Managing Gout Lifestyle changes are a must with this type of arthritis By Eleanor Yap Andrew Ng, 29, has had gout for eight years now. He found out that he had it during his basic military training, when overnight, his leg swelled up suddenly. He underwent a uric acid test, which confirmed that his uric acid level was high and that he had gout.    Today, he still gets gout. “As often as once every two weeks or so, it is usually triggered by something I eat. The joint of the toe starts to hurt, as crystals form at that joint. As I move, they rub against the joint and become inflamed. My feet swells up and the affected area becomes red and warm.” He adds that his most recent attack, which was acute, put him on medical leave for two days. After medication, the swelling subsided in about three to four days.    His doctor has prescribed colchicine and diclofenac (a painkiller) to reduce the inflammation and pain from gout attacks, as well as allopurinol to bring down the uric acid level in his blood. The latter also helps prevent gout, kidney stones and kidney damage caused by uric acid. In addition, he has had to focus on losing weight and exercising regularly, and to be careful of certain foods that can trigger an attack. This includes cutting out alcohol and innards, eating less red meat, fish, beans and soybeans, and eating more of certain vegetables.   What is gout? Gout is more common in men, especially those aged between 30 and 60. It is a type of arthritis caused by excessive amounts of uric acid in the blood. Uric acid is a waste product formed from purine, a byproduct of DNA. It is normally removed from the body by the kidneys. However, in gout, uric acid builds up in the blood and also deposits in the joints, where it crystallises to cause arthritis.   When it hits (sometimes quite suddenly and with no warning), the base of the big toe is usually affected and becomes red, hot, swollen and very painful like what Ng experienced. The pain may last for days to weeks if not treated. Attacks may recur at intervals of weeks or months. Gout can also affect other joints like the ankle, knee, wrist and fingers. Over the years, if the high blood level of uric acid is not controlled, it can be deposited in the skin, especially in the earlobes and near the joints, explains Dr Leong Khai Pang, senior consultant, Department of Rheumatology, Allergy and Immunology at Tan Tock Seng Hospital. These deposits are known as tophi and they can damage the joints permanently.    Treatment Gout is a curable disease, but if left untreated, it can cause kidney stones, which may lead to kidney damage. During an attack of gout, it is best to rest the joint. Excessive activity may prolong the arthritis, warns Dr Leong. A hot compress or ice pack to the affected joint can relieve the pain. He adds that doctors can do two things to help gout sufferers. First, they can prescribe medication to relieve acute episodes of joint pain. Painkillers, usually taken by mouth and sometimes injected, are often used. When the gout patient sees his doctor within the first one to two days, colchicine can also be used. This is a drug that is specially used for treating gout and may even abort an early attack. Unfortunately, it is much less effective if used late in an attack. Occasionally, steroids may be needed. These medications are taken only during an attack.   Second, if the attacks are very frequent (say, more than three per year) and the blood uric acid is elevated, says Dr Leong, drugs can be used to reduce this level. Patients who have tophi also require such treatment. Allopurinol or probenecid are two common uric acid-lowering medications. These medications are taken regularly regardless of whether there is a gout attack.   Gout is often associated with hypertension, diabetes and high cholesterol, so the doctor who treats your gout may perform tests to see if you suffer from these conditions as well.     Lifestyle changes You will need to avoid high-purine food, especially organ meats like liver, kidney and brain. Also, avoid fish like ikan bilis, sardines and fish roe; meat, yeast extracts (like Marmite) and stock cubes, as well as seafood like crab, cockles, prawns and scallops. The following contain moderate amounts of purine, so they can be taken in small amounts: •   Asparagus, cauliflower, mushrooms and spinach; •   Peanuts, dhal, beans and peas; •   Chiku and custard apples; •   Wholegrain breads and cereal; and •   Soybean products like beancurd.     You should also drink plenty of water and avoid taking alcohol. Weight loss also helps the body excrete uric acid. Interestingly, high uric acid levels in the blood without gout attacks may not need medical treatment but the lifestyle improvements listed above should be adopted.   And indeed, having suffered gout attacks for eight years, Ng admits: “Having gout is not crippling. The only drawback is that when you do have an attack, it is very hard to get around as it is very tender and any sudden brush against it will send you wailing in pain. When you learn to manage it and watch what you eat, all these will lead to a healthier lifestyle.”