Gout is a sudden, very painful swelling of a joint, most often the big toe, caused by uric acid crystals. Attacks often start at night after a heavy meal or drinks. On most lab reports, normal uric acid goes up to 420 µmol/L (7 mg/dL) for men and 360 µmol/L (6 mg/dL) for women. If you have gout, the aim is to keep it below 360. Treat an attack early: the sooner medicine starts, the faster it settles.
What a gout attack feels like
- Sudden, severe pain in one joint, often starting at night or early morning
- The joint turns red, hot and swollen, and even a bedsheet touching it hurts
- The pain peaks within 12 to 24 hours
- Without treatment it settles in 1 to 2 weeks
The big toe is the classic place. Gout also affects the ankle, the top of the foot, the knee, fingers, wrists and elbows.
Why it happens
Uric acid is a normal waste product. Your body makes it when it breaks down purines, which are found in your own cells and in some foods. The kidneys clear it in the urine. When there is more than the kidneys can clear, the level rises and sharp crystals form in and around the joints. The body attacks the crystals, and that causes the pain and swelling.
Gout is more common in men from their 30s, in women after menopause, and in people who are overweight, have high blood pressure, diabetes or kidney disease, or have a parent with gout. Genes and kidneys play a bigger part than most people think.
Common triggers
- Alcohol, especially beer, tuak and spirits
- Organ meats: liver, kidney, intestines
- Seafood: prawns, crab, shellfish, sardines and ikan bilis
- Red meat in large amounts
- Sweet drinks with a lot of sugar, including soft drinks and sweet packet juices
- Not drinking enough water, long hours in the heat, crash diets and long fasts
- Some medicines, such as water pills (diuretics) and low-dose aspirin
- A sudden illness, an operation, or an injury to the joint
Vegetables high in purines, such as spinach, mushrooms and beans, do not raise gout risk the way meat, seafood and alcohol do. Tofu and soy are fine too.
What your uric acid number means
| Uric acid level | What it means |
|---|---|
| Below 360 µmol/L (6 mg/dL) | The target for people with gout. Crystals slowly dissolve at this level. |
| Up to 360 (women) or 420 (men) | Within the normal range on most lab reports |
| Above the normal range | High uric acid. Gout becomes more likely the higher it goes. |
Each lab prints its own normal range on the report, so check yours. Two things often surprise people:
- Uric acid can be normal during an attack. The doctor diagnoses an attack by the joint and your story, and checks the level again 2 to 4 weeks later.
- High uric acid without gout does not usually need medicine. It is a reason to look at drinks, weight and kidney health, and to check again.
Treating an attack
Medicine works best when started in the first 24 hours, so do not wait to see if it settles. The doctor chooses from anti-inflammatory tablets, colchicine or a short course of steroid, depending on your kidneys, stomach, other illnesses and other medicines. That is why there is no single "best gout medicine" that suits everyone.
- Rest the joint and raise it on a pillow.
- An ice pack wrapped in a towel, 20 minutes at a time, eases the pain.
- Drink plenty of water.
- Do not take aspirin for gout pain, as it can raise uric acid.
- If you already take allopurinol, keep taking it during an attack.
Painkillers from the pharmacy can help for a day or two, but anti-inflammatory painkillers are risky for people with kidney disease, stomach ulcers or heart disease. See a doctor before using them for more than a short time.
Stopping attacks for good
If you have two or more attacks a year, lumps of crystals under the skin (tophi), kidney stones, or joint damage on an X-ray, the doctor will suggest daily medicine to lower uric acid, such as allopurinol. The dose is raised step by step until your level stays below 360. Taken every day, it stops attacks for most people. In the first months it can set off an attack, so the doctor often adds a low dose of colchicine for cover.
Gout often comes with high blood pressure, diabetes, high cholesterol and kidney problems. A full check-up is worth it after your first attack. Read about normal blood pressure by age.
See a doctor the same day if:
- the joint is hot and swollen and you also have a fever or feel unwell (this can be a joint infection)
- it is your first attack
- the pain is not easing after 2 to 3 days of treatment
Uric acid test in Kota Kinabalu
Walk in any hour at our clinic on Jalan Penampang for a uric acid test, or for treatment during an attack. Our check-up packages also cover kidney function, blood sugar and cholesterol.
WhatsApp usor call 088-239 393See all blood tests and check-up packages.
Questions people ask
Can I eat chicken if I have gout?
Yes, in normal portions. Chicken has less purine than organ meats and shellfish. Keep portions moderate and avoid the skin and organs.
Does drinking water help gout?
Yes. Plenty of water helps the kidneys clear uric acid and lowers the chance of an attack and of kidney stones.
Can gout go away for good?
Attacks can stop for good when uric acid is kept below 360 µmol/L, usually with daily medicine. The tendency stays, so stopping the medicine often brings attacks back.
Is gout caused by eating too much?
Diet plays a part, but genes and how well your kidneys clear uric acid matter more. Many people with gout eat normally.
A general practitioner clinic for the whole family, from babies to grandparents. A doctor and a nurse are on duty every hour of every day, and you can walk in without an appointment. Meet the team
Sources
- NHS: Gout
- FitzGerald JD et al. 2020 American College of Rheumatology Guideline for the Management of Gout
This article is general health information and does not replace a visit to the doctor. If you are worried about yourself or your child, see a doctor.
