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Gout (Sudden Joint Pain & Gout Attack)

  • What is gout?

    Gout is a common disease of the joints. You may experience sudden, severe attacks of pain, redness and tenderness in the joints, especially at the base of the big toe. You may wake up in the middle of the night feeling like your big toe is on fire.

    The affected joint is so tender that you may have difficulty turning over in bed. The most commonly affected joints are the big toe, foot, ankle, heel, instep and knee. Gout rarely affects the joints of the upper limbs such as the fingers or wrists.

  • Gout is caused by too much uric acid in the blood. When the kidneys cannot excrete excess uric acid in the urine, it is deposited in the joints, where it forms crystals (called tophi). These crystals cause swelling and pain. Other causes of gout include:

    • A diet that is excessive in proteins, fat and alcohol
    • Certain medications
    • Gender – Men are more likely to get gout but women have a higher risk of getting gout after menopause
    • Hereditary – Gout often runs in families with a history of gout problems
    • Other diseases such as diabetes, hypertension, leukaemia and kidney disorders
  • The first sign of a gout attack is a sudden warm throbbing of the affected joint. This pain can quickly become excruciating and there is swelling and redness of the joint. Other symptoms include:

    • Difficulty and pain in walking during an acute attack
    • Extremely large uric acid crystals (tophi) in the joints or other tissues
    • Ongoing (chronic) pain with reduced movement in the involved joint
    • The skin around the joint being tender, sensitive, and sore, and extremely painful to touch

    The initial episode usually subsides completely within a week.

  • While there is no cure for gout, its symptoms can be controlled by diet changes and medication. These include:

    • Avoiding foods rich in purine such as alcohol, liver, kidney, salmon, sardine, dry beans, beancurd and soy
    • Limiting daily intake of protein-rich food such as red meat
    • Anti-gout medicine to help relieve acute pain and prevent acute attacks
    • Nonsteroidal anti-inflammatory drugs (NSAIDs), administered by oral tablets or intramuscular injections
    • Steroids injections to relieve pain during an acute attack

    Surgery is rarely used to treat gout, but may occasionally be needed to remove infected uric acid crystals, or those that interfere with joint movement.

    Unless the high uric level in your blood is reduced, uric acid crystals tend to recur. Consult an orthopaedic surgeon to determine the treatment method most suitable for you.

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  • If gout is left untreated, your joints may be damaged, causing deformity and restricted mobility. Deposits of uric acid crystals may form under the skin in nodules. Gout episodes may become more frequent if the high uric acid level is not reduced. Uric acid crystals may collect in the urinary tract, causing kidney stones. If you have chronic gout, you may have reduced kidney function or kidney failure and high blood pressure.

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    • Alan Cheung

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      International Orthopaedic Clinic
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      Mount Elizabeth Novena Specialist Centre
      Singapore 329563
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      Centurion Orthopaedic Centre
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