No one is man enough to take on gout!

Troubled by joint swelling and joint pain?

If so, you are most probably developing the gout syndrome. The number of gout sufferers is steadily on the rise especially among the middle aged men. The regions prone to gout attacks are usually concentrated on the lower limb joints (especially the big toes and knees) with symptoms like swelling, redness, heat and of course pain. What tortures gout sufferers most is the chronic and recurrent intense pain around the affected regions.

Gouty arthritis is also known as metabolic arthritis. The name suggests that when the metabolic function is weak, excess uric acid cannot be eliminated normally or efficiently, leading to harmful waste build-up in the joints. Over time, this harmful uric acid crystallizes and forms crystal deposits (uric acid crystals) in the joints, which causes a gout flare-up. What is really worrying is that this disease tends to occur in the middle-aged men. When it first flares up, the pain may not last long, usually within a few days. The pain is likened to a wind-blow that comes and goes quickly. But, just when you thought it went all right, this is only the beginning of the nightmare.

When purine metabolism disorder happens, it makes uric acid excreted improperly, this leads to high levels of uric acid in the body. As mentioned earlier, the build-up of uric acid will eventually form crystal deposits in the affected regions (especially the big toes and joints), which causes gout. Under normal circumstances, two-thirds of the uric acid is excreted by the kidneys while remaining one-third is discharged through bowel movement. Uric acid is generated and excreted, in and out of the body, in an ongoing manner. As such, uric acid maintains a certain concentration in the blood in any situation.

With the presence of high levels of uric acid in the blood, it results in the formation of monosodium urate crystals in the joints, soft tissues, cartilage and kidneys. Such harmful deposits will then lead to tissue inflammation and hence opening up the doors to gout attacks. If you don’t treat it completely at this stage, things will be getting worse with joint swelling, deformity, stiffness and nodules. By then, the gout-inflicted complications might include kidney stones, renal failure, coronary heart disease, high cholesterol, hypertension, urinary tract stones and other types of organ dysfunction. It can be life threatening in serious cases.

The four stages of gout


Asymptomatic gout

Gout can progress through four stages with the presence of high uric acid levels constituting the first stage (asymptomatic gout). At this stage, apart from developing high levels of uric acid, there are no clinical symptoms of gout, hence making the initial sufferers ignorant about its lurking risk factors.


Acute gout

The second stage refers to the early gout stage (acute gout). At this stage, joint pain begins to surface. Aggravated by the uncontrolled high uric acid levels at the first stage, uric acid will just keep building up and this results in acute inflammatory gouty arthritis. It usually starts in the big toes with symptoms like joint swelling, redness, warmth and tenderness. The affected big toes appear to be very tender and inviting terrible pain when they come into contact with anything. The piercing knife-like pain is the major culprit of the many sleepless nights. The pain would usually go away between a few days and a few weeks.


Interval or inter-critical gout

The third stage is called the interval or inter-critical gout. The gout attack is now striking beyond the first problematic big toe. Gradually, it is hitting the other toes, fingers, wrists, ankles and knees. Soon, the soft tissues and bones of the affected joints will suffer varying degrees of damage and dysfunction. Uric acid crystals keep building up, which will lead to the formation of gouty stones. At this point, the normal renal function or performance begins to deteriorate.


Chronic tophaceous gout

The fourth stage is the late stage of gout (chronic tophaceous gout). At this stage, expect worsening joint deformity and dysfunction as the build-up of uric acid crystals rises continuously to expand the affected areas. Then come the nodules of uric acid (known as tophi) in the soft tissues around the affected joints. Given the fact that the permanent joint deformity will badly affect the daily life of the sufferers, this brings about great physical and mental suffering as well. As more and more monosodium urate crystals trapped in the kidneys, this will accelerate the formation of kidney stones. The clinical characteristics or symptoms that follow include swelling, oliguria (the production of abnormally small amounts of urine), proteinuria (the presence of abnormal quantities of protein in the urine), nocturia (the need to get up during the night to urinate), hypertension and anemia. At this point, the normal renal function has been compromised and begins to deteriorate, leading to renal failure and other life-threatening complications.

Celebrities Tormented by Gout

Renowned Hong Kong entertainer Eric Tsang was recently exposed by the media to have been in a state of immobilisation, relying on a wheelchair to get around.

It was later confirmed that he was paying the price for excessive consumption of alcohol. Eric Tsang was suffering from severe gout attacks that immobilised him.

His good friend, Alan Tam, revealed that the seriousness of such disease had even deterred Eric Tsang from taking care of himself personally.

Paul, the renowned lifestyle guru from Taiwan, was first struck by gout ten years ago. Recalling his ordeal, he said that the presence of gouty stones (uric acid crystals) in his thumbs was among the most miserable experiences he ever had. Paul had even compiled his stories, sharing a series of his fights against gout with the netizens so that they could learn a lesson from his ignorance – never getting yourself entangled in gout attacks!

Paul shared that the worst happened some two years ago since he first had gout. The excruciating pain lasted for one whole month, forcing him to confine himself at home. The pain had even forced him to crawl up the toilet. And once he finally managed to sit on the toilet, the pain didn’t seem to go away at all. He had to sit on the toilet for up to an hour or longer or until the movie on TV was over. It sounded unreal but the torture of gout was true beyond words.

Apart from the foreign cases, Malaysia’s very own celebrity chef, Ismail Ahmad, had also suffered from gout attacks. Being a victim of the torturous disease himself, however, inspired chef Ismail to make drastic changes to the menu of his restaurant. He decided to cut down on the portion of meat while increasing of serving of vegetables. This is to encourage his customers to fall in love with the concept of a healthy diet.

According to chef Ismail, prior to developing gout, his buffet menu was characterised by at least 70% meat-based selections. But after suffering from gout, his menu is now very health-oriented, featuring fresh vegetables as the key ingredients. He places great emphasis on low-sugar food and cuts down on rice consumption in his personal diet to prevent another round of gout attacks.

Frankly speaking, gout cases are so common around us. Unfortunately, the media report on gout is very limited and making it worse, the general public tends to ignore it simply because they have very little knowledge about it, which leads to the prevalence and incidence of gout.

Health Tips

  • The main culprit behind hyperuricemia is the presence of high blood uric acid levels.
  • For adult male, uric acid levels exceeding 7.0 mg/ dL (milligrams per decilitre) means hyperuricemia.
  • For adult female (before menopause), the normal uric acid levels are below 6.0 mg/ dL.
Gout and uric acid blood analysis
Serum Uric Acid (SUA) levels (mg/ dL) Probability of first gout incident Probability of gout recurrence
< 6 0.5 0.8
6 -6.9 0.6 0.9
7 - 7.9 2.0 4.1
8 - 8.9 4.1 8.4
9 - 9.9 9.8 43.2
> 10 30.5 70.2

Doctor's advice

Reducing uric acid is key to gout treatment

  • Embrace a healthy diet and avoid organ meats.
  • Drink plenty of water every day.
  • Limit alcohol and fat intake.
  • Maintain a healthy weight.

Self Test

Do you belong to the high-risk group of hyperuricemia?


Let us know if you have any questions