Cheok was getting ready to work this morning. As he was putting on his socks, he noticed that there was a small lump forming around his big toe, but there was no pain and he was feeling okay.
Later that evening, just when he was about to go to bed, suddenly he felt a strange sensation around his big toe. It was numb, uncomfortable and slightly painful.
The next few days, the pain was so intense Cheok had to go to a doctor and the doctor told Cheok that he’s got a GOUT ATTACK!!
What is gout?
Gout is a form of arthritis caused by formation of little uric acid crystals in between your joints. These crystal pieces can trigger inflammation and cause pain & swelling in the joints.
A gout attack normally happens when the uric acid levels in your body get too high and when you are not drinking enough fluid throughout the day.
Anyone who has had it before would describe the pain as one of the worst they have had in their lives. The scary part is – if your uric acid levels remain uncontrolled, you will probably get another attack in the future.
What is uric acid (and purine)?
In order to understand uric acid, first you need to know about this substance here – purine.
Purines are a specific type of molecules that can be found in the nucleus of any plant or animal cell. They are considered building blocks of cells’ DNA and RNA.
When we eat (plant or animal), we metabolise the content and the purines in the food are broken down by the liver. In the process, a by-product is produced.
That’s URIC ACID.
Uric acid then gets into the bloodstream and got carried to the kidneys where it eventually gets excreted in the urine. (Uri-ne, get it?)
What causes high uric acid?
High uric acid occurs either when your body produces too much uric acid (eating too much high purine food) or when your kidneys are not eliminating the uric acid efficiently enough or BOTH.
Here’s a list of factors that cause high uric acid:
- Increased Uric Acid production:
- Taking medications such as diuretics (found in certain heart and blood pressure medications)
- Drinking too much alcohol
- Genetics or family history
- Side effect of some anti-cancer drugs
- Taking in too much sugar
- Eating too much purine-rich diet (more on this below)
- Reduced Uric Acid excretion:
- taking diuretics medications
- Kidney problems
- Type 2 diabetes
- Insufficient water intake
What is the normal level of uric acid?
Now, how do you know if your uric acid level is high?
You can always get your uric acid level checked at your local pharmacy. You don’t need to do anything special before the test eventhough some said it might be better to do it before food or at least a few hours after food.
The normal uric acid levels are
Men: 3.4 – 7.0 mg/dL Women: 2.4 – 6.0 mg/dL
If your uric acid is high (higher than 7mg/dL for men or 6mg/dL for women), you are more likely to get a gout attack.
Gout: arthritis caused by high uric acid in blood.
Uric acid is only partially soluble in the water. This low solubility causes them to easily crystalise in the blood, especially when water intake is low. We call these crystals the urate crystals, and they are normally sharp and needle-like.
Gout happens when urate crystals form and accumulate in your joints (normally the smaller joints are more easily affected), causing inflammation and intense pain.
Symptoms of gout
An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire.
The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.
Symptoms of gout include:
- Intense joint pain: Most common spot affected by gout is usually the joint of your big toe. The pain caused by a gout attack is normally most severe within the first hour to 12 hours after it begins
- Lingering discomfort: After the pain subsides, you might still feel discomfort in the affected joints for a few days to a few weeks.
- Inflammation and redness: The affected joints might become red, swollen and tender due to inflammation.
- Reduced joint function: You might find it hard to move the affected joints normally due to the swelling and inflammation.
What to do when you have a gout attack?
Anyone who has had a gout attack would tell you that it’s probably one of the worst pains they had in their lives.
When you are experiencing a gout attack, you need to stay calm and act quick – the aim of treatment is to reduce the pain and inflammation.
Here’s a list of things you can do:
- Take anti-inflammatory medications: Most anti-inflammatories you can get over-the-counter in Malaysia at any pharmacies. Example of anti-inflammatories are Ponstan, Voltaren, Nurofen etc. Remember that these anti-inflammatories should be taken after food as they may sometimes cause stomach damage. (Tip: Cataflam is a fast acting anti-inflammatory and normally that’s what I provide my customers with gout attack. You may take this anti-inflammatory without food – as long as it doesnt upset your stomach.)
- Apply ice: Applying ice to the inflammed joint might help to ease with the swelling and inflammation. Get a hot/cold pack from your local pharmacy and have it in the freezer all the time. When you get a gout attack, get the cold pack out from the freezer and apply it to the affected area for 20-30 minutes several times a dayYou can also wrap a pack of crushed ice in a dish cloth.
- Drink plenty of water: High water intake might help to flush out the uric acid and dissolve the urate crystal.
- Avoid alcohol: You probably will not be in the mood for alcohol anyway, but alcohol can further dehydrate you as well as further increasing the level of your uric acid in blood. So NO ALCOHOL during a gout attack!
- Go to a doctor: If anti-inflammatories and ice pack aren’t strong enough and the pain is so unbearable, you might want to consult a doctor and get prescriptions for stronger medications such as steroids or colchicine.
Just remember one thing: All these medications for acute gout attack needs to be taken after food as they can cause stomach damage.
Also, your doctor might prescribe allopurinol which is a medication to help uric acid control to you. Just remember not to start or stop allopurinol treatment during a gout attack. They are to be started after the gout attack to help reduce the uric acid level and prevent further gout attack. They will not help during a gout attack.
What to do after you have had a gout attack
Once the gout attack subsides, you will want to focus on reducing your uric acid level so that you won’t get another gout attack in the future.
The aim of treatment is to reduce your uric acid level.
So what can you do to lower your uric acid level:
- Low purine diet: Purines are found normally in normal diet – and they are not necessarily harmful. It is the waste product (uric acid) that gets produced after digesting purine foods that cause all the problems.There are certain foods which contain higher purine content and these are the foods that gout sufferer should avoid or limit their intake.we will go through purine diets in more details in the following paragraphExamples of high purine foods include: alcohol, red meat, seafood, animal organs, high fructose corn syrup etc.
- Medications: There are a few medications that might be prescribed by the doctor. The most common medication is allopurinol – normally 100mg – 300mg once daily.Other less commonly prescribed medication include probenecid and Febuxostat (Brand name: Feburic)Doctor will sometimes recommend a urine alkaliniser. You can normally get urine alkaliniser over-the-counter from a pharmacy even without a prescription. An alkaliniser helps to facilitate the disposal of uric acid via the urine, and it enhances the effectiveness of allopurinol when taken together.Common urine alkalinisers you can get in Malaysia are Ural and potassium citrate solution etc.
- Supplements: Besides medications, you can also try natural supplements to help reduce uric acid.
Some of the supplements you can get here in Malaysia for gout are :
- Tart cherries extract
- Magnesium supplement
- Vitamin C
- Apple Cider Vinegar
- Drink plenty of fluid every day: Water helps to flush the extra uric acid out via urine. Also as uric acid is partially soluble in the water, staying hydrated will help to reduce the chance of it crystalising due to lack of water.
- Control sugar intake: Recent studies have found a link between diabetes and gout. People with type-2 diabetes are more likely to have high uric acid level, and people with gout are more likely to get diabetes.
We are still not quite sure what’s the cause of it but some experts have suggested that insulin resistance (type-2 diabetes) may play a role in the development of gout.
Gout Complications: what will happen if gout is left untreated?
The underlying cause of gout attack is high uric acid and the main aim of treatment is to reduce the uric acid for long term.
Most people only treat gout attack with pain-relieving medications – mainly taking pain meds only when they are experiencing pain. This could be harmful because the underlying cause of gout attack is not being rectified.
With persistently high uric acid, one may get:
- Recurrent gout attack: They might easily get another gout attack again especially when they are under stress or when they are not hydrated enough. It’s estimated that almost 85% of people who have it once have another episode within 3 years.
- Joint damage or even deformity: People suffering from chronic gout may sometimes get deposits of urate crystals that formed underneath the skin, called tophi.
Tophi feels like hard bumps under the skin and are usually not painful. They can form in the joints, cartilages, bones and other places. Sometimes, tophi break through the skin and appear as white or yellowish-white, chalky nodules.As tophi continue to grow, they can erode the surrounding skin and tissues of the joints, causing damage and eventual joint destruction.
- Kidney stones: With persistent high level of uric acid, the same urate crystals can also form in the kidneys – we call them kidney stones. Kidney stones can be extremely painful and can affect kidney function.
- Heart disease: Although still unsure, but studies have found that persistent high level of uric acid can increase one’s risk of getting heart disease.
Low Purine Diet: What to eat and what not to eat when uric acid is high.
We will end this article with a list of foods that you probably should avoid or limit their intake when you have high uric acid.
A good general guideline to uric acid diet plan goes like this:
- Limit meat and seafood consumption: Experts recommend that people with gout limit purine intake by eating no more than 4 to 6 ounces of meat, poultry or seafood per day.
- Low-fat dairy product: People who consume low-fat dairy products such as skim milk and yogurt can decrease their levels of uric acid and thereby decrease their risk of gout attacks. Experts recommend 16 to 24 ounces of daily low-fat dairy consumption. One thing to note is that high-fat dairy products do not appear to have the same protective effect.
- Eat plenty of plant-based proteins: People with high uric acid should consider getting their protein from plant-based protein sources such as nuts and legumes. This will help reduce their intake of high purine meat, poultry and seafood products.
- Cut down on alcohol consumption: Alcoholic beverages, especially beer contain very high purine content and their intake should be limited. Also alcohol is a diuretic that can further dehydrate you and make it even easier for urate crystals to form.
- limit high fructose and sugar-sweetened beverages: Eventhough they are not rich in purines, studies have found that they can increase the risk of gout and gout attacks.
Uric Acid control diet chart
I hope this post about Uric acid answers some of your questions about gout and uric acid. Let me know in the comments section any other questions you might have about uric acid.
Oh ya, Cheok is now on allopurinol 300mg and regularly checks his uric acid level at the pharmacy. He’s able to maintain his uric acid regularly at 5.5 mg/dL and he has not had any gout attack since then.