What is gout?

Gout is a common form of inflammatory arthritis that can cause intense pain and swelling in the joints. If gout is left unaddressed, the flares will become more frequent and severe over time, and are more likely to develop other complications.

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Overview

Gout can affect any joint in the body, but over 90% of gout cases involve the big toe joint. When gout is left unaddressed for prolonged periods, the buildup of uric acid crystals, tophi, can permanently damage bones and other internal organs, depending on its location. Long term complications include kidney failure and gout induced osteoarthritis. With early diagnosis and effective management, gout can be controlled and even mitigated to become gout free.

Many patients assume their joint pain is due to bone, muscle or tendon injury, especially if it is the first time they are experiencing an acute gout attack. While symptoms may come and go, untreated gout can worsen and result in long term complications.

What causes gout?

Gout is caused by having too much uric acid in the bloodstream, the uric acid crystals can settle and clump together in the joints causing the sudden pain and other symptoms. It is most common in middle-aged men, but can affect anyone. The most common cause for gout in most patients however, is their diet and/or lifestyle.

The average Singaporean diet is protein-heavy, which increases the likelihood of a gout attack as the body produces more uric acid while breaking down these purine-containing foods. Those who regularly consume foods, such as organ meats, venison, sausages, bacon, seafood, and shellfish, face even greater risk due to the very high concentration of purines.

Alcohol consumption also affects uric acid levels in the body by slowing down the excretion of uric acid from the kidneys due to dehydration. Instead, the crystals are deposited in the joints.

Risk factors for gout include:

  • Obesity, excessive weight gain especially in youth
  • Moderate to heavy alcohol intake
  • High blood pressure, high cholesterol and Ischaemic heart disease
  • Diabetes and abnormal kidney function including renal failure
  • Certain medication, such as diuretics
  • Certain diseases, such as Lesch-Nyhan syndrome

Some studies have also shown that patients with abnormally low or high thyroid hormone levels may develop gout due to complications associated with kidney function

What is a gout attack?

Acute gout attacks are characterised by a rapid onset of pain in the affected joint. The attacks may be brought on by a spike in alcohol consumption, stress, starvation, rapid weight loss, and the introduction of uric acid-lowering drugs. Some patients report that the acute pain is so intense that even a bed sheet touching the toe causes severe pain. In some instances, an attack may not subside entirely, especially if the patient’s uric acid levels are consistently high.

The symptoms usually reach maximum intensity within 8-12 hours of onset and can reach excruciating levels of pain that disable the patient. While the big toe joint is the most common site for an attack, other joints can also be affected, including the midfoot, ankles, knees, wrists, fingers, and elbows.

Three types of gout patients we commonly see:

  1. First time occurrence of a gout flare-up
  2. Occasional flare-ups with some long term effects on their joints setting in
  3. Advanced stages of gout with tophi and gouty erosions present within and around the joints


The long-term effects of leaving gout unaddressed?

Gout is a progressive disease; leaving gout attacks allows uric acid crystals to accumulate within a joint, leading only to further attacks in the future.

Over time, patients often develop severe bone erosions from the chronic uric acid build-up and crystal deposition into the joints. As the feet can take up to 300% of a person’s body weight daily, joint erosions can quickly advance into secondary, painful arthritis.

When joints are already damaged, medication alone is insufficient to address the cause of pain or resolve the underlying joint problems. The joint may be compromised by gout, causing secondary musculoskeletal pains in other areas of the foot and ankle, or knee.

Ultimately, failure to properly manage uric acid in the body will result in more than joint damage. Long-term crystallisation of these compounds can cause attacks of kidney stones and uric acid crystals build-up in the kidney filtering tubules, leading to kidney failure.

What should you do if you suspect you have gout?

Gout management in Singapore can be divided into several phases. The first phase is to deal with pain and inflammation. This can be done by staying hydrated, resting, and using an ice pack to relieve the inflammation until a foot specialist or a podiatrist is able to assess the affected area.

To confirm the diagnosis, patients will undergo clinical evaluation and a thorough history taking to determine if gout is the true cause of their pain and foot/ankle problem. This can include utilising clinical imaging, such as diagnostic ultrasound or x-rays to give a clear visualisation of the underlying problem.

Oral medications should be continued to help to manage the systemic cause of gout, aiming to prevent further attacks and complications, such as gouty arthritis, kidney stones, and tophi in the soft tissues. However, it will not address the joint or bone damage already caused by gout.

A podiatrist will use various non-invasive clinical modalities/ therapies to reduce the immediate pain and inflammation of gout attacks. Once the immediate effects of the attack have been reduced, podiatrists can address the resulting joint pain and deformity by adjusting the foot and lower limb biomechanics by using customised in-shoe devices for joint stabilisation and utilising advanced technologies for improving joint quality and mobility, while enhancing pain-free lower limb function while minimising long-term joint damage.

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Common Symptoms

Inflammation
Painful swelling
Reddish discolouration

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Very helpful and friendly. They helped with my gout and improved my walking posture.

Li Zhang Tan
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Our Podiatry Care Strategy

Non-invasive therapies to reduce the immediate pain and inflammation of gout attacks

Podiatrists can address the resulting joint pain and deformity by adjusting the foot and lower limb biomechanics by using customised in-shoe devices for joint stabilisation and utilising advanced technologies for improving joint quality and mobility.

A thorough assessment of your ankle

Immobilising the area with splints

Utilising technological therapies

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Michael Lai
Principal Podiatrist

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