Gout is a type of arthritis caused by too much uric acid (asid urik) in the blood, which forms crystals in the joints and causes sudden attacks of severe pain, swelling and redness, most often in the big toe. An attack usually lasts 1 to 2 weeks without treatment and is treated with anti-inflammatory medicines, colchicine or steroids from a doctor. To stop attacks coming back, the Malaysian Ministry of Health gout guideline recommends uric acid-lowering medicine (allopurinol first) with a target serum urate below 360 µmol/L, together with a healthy weight, no alcohol, fewer sugary drinks and limiting purine-rich animal foods such as organ meats, red meat and shellfish.
What is gout (penyakit gout)?
Gout (penyakit gout) is a type of arthritis. According to the NHS, it is caused by having too much uric acid in your blood, which can lead to crystals forming around your joints and causing pain. Uric acid is a waste product your body makes when it breaks down purines, which are found in your body and in some foods.
The Malaysian Clinical Practice Guidelines on the Management of Gout (2nd edition, 2021) note that gout is traditionally a disease of middle-aged and older men, and is unusual in men under 45 or in women before menopause. Studies from Malaysian hospitals found that gout usually started between the ages of 30 and 60, and most patients were men.
Tanda gout: what are the symptoms of gout?
According to the NHS, the main symptoms of gout are:
- sudden, severe pain in a joint, usually the big toe (gout kaki), but it can be in other joints in the feet, ankles, hands, wrists, elbows or knees;
- hot, swollen, red skin over the affected joint (redness may be harder to see on darker skin).
An attack (gout flare) usually lasts 1 to 2 weeks if left untreated. Without treatment, future attacks may last longer, and gout can cause lasting damage to the joints.
Complications. Repeated attacks over a long time without treatment can lead to:
- joint damage;
- tophi: hard lumps of uric acid crystals under the skin, usually on the ears, fingers or elbows;
- kidney stones; see our guide to batu karang.
Punca gout: what causes gout?
The main risk factor for gout is having high uric acid levels (hyperuricaemia) for a long time. The Malaysian guideline lists these risk factors:
| Type | Risk factors |
|---|---|
| Cannot be changed | Getting older, being male, menopause, ethnicity and genes |
| Can be changed | Being overweight or obese; alcohol; sugar-sweetened drinks and high-fructose corn syrup; red meat; seafood (except oily fish) |
| Medicines | Some blood pressure medicines, especially diuretics (water pills), and also ACE inhibitors, beta blockers and some other blood pressure tablets |
| Other conditions | Chronic kidney disease, high blood pressure, psoriasis and some blood cancers |
Excess weight is a major risk factor, and the guideline notes that people with a BMI of 30 or more were about twice as likely to develop gout. If you are overweight, losing weight gradually, without crash diets, can help; see our guide to weight loss in Malaysia.
Gout is also linked to darah tinggi and diabetes. If you take blood pressure medicine and have gout, do not stop it yourself; ask your doctor whether a different medicine would suit you better.
Things that can trigger an attack. According to the NHS, a gout attack can be triggered by an illness with a high temperature, drinking too much alcohol, eating a very large meal, getting dehydrated, injuring a joint, or taking certain medicines.
Asid urik: what uric acid level should you aim for?
Your doctor can check how much uric acid is in your blood with a blood test (serum urate). The Malaysian guideline recommends a treat-to-target approach for everyone with gout: lowering serum urate to below 360 µmol/L (6 mg/dL). At this level, the urate crystals dissolve over time.
The guideline notes that a normal or low uric acid level during an attack does not rule out gout. Gout is best confirmed by a doctor, sometimes by taking a small sample of fluid from the joint to look for crystals.
Ubat gout: how is a gout attack treated?
Treat a gout attack as soon as possible. The Malaysian guideline recommends one of these medicines, prescribed by a doctor, or a combination if one is not enough:
- colchicine;
- NSAIDs (anti-inflammatory painkillers) or COX-2 inhibitors;
- corticosteroids (steroids), as tablets or an injection.
The NHS says medicine for an attack should start to work within 2 days. Take it as soon as you feel an attack starting.
What you can do at home, according to the NHS and the Malaysian guideline:
- rest and raise the affected limb;
- keep the joint cool: apply an ice pack wrapped in a towel (never directly on the skin) for up to 20 minutes at a time;
- drink plenty of water, unless a doctor has told you not to;
- keep bedclothes off the joint at night, and do not put pressure on it.
If you already take allopurinol, do not stop it during an attack.
How do you stop gout coming back?
Gout can come back after a few months or after years, and it comes back more often if it is not treated. If you have frequent attacks or high uric acid levels, you may need uric acid-lowering medicine. According to the Malaysian guideline:
- allopurinol is the first-line medicine; it should be started at a low dose and increased gradually;
- if allopurinol is not suitable, febuxostat or other medicines may be considered;
- medicine to prevent flares (such as colchicine) is usually given for at least 3 to 6 months when starting treatment;
- uric acid-lowering medicine needs to be taken long-term to stop new crystals forming, even when you have no symptoms.
Allopurinol safety. Most side effects of allopurinol are mild stomach upsets, but it can rarely cause a serious allergic skin reaction. The guideline advises stopping it and getting medical advice straight away if you develop a rash or itching, unexplained red eyes, or ulcers in the mouth or genitals.
Can gout be cured? The Malaysian guideline describes gout as potentially "curable", because keeping uric acid below the target dissolves the crystals. However, the medicine must be continued to stop new crystals forming, and joint damage that has already happened is permanent. There is no quick home remedy that removes gout permanently.
Makanan pantang gout: what should you eat and avoid?
Alongside medicine, the Malaysian guideline recommends a healthy, balanced diet based on the DASH diet (the same eating pattern used for high blood pressure), drinking at least 2 litres of fluid a day unless you are on a fluid restriction, and these specific changes:
| Limit or avoid | No need to restrict |
|---|---|
| Animal purine-rich foods: organ meats such as brain, heart and kidney; meat extracts, broth and gravy; shellfish, scallops, prawns and lobster; goose; red meat such as beef and mutton | Oily fish: anchovies, ikan kembung, tenggiri, ikan parang, sardines and tamban, salmon and trout |
| Sugar and fructose: sugar-sweetened drinks, large amounts of fruit juice, honey, syrups, sweets, desserts, bottled tomato and chilli sauce, and jam | Plant purine foods: soy foods such as tofu and tempeh, peas, beans and lentils, spinach, mushrooms, cauliflower and oats |
| Alcohol: beer, wine and spirits | Nuts and seeds, and low-fat dairy products |
Fruit and vegetables. Purine-rich vegetables and soy foods did not increase the risk of gout in the studies reviewed by the guideline, and eating whole fruit was not linked to gout. The risk comes from sugary drinks and fruit juice, so choose whole fruit over juice and cut down on sweet drinks such as teh tarik and soft drinks; see our guide to healthier Malaysian drinks.
Vitamin C and cherries. The guideline notes that vitamin C may slightly lower uric acid, and that eating cherries was linked to fewer gout attacks in one study, but says more evidence is needed for both. The NHS suggests asking your doctor about vitamin C supplements; see our guide to vitamin C. Supplements do not replace uric acid-lowering medicine.
The guideline also advises people with gout to stay well hydrated, exercise regularly and stop smoking.
When should you see a doctor?
According to the NHS, see a doctor if:
- you have symptoms of gout for the first time;
- you have gout and your usual treatment is not helping.
Get urgent medical help if you have sudden pain and swelling in a joint and the pain is getting worse, you have a very high temperature or feel hot, cold or shivery, or you feel sick or cannot eat. These could be signs of an infection inside the joint, which needs urgent treatment.
Frequently asked questions (FAQ)
What is gout in Malay (penyakit gout)?
Gout is called gout or penyakit gout in Malay. It is a type of arthritis caused by too much uric acid (asid urik) in the blood, which forms crystals in and around the joints. It causes sudden attacks of severe pain, swelling and redness, most often in the big toe.
What are the early signs of gout (tanda gout)?
A gout attack starts suddenly with severe pain in one joint, most commonly the big toe. The skin over the joint becomes hot, swollen and red. Gout can also affect the feet, ankles, knees, hands, wrists and elbows.
What is the best ubat gout?
A gout attack is usually treated with an anti-inflammatory painkiller (NSAID), colchicine or steroids, prescribed by a doctor. To stop attacks coming back, the Malaysian gout guideline recommends allopurinol as the first-line uric acid-lowering medicine, started at a low dose. Take it every day, even when you have no pain.
Can gout be cured permanently (cara hilangkan gout selamanya)?
Gout can be well controlled. The Malaysian guideline explains that keeping serum urate below 360 µmol/L dissolves the crystals that cause gout, but uric acid-lowering medicine needs to be continued long-term to stop new crystals forming. Joint damage that has already happened is permanent.
What foods should people with gout avoid (makanan pantang gout)?
The Malaysian guideline advises limiting animal-based purine-rich foods such as organ meats, red meat and shellfish, meat extracts and gravy, alcohol, sugary drinks, large amounts of fruit juice, honey and sweets. Oily fish such as ikan kembung and sardines, vegetables like spinach and mushrooms, beans, tofu and nuts do not need to be restricted.
Which fruits are not allowed for gout?
Eating whole fruit was not linked to a higher risk of gout in studies reviewed by the Malaysian guideline, so fruit does not need to be avoided. What raises the risk is sugar, especially sugar-sweetened drinks and large amounts of fruit juice such as orange juice. Eat whole fruit instead of drinking juice.
When should I see a doctor about gout?
See a doctor if you have gout symptoms for the first time or your usual treatment is not helping. Get urgent help if a hot, swollen joint is getting worse and you also have a high temperature, feel hot, cold or shivery, or feel sick, as this could be an infection in the joint.
Disclaimer
This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor or pharmacist. Do not start, stop or change any medicine without speaking to your doctor. Health supplements are not intended to diagnose, treat, cure or prevent any disease.
