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 is called when uric acid saturation arises without coexisting diseases or drugs that alter uric acid production and excretion.
While in secondary hyperuricemia there is an excessive uric acid production or diminished renal clearance that occurs as a result of a disease, drug, dietary product or toxin.

Patient Education

  • Patient education & appropriate lifestyle advice 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 & compliance when done at the start of therapy

Lifestyle Modification

  • The goal of lifestyle modification is to help prevent both gouty attacks & complications, together with its comorbidities
Body Mass Index (BMI)
  • Aim to have ideal body weight through gradual weight loss (0.5-1 kg/week), with gradual caloric restriction & exercise
    • Avoid “crash dieting” & high protein/low carbohydrate diets since these may cause ketosis & 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
  • Restrict consumption of high purine foods (eg brain, liver, kidney, anchovies, sardines, mackerel, seafood) to <200 mg/day
  • Reduce intake of red 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 & beverages containing fructose
    • Limit up to 4 cups of coffee/day
  • Consider taking vitamin C supplements (500 mg/day)
Alcohol Intake
  • Restrict alcohol consumption to <21 units/week for men & 14 units/week for women
    • Avoid beer, wine & spirits
    • 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
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