文章使用中英對照 Article is in both Chinese & English
What is Gout?
Gout is a painful arthritis, commonly felt in a big toe, or thumb, or in any small joints in your body, like the fingers and toes.
By a buildup of uric acid in the blood, known as hyperuricemia. A gout attack happens when uric acid forms crystals in the joint, causing inflammation, swelling, and pain. As your blood uric acid level rises, so does the chance for gout and gout attacks. If gout is not treated, over time, these attacks, or flares, can become severe, last longer, happen more often and one will become more debilitated.
Acute versus Chronic Gout
Acute Gout=painful gout attack
Chronic Gout=chronic inflammation and pain which can affect more than one joint.
Who is at risk for gout?
-Men, between 40-50 years old, are more likely to develop gout than women. Gout is the most common form of inflammatory arthritis in men.
-Women develop gout at an older age than men, typically after menopause.
-Many people have family history of gout.
-People with certain health conditions, including high blood pressure, diabetes, obesity, and/or kidney problems.
Gout- Signs and Symptoms
-Sudden attack of severe pain usually happens at night, without warning.
-Affected joint/joints become hot, red and swollen, at times tender to touch.
-It happens more often in the big toe or the thumb, or any other parts of the body.
-Researches showed that gout occurs 76% in big toe, 50% in ankle or foot, 32% in knees, 25% in fingers, 11% in more than one site and 10% in wrist.
How Gout progresses?
First experience of gout, it comes suddenly, without warning, severe pain in the middle of the night for a week or longer. One may have gout attacks for years, gout can become a chronic disease, which means it may get worse over time if not treated.
Gout can progress silently, before the first painful attack. If blood uric level is high, joint damage may occur even between attacks. Deposit of uric acid crystals-called Tophi – may form in the joints. Long term consequences may include chronic pain that does not go away, damage to joints, and limited movement in the affected joints and tendons.
The 4 stages of gout
Stage 1 – High blood uric acid levels – no symptoms. During the first stage, one may have high uric acid level, but have no symptoms, and don’t actually have gout. Those who have gout may have more than 20 years of high blood level of uric acid level before first gout attack. It is very important to maintain your blood uric acid level below 6mg/dl. Ask your doctor for a simple blood test of uric acid to know your baseline level.
State 2 – Gout attack. A gout attack is very painful. One may not be able to put on shoes or even walk a few steps. Sometimes even a light bed sheet touching the painful joint can be agonizing.
What triggers a gout attack?
A buildup of uric acid in the body causes gout. It sometimes occurs for no apparent reasons. Sometimes alcohol, certain medicines, another illness or stressful events may trigger gout attacks.
Other known gout triggers include:-
Stage 3 – Between Gout Attacks
Once the immediate gout attack is over after proper management, it is time to talk to your doctor about ways to reduce the risk of having attacks in the future.
Unfortunately many who have suffered an acute gout attack will suffer another one within a year.
Stage 4 – Chronic Gout
When blood uric acid level maintain higher than 6mg/dl and repeated gout attacks over years, gout will become chronic.
Short and long term goals of effective gout treatment should aim at:-
Lowering Uric Acid Level
Goal – is to maintain less than 6mg/dl. Ask your doctor for a blood test of uric acid if you don’t know your uric acid level.
Higher than 6mg/dl uric acid level=Higher risk of future attacks.
Lower than 6mg/dl uric acid level=lower risk of future attacks.
1. Medication for the treatment of gout.
Medication helps to reduce the production of excess uric acid in your body. To reduce your risk of gout flares, you need to keep your blood uric acid level down and keep it below 6mg/dl at all times.
2. The role of high purine foods
The uric acid in your blood comes from purines, substances that are produced by your body and also found in many food. Most of your uric acid (2/3) is produced naturally by your body, while the rest (1/3) comes from your diet. High purine diet can trigger a gout attack but it is not the cause.
3. Drinking plenty of non-alcoholic beverages especially water will help.
4. Healthy life style changes.
-Maintain a healthy weight
-Getting regular exercises
-If you notice after eating certain food and drinking certain beverages you have a gout flare, avoid those choices.
-Even some people follow the strictest low-purine diet, generally don’t reduce their uric acid levels by not much more than 1mg/dl.
-若您已有高血尿酸, 避免及減少進食高嘌呤食物, 可降低引發有突發痛風的風險。
a) Drink plenty of liquids, like water. Fluids like water help to remove uric acid from your body.
b) Add low-fat dairy products to your diet. Eating more of the low-fat dairy product is associated with a lower risk of gout.
c) Avoiding or limiting high purine food may help to reduce the risk to trigger a gout attack if you already have a high uric acid level.
-肉類 - 如豬, 牛, 羊肉及內 臟 (肺, 肝, 腸, 腎及腦), 及肉汁。
-海鮮如鳳尾魚, 沙丁魚, 鯡魚，魚子, 青口貝, 鱈魚, 扇貝(帶子), 鱒魚, 及黑線鱈魚。
-疏菜-菠菜, 蘆筍, 椰菜花, 及菌類。
-其他-燕麥片, 豌豆, 干豆, 及扁豆。
High purine food
-Meat like beef, pork, lamb, organ meat (liver, kidney and brain ) and meat base gravies.
-Seafood like anchovies, sardines, herring, roe( fish eggs ), mussels, codfish,
scallops, trout and haddock.
-Beverages – beer.
-Vegetables-spinach, asparagus, cauliflower and mushrooms.
-Others-Oatmeal, peas, dried beans and lentils.
-飲品-有氣的碳酸飲品, 咖啡, 奶, 及奶類飲品。
Low purine diet
-Beverages-carbonated drinks, coffee, milk and milk products.
-Vegetables-tomatoes and some green vegetables.
記著與您的醫生溝通有關完整的治療計劃,來講及健康生活的改變, 包括進食及運動, 有痛風突發的治痛處理, 及長期的治療高尿酸所引致痛風症。時常跟進醫生的建議。 您會如任何人一樣健康。
Remember to keep communicating with your doctor about a comprehensive treatment plan that addresses healthy life style changes, including diet and exercise, pain management for gout attacks, and long term treatment of high uric acid level that causes gout. Follow doctor’s advices at all times. You can be just as healthy as anyone.
Prevention is better than cure