Gout: The Painful Truth

Gout is a common form of inflammatory arthritis that affects the joints. It is one of the most common forms of arthritis in Malaysia. Symptoms of pain and swelling often begin in the big toe but can also affect other joints in the lower limbs.

The Three Stages of Gout

• Asymptomatic hyperuricemia — High uric acid levels without any symptoms.
• Acute gout — Sudden and severe attacks of intense pain that usually peak within 24 hours.
• Chronic tophaceous gout — Frequent attacks lead to the formation of tophi (densely packed crystals) that can cause permanent joint damage.

How Does Gout Develop?

Gout occurs when there is a build-up of uric acid in the body. Although uric acid acts as a natural antioxidant, excess amounts can form crystals in the joints, leading to pain and swelling. This build-up happens due to either over-production or under-excretion of uric acid.

What is Uric Acid?

Uric acid is a by-product formed when the body breaks down purines. Purines are found naturally in the body and in certain foods. The more purine-rich foods you consume, the more uric acid your body produces. Persistently high levels increase the risk of crystal formation in the joints, although not everyone with high uric acid develops gout.

Who Is at Risk of Gout?

• Gender (more common in men)
• Age (risk increases with age)
• Family history of gout
• Health conditions such as obesity, high blood pressure, heart failure, diabetes, kidney disease or kidney stones
• Diet high in purines, alcohol and fructose
• Certain medications (diuretics, low-dose aspirin, excess vitamin B3, cyclosporine)

Medical Management of Gout

Medications are used to relieve pain during flares and to lower uric acid levels long-term.

During acute attacks: Non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine.

To lower uric acid: Allopurinol, febuxostat or probenecid.

Always consult your doctor, as some medications can have side effects and the best option depends on your individual health.

Dietary and Lifestyle Modifications

Maintain a Healthy Weight

Maintaining a healthy weight reduces the risk of gout. If you are overweight, gradual weight loss through sustainable healthy eating and exercise can lower uric acid levels and reduce stress on your joints.

Physical Activity

Aim for at least 30 minutes of activity most days (or 150 minutes per week). Start with low-intensity activities such as walking and gradually increase as you feel able.

Diet Recommendations

Foods to include more of:

• Tart cherries (fresh, frozen, juice or powder)
• Low-fat dairy products (milk, yogurt, cheese)
• Fruits and vegetables
• Eggs
• Grains and cereals (rice, noodles, bread)

Foods to reduce:

• Organ meats (liver, kidney)
• Red meat and poultry
• Certain seafood (sardines, anchovies, tuna, mackerel, mussels, cockles)
• Alcohol (limit to 1–2 standard drinks)
• High-fructose beverages

Some vegetables such as mushrooms, asparagus, cauliflower and spinach are higher in purines, but studies show they do not significantly raise uric acid levels. Focus mainly on limiting animal sources of high-purine foods.

Staying well hydrated by drinking plenty of water helps the body excrete uric acid through urine.