The Beginner's Guide To Gout: All You Need To Know About Preventing This Lifestyle Disease

There is no doubt that having a family history of gout puts you more at risk in developing the condition, but you can still play your part in reducing the risk by leading a healthy lifestyle. At Asia Arthritis & Rheumatology Centre (AARC), we assist patients in taking concrete steps to lower their risk of developing gout. Gout was historically labelled as the ‘disease of kings’ because a considerable number of affluent people who lead overly indulgent lifestyles suffer from gout. This explains  why gout is highly prevalent in Singapore, as data from SingHealth reports that more than 4% of adults here are afflicted with the disease.

Demystifying gout

Gout is a type of inflammatory arthritis that emerges when urate crystals accumulate in the joints. The condition is usually defined by sudden, intense attacks of pain, redness, swelling and joint tenderness. While gout predominantly targets the big toe, it can also affect various joints like the feet, ankles, knees, elbows, wrists, and fingers. As a result, gout has the potential to limit an individual’s range of motion. In some instances, individuals may experience a low-grade fever during acute attacks accompanied by other systemic symptoms such as fatigue and malaise.

Understanding the main cause of gout and potential complications

The primary cause of gout is an elevated uric acid level in the blood, a condition referred to as hyperuricaemia. Uric acid is a waste product resulting from the body's breakdown of purines, naturally occurring substances in certain foods and the body's cells. Nonetheless, when too little uric acid is removed or the body's production of the waste product is excessive, uric acid accumulates and may form urate crystals in joints and surrounding tissues. These crystals can lead to joint inflammation called gout attacks.

However, having abnormally high uric acid levels alone does not guarantee the onset of gout. The relationship between uric acid levels and gout is complex, and other factors like genetics and lifestyle play a role in determining whether someone will develop the condition. 

If left untreated or poorly controlled, gout can become a serious condition that leads to an impaired quality of life and joint damage. For severe chronic cases, collections of solid urate called tophi may develop, potentially damaging the joints and affecting the ears or tendons. Other possible complications include kidney stones, kidney damage, cardiovascular disease, diabetes, and metabolic syndrome.

Guarding against gout

Thankfully, there are some evidence-based ways to lower your risk of developing gout in the first place. Effectively preventing gout involves a holistic approach because, contrary to popular belief, poor diet per se does not cause gout, as only up to 30% of the uric acid burden is attributed to dietary factors. While dietary patterns play a pivotal role in determining one’s susceptibility to gout, other lifestyle factors are also paramount. Rheumatologists believe that the following lifestyle habits help to keep gout at bay.

Food intake

• Minimise purine-rich foods: Adopt a diet that limits purine-rich foods, such as seafood, red meat, and organ meats. These foods contribute to uric acid production, and reducing their intake helps mitigate the risk of gout.

• Maintain a balanced diet: Embrace a balanced diet filled with plenty of fruits, vegetables, whole grains, and low-fat dairy products. This not only supports overall health but also aids in preventing gout by providing essential nutrients without contributing to excessive uric acid levels.

Hydration

• Limit alcohol intake: Consume alcohol only during special occasions, especially refrain from binge drinking beer and hard liquor. This is because excessive alcohol consumption poses a significant risk, interfering with the body's ability to eliminate uric acid.
• Minimise beverages with high fructose content: Drinks containing high fructose corn syrup, like sugary soft drinks and fruit-flavoured beverages, should be avoided. This is because they contribute to elevated uric acid levels, increasing the risk of gout. Try to stay clear from fresh, cold-pressed or pre-packaged juices as well. They are loaded with fructose, which produces more uric acid that can lead to gout.
• Opt for plain water and stay well-hydrated: Stay sufficiently hydrated by consuming about 1.5 - 2L of fluid a day — this recommended intake includes not only water but also the fluid from food (e.g. porridge, fruit). Keeping yourself well-hydrated supports the flushing out of uric acid from the body.

Weight maintenance

• Eat in moderation: Stop eating when you are 70% full. Refrain from distracted and hurried eating since these habits make you more prone to overeating. Maintaining a healthy weight is key since obesity is a recognised risk factor for gout.
• Exercise regularly: Engage in at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity physical activity per week to mitigate obesity. Be sure to exercise safely, for instance, by being aware of your surroundings, as physical trauma and joint injuries can sometimes trigger gout attacks in susceptible individuals. 

Management of other chronic conditions

• Schedule regular follow-up appointments with your doctor: It is imperative to monitor your other medical conditions, such as diabetes, high blood pressure, kidney disease, and metabolic syndrome, since they can contribute to gout.
• Adhere to the recommended treatment plan: In order to control the aforementioned conditions, heed your doctor’s advice by, for example, taking the prescribed medication(s) on time and at the right dosage.

When to see a rheumatologist

Prevention is better than cure. Adopting a robust prevention plan to fight against gout is especially important for those with a high or borderline high level of uric acid in their blood, and people with a family history of gout. Elevated uric acid levels alone may not always indicate gout. However, when combined with symptoms or a history of gout attacks, they can be concerning. Consulting a rheumatologist, a doctor specialised in inflammatory and autoimmune conditions including gout, can be beneficial if one or more of the following points pertain to you:

• Family history of gout:  A rheumatologist can assess your risk profile for gout and provide a personalised preventative plan, which is recommended for certain individuals with close relatives suffering from gout. 
• Recurrent Gout Attacks: If you have frequent and recurrent gout attacks, a rheumatologist can help assess your condition and provide targeted treatment plans.
• Joint Involvement: Gout typically affects the joints, and if you notice persistent joint pain, especially in the big toe or other joints, it is crucial to seek specialist care.

Senior Consultant Rheumatologist Dr Annie Law and her Team at AARC are committed to supporting you on your journey to understanding, managing, and thriving despite gout. AARC is part of the Beyond Medical Group, a collective of medical specialists that has also been ranked as one of Singapore’s Top 100 Fastest-Growing Companies for 2024. For more in-depth information, feel free to book a consultation with Dr Annie Law to explore AARC’s comprehensive services and stay informed on the latest developments in gout care.

Summary

All in all, the risk of developing gout is not solely predetermined by genetics; lifestyle choices play a pivotal role in mitigating this autoinflammatory disorder. Taking control of one's lifestyle choices can significantly contribute to reducing the risk of developing gout, enhancing overall health and well-being. It is recommended for those who require specialised gout-related care to consult a rheumatologist.

Dr Annie Law is a Senior Consultant Rheumatologist and the Medical Director at Asia Arthritis & Rheumatology Centre with a subspeciality interest in Systemic Lupus Erythematosus.

Prior to joining private practice, Dr Law devoted 12 years of her life to the Department of Rheumatology and Immunology at SGH, tirelessly caring for her patients. In recognition of her outstanding service to her patients, she has been duly recognised by SGH with numerous awards.

Asia Arthritis & Rheumatology Centre Website: https://aarc.sg/

Dr Annie Law Profile: https://aarc.sg/dr-annie-law/

Appointment Line: +(65) 8030 7862

Email: info@aarc.sg