It began with what felt like a sprained ankle. “The strange thing was, I couldn’t recall twisting my ankle,” said Norman Sequerah.
The 46-year-old Singaporean, who leads a manufacturing team, was then in his mid-30s. After limping around for two days, waiting in vain for the swelling to subside, he finally visited a doctor.
"He took one look at my ankle and said, ‘You have gout’,” he recalled.
Sequerah isn’t the only one who has been diagnosed at an age earlier than what gout is usually associated with.
According to the US’s National Institute Of Arthritis And Musculoskeletal And Skin Diseases, gout, which doctors consider a common form of arthritis, typically happens between the ages of 40 and 50.
Research consistently shows that even the strictest diet does not reduce uric acid enough to prevent gout attacks and gout-related complications, if not combined with medications.
Although there isn’t a national registry for gout in Singapore, Dr Lui Nai Lee, a rheumatologist with Gleneagles Hospital, said that “certainly, there are more patients in their 30s with gout”.
Dr Cho Jiacai, an associate consultant with the National University Hospital’s Division Of Rheumatology, said that the number of local cases is probably the same as in the UK, which “has seen an increase of 30 per cent in attendances for gout over the last 15 years”.
The youngest gout patient – at least for Dr Cho – is a 17-year-old. “He started getting refractory foot and ankle pain but did not see the doctor for gout initially as gout is not usually thought of at that age,” he said.
WHY ARE MORE YOUNG PEOPLE GETTING GOUT?
The beef could be with your diet. “Young people are consuming high-protein diets, increasing their alcohol intake but also lacking water intake,” said Dr Lui.
Gout is caused by an excess of uric acid in the blood known as hyperuricemia. Uric acid is produced when the body breaks down purines found in purine-rich foods such as meat, poultry, seafood and alcohol, especially beer.
Normally, uric acid is dissolved in the blood and excreted in the urine via the kidneys. But when there is too much uric acid in the body – either from digesting too much purines or too little uric acid is excreted – it crystallises into needles in the joints.
The pain associated with a gout attack – often sudden and severe, and located at the joint of the base of the big toe – can feel like the toe is on fire. The affected area is hot, swollen and so tender that even the weight of the sheet on it may be intolerable, according to the Mayo Clinic website. The pain can wake you in the middle of the night.
“Most of the time, it is not the diet alone that has caused the gout,” said Dr Cho. “It is simply not true that the patient had gout because he was a meat or seafood lover. Most of the time, many other risk factors play a role.”
These factors include hypertension, obesity, and a family history of gout. The arthritic condition also tends to hit men more than women; post-menopausal women are more likely to develop it, said Dr Lui.
GET THAT ‘SPRAIN’ CHECKED
The hallmark of gout is sudden joint pain and swelling that last for a few days before subsiding, said Dr Cho. “I often hear, ‘Oh my knee hurt so badly at that time. I probably knocked it against a furniture but I cannot remember’. But it was actually a gout flare.”
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Like Sequerah, some patients may also mistake the early signs for a sprain, said Dr Lui. They may also misconstrue the pain in a joint without swelling as soreness from running, for instance.
The fact that urate crystals tend to form in the joints means that joint deformity may be on the cards if the gout is not treated, according to the Healthline website.
It noted that the inflammation, tophi growth (deposits of urate crystals under the skin), bone erosion and cartilage loss can lead to the complete destruction of the joint.
The same urate crystals can also lead to painful kidney stones. According to the National Kidney Foundation in the US, many patients with gout also have chronic kidney disease that can sometimes end in kidney failure. However, it is not conclusive whether a pre-existing kidney disease creates the high uric acid levels that cause gout, according to Healthline.
HELP FOR GOUT
Medications such as allopurinol can help to reduce the excessive levels of uric acid without causing dependence or harm to the kidneys, said Dr Cho. Another way to manage gout is to lose weight and address other related conditions like hypertension, he said.
As for the diet, many gout sufferers are under the impression to stay away from meat and alcohol as these foods are high in purines.
Said Dr Cho: “Many patients think they can treat gout by adhering to a strict diet. But research consistently shows that even the strictest diet does not reduce uric acid enough to prevent gout attacks and gout-related complications, if not combined with medications”.
Dr Lui added that “we usually advocate that patients can eat all kinds of food but in moderation, followed by adequate water intake".
In fact, according to Dr Cho, “soy beans and legumes actually protect against gout, contrary to popular belief”.
“Of course, there are patients who are very sensitive even to small amounts of food such as anchovies and peanuts. If they are, they should avoid eating those foods,” said Dr Lui. If you are uncertain, consult a nutritionist or dietitian.