You Ask , They Answer
Q
: What ’ s gout and why is it considered a disease common in “ old and rich men ”?
A
: The reasons are that the incidence of gout is higher in males compared to females and rises with age . Males tend to have higher uric acid levels compared to females . In older people , there may be more diuretic use for hypertension or congestive cardiac failure , renal insufficiency leading to less excretion of uric acid , greater use of low dose aspirin which reduces uric acid excretion , and alcohol ( ethanol ) abuse . These can contribute to the development of hyperuricemia and gout in the elderly .
Back in those days ( no longer the case now ), gout stemmed from food that only the rich could afford , e . g ., red meat , seafood , alcohol , which explains why it was considered a disease of “ old and rich men ”.
Q
: What are the telltale signs of the condition that warrant a medical check-up ?
A
: 1 . Intense joint pain – gout usually affects the big toe , but other common joints affected include ankles , knees , elbows , wrists , and fingers 2 . Lingering discomfort – even after the severe attacks subside 3 . Swollen , tender warm and red joints 4 . Joint stiffness
Q
: Should all the tell tale signs you mentioned be present for people to see a doctor and for how long should these symptoms be present to sound alarm bells ? Should patients see an orthopaedic specialist or a rheumatologist ?
A
: They need not all be there . They all warrant medical attention when it occurs . They can either see a GP , orthopaedic surgeon , or rheumatologist . All can manage gout .
Q
: What are the medications and lifestyle changes that can treat gout ?
A
: Diet is the first line , followed by medications such as
NSAIDs and Colchicine for acute flare ups . Allopurinol is used to lower uric acid levels to prevent further attacks , while intra-articular steroid injections can treat severe pain . In general , medications are pretty effective if patients are compliant .
Q
: Are there any prevention measures for gout ?
A
: Avoid foods that can trigger a gout flare-up . Foods high in an organic compound called purines ( containing more than 150 – 200mg of purines per 100 grams ) may raise your uric acid levels . These include organ meats like liver , kidney , and brain ; red meat and game meat such as veal and venison ; seafood like scallops , crab , shrimp , and roe ; and sugary drinks like fruit juice and carbonated drinks . When purines get digested , uric acid is produced as a biproduct , which can lead to gout .
Also , limit or avoid alcohol and drink plenty of water while maintaining a healthy body weight . And avoid medications that can trigger an acute flare , e . g ., diuretics . As mentioned , you can also take uric acid lowering drugs like allopurinol .
Dr Kevin Koo Oon Thien
Dr Kevin Koo Oon Thien is a Consultant Orthopaedic Surgeon at Mount Elizabeth Hospital in Singapore .
12 ISSUE 5 | 2022 GlobalHealthAsiaPacific . com