Posted on Thursday, March 29, 2018
When it comes to eating out, Singaporeans are no doubt one of the biggest spenders in Asia. Based on the results from a 2017 survey on consumer dining habits, the average Singapore citizen chalks up an average spend of S$379.80 a month just at restaurants.
Indulging in an eating-out culture has put many Singaporeans at risk of contracting ailments which are generally associated with a “rich diet”. One of the most common of such diseases is Gout, a form of inflammatory arthritis caused by overconsumption of foods rich in Purines. Purine is an organic compound that can be found in the cells of most living organisms as well as in a wide assortment of common foods. Although Purines play an important role in the synthesis of both DNA and RNA, high level of purines in a human body can cause serious health problems. Purine-rich foods commonly consumed by Singaporeans include durian, salmon, cockles, Bak Kut Teh (pork rib broth), Bak Chor Mee (pork liver noodles), Beef Hor Fun (beef glass noodles), drunken prawns, chilli crab and even popular Asian food products such as Chicken Essence and mooncake.
Purines in the foods we eat are broken down into uric acid during the digestive process and high levels of uric acid in a person’s blood will make him or her more susceptible to Gout. This is due to the build-up of uric acid in the bloodstream that will eventually precipitate into uric acid crystals, which then accumulate in the joints causing severe pain and inflammation.
Gout sufferers usually wake up in the middle of the night with a hot, painful joint on their foot. The pain makes it difficult to even walk and can last for few days and even weeks. Worst of all, these excruciating flares may become more and more frequent if the condition is not managed.
The pain can make it difficult to just move around and walk. Moreover, Gout may also be a sign that the kidneys are malfunctioning. If left untreated and unmanaged, Gout may lead to kidney damage through the development of kidney stones, causing even urination to become painful.
The big toe joint is involved in 90% of people with Gout. However, this ailment can also attack the top of the foot and the ankle, and sometimes to other joints in the body.
Statistically, 1 in every 200 people is affected by Gout worldwide. Men are usually affected more than women, and more often as they approach 40 – 50 years of age. It may also be a hereditary condition. Should someone have a history of Gout in the family, close relatives should go for a full medical checkup to review their uric acid levels and they may want to maintain a low-purine diet to avoid future complications.
According to a study carried out in Singapore, the prevalence of Gout in our country is much higher than the world average due to the food we eat. This study, involving 52,322 participants also reported that gout sufferers in Singapore often have underlying medical conditions such as hypertension, hyperlipidaemia, impaired kidney function, ischaemic heart disease, and diabetes. Obesity (people with the Body Mass Index of more than 25) is present in 66% of the Gout patients involved in this research. This reinforces the claim that the eating habits of Singaporeans are a major influence on a person’s susceptibility to Gout.
It is important to first recognize the signs and symptoms of Gout. The most well-known symptom is throbbing pain and swelling in the joints that can last for hours to days. The pain may subside and seemingly disappear for a few weeks or months after the initial attack, but this relief is only temporary as a subsequent attack will eventually occur. Gouty flare-ups are common in the foot, ankle and knee joints and may be triggered an illness or traumatic injury.
During a Gout attack, it is advisable to elevate the leg to reduce swelling and drink plenty of water. Applying an ice pack to the affected area may offer some relief, but too much cold can actually cause more uric acid crystals to deposit in the joint worsening the condition. The best solution may be Contrast Therapy, a method that involves switching between a hot compress for 2 – 3 minutes and a cold compress for 30 – 45 seconds on the affected area. Contrast therapy can help reduce pain and swelling that occurs during a gout attack.
Gout patients are usually able to “predict” when their attack may happen, especially when it is due to diet choices. Hence, maintaining a healthy lifestyle is important in helping to reduce the chances of gout attacks. If you already have a history of Gout some preventative measures to avoid an attack include:
Gout at an acute stage (redness, pain and swelling) can be controlled and regulated with anti-inflammatory drugs prescribed by a doctor. Such a prescription usually helps alleviate pain and inflammation within 1 – 2 days. Once the pain is gone, follow up with a specialist doctor is critical. A doctor may confirm the diagnosis with a series of tests including x-rays, ultrasound imaging, and/or aspiration of joint fluid to examine uric crystals. Gout may sometimes be mistaken for some other form of arthritis, including rheumatoid arthritis or even septic arthritis, and may also present in the absence of increased uric acid levels.
If your attack has become more frequent, it is best to consult a specialist doctor such as a rheumatologist or endocrinologist to maintain your uric acid levels through prescribed medications. Leaving your gout condition untreated will increase your risk of developing secondary problems such as multi-joint gout attacks and permanent joint deformities, including in the hands. This will permanently affect your quality of life, interrupting your daily activities such as simple walking.
For long-term management of Gout, medication alone is insufficient. Gout patients will need to include regular visits with a Podiatrist to quicken their recovery process. A Podiatrist will ensure that the structures in the patient’s foot are well-preserved and play an important role in minimizing joint damage during gout flare-ups, relieving stress from the affected joints.
Through a thorough foot examination and gait assessment, a Podiatrist will base their design of the foot orthotic on the results and findings, including advice on the appropriate footwear to help manage the affected joints. Foot orthotics also serve to minimize the patient’s risk of developing other foot ailments which result from secondary arthritic changes.
When necessary, therapeutic treatment modalities could be used to alleviate acute gout attacks as well. Treatments such as therapeutic ultrasound have been reported to offer instant pain relief for gout sufferers as it promotes blood flow through the capillaries, helping to wash out uric acid crystals. This treatment modality will also repair the patient’s lymph and capillary vessels and aid in better absorption and metabolism of waste products.
Podiatrists may also address any other foot conditions or problems a patient may present with. This includes soft tissue complaints such as tendinitis, flat or high-arch foot conditions and other foot problems which may affect a patient’s quality of life.
Author: Sani KAMIS, MSc (UK), BSc (Hons) (UK), MFPM RCPS (Glasg)
Senior Podiatrist at East Coast Podiatry
Sani is a licensed and registered Podiatrist with the U.K. Healthcare Professions Council, and a member of Faculty of Podiatric Medicine, Royal College of Physicians and Surgeons (Glasgow). Sani practices in Singapore at East Coast Podiatry Orchard and Novena clinics, his clinical and PhD research focuses on rheumatological conditions of the foot.
Editor: Dr. Michael Lai, D.P.M. (USA)