Gout

What is Gout?

Gout is a form of inflammatory arthritis caused by a build-up of uric acid in the blood.

Uric acid is a natural waste product formed when the body breaks down nuclear material (purines) from its cells.
In most people, uric acid is removed from the body by the kidneys.
But in some individuals, even with normal kidney function, the kidneys don’t excrete uric acid efficiently.
When blood levels rise above normal, uric acid starts to crystallize and deposit in joints, triggering painful inflammation.

What Triggers a Gout Attack?

A person with high uric acid may not always have symptoms – until a trigger leads to a sudden flare.

Common triggers include:

Foods high in purines:
- Red meat (beef, lamb, pork)
- Organ meats (liver, kidney)
- Seafood (sardines, anchovies, shellfish)
- Alcohol (especially beer and spirits)
- Sugary drinks and fructose
Dehydration
Crash diets or fasting, Sudden weight loss
Recent surgery or trauma
- Some commonly used medications can raise uric acid Diuretics (water tablets) such as:
  - Furosemide (Lasix) ,Thiazide diuretics (e.g. hydrochlorothiazide)
  - Low-dose Aspirin

What Does a Gout Attack Feel Like?

Sudden, severe joint pain- warm, red, swollen Extremely tender (even a bedsheet touching it may hurt)

Common joints:

Big toe (most common)
Ankles
Knees
Sometimes wrists, elbows, or fingers

Diagnosis

Sometimes gout can mimic joint infections, so accurate diagnosis is important.

Doctor’s clinical exam+tests -to exclude a infection.
Blood tests (uric acid, inflammatory markers)
X-rays or ultrasound to detect crystals or joint damage
Joint fluid aspiration may be done to confirm uric acid crystals

Treatment During an Acute Attack

Goal: Reduce pain and inflammation quickly.

NSAIDs (e.g., Etoricoxib, Naproxen)
1. Only if kidney function is normal
Steroids (oral or injection)
Colchicine
1. An anti-inflammatory specific to gout
2. Must be taken early in the attack

Do NOT start uric acid–lowering medications-allopurinol , febuxostat during a gout attack if you’re not already on them. Starting them during an acute flare can make the attack worse.

Long-Term Management (After Attack Settles)

1. Lifestyle Measures

Hydration: Drink at least 2–3L of water daily
Avoid high-purine foods and alcohol
Weight loss (gradual)
Limit sugary drinks

2. When to Start Uric Acid–Lowering Therapy

Consider urate-lowering medications if:

You have several attacks per year
You have tophi (lumps of uric acid near joints/tendons)
You have had kidney stones
You have chronic kidney disease
Target uric acid: < 6 mg/dL

Medications to Lower Uric Acid

Allopurinol
Febuxostat

These reduce uric acid production in the body.

Monitoring:

Full blood count, liver function, and renal function tests
Risk of allergic reactions – report any rash, fever, or mouth ulcers

Start only when the patient is symptom-free and under medical supervision.

When to Contact Your Doctor

Sudden joint pain or swelling
Fever or signs of infection
Rash or reaction after starting new gout medication
Recurrent attacks despite medication

Sri Lankan Foods That May Trigger Gout

Certain foods common in Sri Lanka are high in purines or can raise uric acid levels.

These include:

Maldive fish (umbalakada)
Dried fish (karawala)
Sprats (halmasso)
Organ meats (liver, kidney)
Large amounts of red meat (beef, mutton, pork)
Shellfish (prawns, crab)
High-fructose juices and sugar-sweetened drinks
Alcohol – especially beer and arrack

Tip: Instead of eliminating these foods completely, try to reduce portion sizes, avoid frequent consumption, and increase hydration (2–3L water per day).

Other Risk Factors

Gout can also occur in people with chronic kidney disease, high blood pressure, metabolic syndrome, or those taking medicines such as ciclosporin, low-dose aspirin, or diuretics like furosemide (Lasix). These medications can increase uric acid levels.

Final Message

Gout is painful but treatable.

With the right treatment and lifestyle changes, you can reduce attacks and prevent long-term damage.

🩺 Talk to your rheumatologist, follow your plan, and never stop or start medications without medical advice.

Rheumatology