Gout: painful disease you need to know

http://www.koreatimes.co.kr/www/nation/2020/03/113_285615.html

A man rubs his foot to relieve gout symptoms. According to government data, 430,953 people were diagnosed with gout in 2018. /Korea Times file

By Bahk Eun-ji

Gout is an intensely painful form of arthritis that can affect anyone, but more commonly affects men. The disease is on the rise in the country as Korean diets include more processed and high-fat foods, as well as high-protein ingredients. An attack of gout usually involves severe pain, swelling, redness and tenderness in the joints, often, specifically, the joint at the base of the big toe.


While the stereotypical image of a patient with gout is often an overweight, middle-aged man, the illness is, in fact, not as rare in younger adults as one might think.

When Lim Seung-joon, 27, an office worker in Seoul, first experienced unusual pain and swelling in his feet last June, he visited an orthopedic doctor.

"My doctor said it was because of a back strain, and recommended that I have spinal manipulative therapy, but my foot didn't get any better. I finally visited a rheumatologist and found out I was suffering from gout, after wasting seven months with the orthopedic hospital," Lim said.

Lim said he could not have predicted that his swollen feet and severe pain were due to gout.

Cause and risk factors

Gout is a form of arthritis caused by an excess of uric acid in the bloodstream, also called 'hyperuricemia'. Uric acid is produced in the body during the breakdown of purines ― chemical compounds that are found in high amounts in certain foods such as red meat or alcohol.

Uric acid is normally diluted in the blood and is excreted from the body via the kidneys, in urine. If too much uric acid is produced and not excreted it can build up and form needles around the joints that cause inflammation and pain.

Purines, which can raise uric acid levels in the blood, are found in certain foods such as steak, organ meats and seafood. Other foods which can trigger a gout attack include alcoholic beverages ― especially beer ― and drinks sweetened with fruit sugar, or fructose.

In addition to excessive consumption of the above foods, there are a number of additional factors said to increase the possibility of developing gout. Age and gender matter, as men produce more uric acid than women. Women's levels of uric acid approach those of men after the menopause, however.

According to data from the Health Insurance Review and Assessment Service (HIRA), the number of gout patients is increasing every year, particularly among men.

HIRA records state that 430,953 people were diagnosed with gout in 2018, up 40 percent from 2014's 308,725. The number of male sufferers was about 10 times higher than female sufferers, with 397,440 patients, or 92 percent, listed as men in 2018.

"Patients suffering from gout should pay extra attention to foot care, particularly at this time of year during the last cold snap before spring, as the toes, which are the coldest parts of our body, are repeatedly aggravated during this time," said Hong Seung-jae, professor of the Rheumatoid Arthritis division at Kyung Hee University Hospital.

Lifestyle choices can also be another risk factor. Alcohol consumption interferes with the removal of uric acid from the body, and following a high purine diet can increase uric acid formation. A family history of gout can also increase the likelihood of the condition developing as well, Hong said.

Symptoms and treatment

The first symptom of gout is a sudden, intense pain caused by the needle-like build up of uric acid around the joints. Sometimes there can be months or even years between attacks. Over time, uric acid buildup can form lumps under the skin around the joints, on the rims of the ears, and in the kidneys, leading to varying degrees of kidney impairment and hypertension.

Gout usually affects the big toe, but it can also occur in the ankles, knees, elbows, wrists and fingers. After the initial, intense pain subsides, joint discomfort can last from a couple of days to a few weeks. Pain attacks which come later are likely to last longer and affect more joints.

"Although the experience of gout is one of the most painful types of arthritis, the best treatment of gout is prevention," Hong said.

While medication is often prescribed, a change in lifestyle and diet is highly recommended in managing the acute pain and preventing both the initial formation of gout, and any recurrence.

Gout sufferers should drink plenty of water in order to stay well-hydrated, and limit beverages sweetened with high fructose corn syrup. Doctors will advise patients as to whether alcohol consumption is safe for the patient, as drinking beer is particularly likely to increase the risk of symptoms.

While losing weight can decrease uric acid levels in the body, fasting or rapid weight loss may temporarily raise uric acid levels.