Gout

Gout is a complex type of arthritis caused by the accumulation of urate salt crystals inside a joint. When a specific chemical called uric acid, is either produced in large or small quantities (as opposed to the normal quantity) and is excreted into the urine by kidneys, it builds up in your blood forming sharp needle shaped crystals. These crystals can get piled up in a joint stimulating a chemical reaction within and cause inflammation.

Under normal circumstances, uric acid easily dissolves in the blood and is passed out from the body in urine. Uric acid is the breakdown product of genetic material in our body and also of certain foods and drinks. The chemical imbalance occurs when we add an increased amount of foods containing uric acid in our diet. Foods such as steak, liver, shellfish, kidney and drinks like beer or beverages sweetened with fruit sugar contribute to an increase in blood level of uric acid. 

However, diet consisting of the above mentioned items is not necessarily the cause of disease. It can be associated with diabetes, obesity, high blood pressure, certain medications (for example thiazide diuretics), high lipid levels in blood, family history of gout, recent surgery or trauma and age. It is seen more commonly in males above the age of 45 years. Women become more susceptible after menopause.

An attack of gout characteristically involves a single joint. Often, the base of the big toe in one of your feet is the target of the first episode. As the disease progresses, recurrent episodes occur in the same or different joints. The knee or ankle can also be affected. Urate crystals can also lead to uric acid kidney stones. Untreated gout can advance on to the appearance of “Tophi”. These are small lumps, noticed on the feet, back of ankles, hands and fingers, as a result of local crystal concentration.  

Here is what you can expect in a typical episode of gout:

  • Sudden, severe attack of pain in one specific joint (usually the big toe). This is excruciating and continues for a few hours. It may happen anytime without a warning and can even wake you up in the middle of the night.

  • Swelling of the same joint

  • You may notice the skin of the affected joint is red-purplish in colour and it may seem tight and shiny

  • The specific site might be slightly warm on touch

  • You could have a fever (not always)

Subsequent episodes possibly last longer than the first ones. As the medical condition progresses, repeated attacks on a joint may lead to loss of mobility and function.​


Any joint pain, especially if only one joint is bothering you, should be a sign to seek medical advice. When you have an intense episode as described above, make an appointment with a doctor from the Musculoskeletal and Sports Medicine Service Line at The Aga Khan University Hospital.

For a preliminary examination, you can also consult a doctor from the Family Health Services at The Aga Khan University Hospital. Do not delay, as it is important for gout to be treated at the earliest. Otherwise, it can cause much damage to your joint. ​
​

​Your time with your doctor may be limited, so make sure to prepare for your visit beforehand. Here are some tips to help get you started.​


​

After examination of your joints, your physician may choose to conduct the following tests:

  • Blood test: to measure uric acid and creatinine levels in blood, or the white cell count for infection

  • Imaging tests: to get a visual perspective of the changes inside your joint. X-ray or ultrasound may be ordered

  • Joint aspirate analysis (arthrocentesis): a sample of fluid from your joint will be extracted through a fine needle for microscopic evaluation of crystals​​


An acute presentation is usually handled with anti-inflammatory medication, steroids (as oral tablet or injection into joint/muscle), or colchicine (oral/injection) for relief of symptoms.

Once the episode subsides, your health care provider will focus on preventing future attacks and complications. Amongst the options for long-term control, are medications that either reduce the production of uric acid in your body, or enhance its removal in urine. ​


The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage.

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.​


​Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage.​


​

 

 
The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.