gout
GOUT
Gout is a condition that resulted from deposition of monosodium urate crystals in various tissues (eg joints, connective tissue, kidney).
The patient experiences acute and chronic arthritis, soft tissue inflammation, tophus formation, gouty nephropathy and nephrolithiasis.
Primary hyperuricemia occurs when uric acid saturation arises without coexisting diseases or drugs that alter uric acid production or excretion, while secondary hyperuricemia is a condition where excessive uric acid production or diminished renal clearance occurs as a result of a disease, drug, dietary product or toxin. 

Gout Patient Education

Patient Education

  • Patient education, appropriate lifestyle advice and shared decision making are core aspects of the management
  • Give advice on possible changes of life habits that can lead to an improvement in overall metabolic profile of the patient
  • Often improves patient’s understanding and compliance when done at the start of therapy

Lifestyle Modification

  • The goal of lifestyle modification is to help prevent both gouty attacks and complications, together with its comorbidities
  • It is a part of long-term management of gout

Body Mass Index (BMI)

  • Aim to have ideal body weight through gradual weight loss (0.5-1 kg/week), with gradual caloric restriction and exercise
    • Avoid “crash dieting” and high-protein/low-carbohydrate diets since these may cause ketosis and result to hyperuricemia
    • Daily or at least 45-minute, 4-times-a-week, low-impact (eg walking, biking, swimming) or aerobic exercise is recommended

Dietary Management 

  • Dietary restriction can decrease the occurrence of gouty attacks but has little role in lowering serum urate levels in patients with gout
  • Restrict consumption of high purine foods (eg brain, liver, kidney, anchovies, sardines, mackerel, seafood)
  • Reduce intake of meat (beef, lamb, pork)
  • High intake of vegetables, nuts, legumes, vegetable protein reduces the risk of gout (lower serum uric acid)
  • Consumption of low-fat dairy products or skim milk up to 2 servings daily
  • Limit sugar-sweetened softdrinks and beverages containing fructose

Alcohol Intake 

  • Restrict alcohol consumption to <21 units/week for men and 14 units/week for women
    • Have at least 3 alcohol-free days/week
  • Avoid alcohol intake when suffering from frequent gout attacks or when gout symptoms are poorly controlled

Smoking 

  • Complete cessation of smoking is recommended

Adequate Fluid Intake 

  • Recommended fluid intake is 2-3 L/day
  • Restrict fluid intake in some patients (eg with heart failure or severe renal insufficiency)
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