prevent recurrences.
- Dietary Adjustments: Avoid high-purine foods, drink plenty of water, maintain a balanced diet, and avoid alcohol and sugary drinks.

Gout cannot be cured, but it can be effectively managed with medication and lifestyle changes.

Adjusting diet, maintaining a healthy weight, regular exercise, and adhering to prescribed medications.

Untreated Gout may lead to permanent joint damage, kidney stones, and kidney dysfunction.

Patients should follow medical advice and take the following measures: Control Diet: Avoid high-purine foods and drink adequate water. Maintain a Healthy Lifestyle: Regular exercise, avoid smoking and excessive alcohol, and keep a healthy weight. During Acute Attacks: Rest, apply ice to the affected area, and avoid excessive use of the affected joint.