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Gout is a common musculoskeletal and joint disease in the elderly. The main causes are genetics and excessive intake of certain proteins, which when broken down into uric acid accumulate as deposits in the joints. This leads to acute inflammation of the joints or surrounding tissues. Most gout patients also tend to have high uric acid levels in their blood.
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<h2>Incidence of Gout 
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Statistics show that the higher the uric acid level, the higher the incidence of the disease and the faster symptoms appear. This disease is about 10 times more common in men than in women, but the incidence increases in women after menopause.
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<h2>Symptoms of Gout 
</h2>
Gouty arthritis symptoms usually occur suddenly and severely. The symptoms include swollen, red, and very painful joints. The severity is highest during the first 1-2 days, after which the inflammation usually decreases either through treatment or naturally.
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Normally, if the accumulation of uric acid in the body is not treated to reduce it, severe gouty arthritis symptoms can recur, sometimes after several months or years. The symptoms tend to occur more frequently and take longer to resolve over time.
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If left untreated for many years, some patients will start to develop uric acid deposits under the skin called tophi, which means that internal organs may also have tophi of various sizes accumulated.
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<h2>Where Does Uric Acid Come From? 
</h2>
Uric Acid is a substance produced naturally by chemical processes in the body during the creation or repair of cells. Another source is from consuming foods high in uric acid, such as poultry, organ meats, vegetable tops, various beans, or beverages like beer and fruit juices containing fructose.
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When the body has more uric acid than the kidneys can excrete, or if the kidneys are impaired and their ability to eliminate uric acid decreases, such as in patients with kidney disease or kidney failure, uric acid accumulation increases.
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Gouty arthritis in patients with already high blood uric acid levels may be triggered by eating a large meal or foods high in uric acid. Sometimes even a small amount can add to the existing accumulation until the body shows symptoms. The severity varies among individuals.
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Currently, it is also found that long-term high uric acid accumulation can cause kidney deterioration, hypertension, which leads to heart disease and stroke, increasing the risk of paralysis. Studies show that male patients with kidney failure requiring dialysis partly have a history of gout or high uric acid levels, while most female dialysis patients have diabetes.
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<h2>Treatment of Gout 
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Since gout is caused by uric acid accumulation in the body, treatment must be continuous, focusing on lowering blood uric acid levels below the threshold that causes further accumulation and gradually reducing existing deposits. The general goal is to reduce blood uric acid levels to less than 6 milligrams per deciliter (mg/dL) by increasing uric acid excretion through urine or reducing uric acid production with medication, combined with avoiding foods high in uric acid.
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During severe joint inflammation, usually occurring in the big toe or ankle joints, treatment with non-steroidal anti-inflammatory drugs or colchicine is necessary to relieve pain and reduce inflammation within the first one to two days.
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After the inflammation subsides and returns to normal, blood uric acid levels and kidney function should be checked. If uric acid levels are above 6 mg/dL, continuous uric acid-lowering medication should be administered with regular follow-up.
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Even when blood uric acid levels are successfully lowered below 6 mg/dL, patients should continue medication to maintain levels below 6 mg/dL permanently. Proper control greatly reduces the chance of severe joint inflammation recurrence and helps preserve kidney function from damage caused by high uric acid.
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<h2>Recommendations for Patients with Gout or High Blood Uric Acid</h2>
<ol>
<li>Take medications exactly as prescribed by the doctor.</li>
<li>Drink plenty of water daily to help excrete uric acid and improve kidney function.</li>
<li>Avoid foods high in uric acid and alcoholic beverages.</li>
<li>Inform your doctor if you need treatment for other diseases or surgery to avoid medications that may affect gout or prevent gout flare-ups after surgery.</li>
<li>Attend regular check-ups and follow-up on symptoms and treatment results as scheduled by your doctor.</li>
</ol>
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Assoc. Prof. Dr. Kitti Totemchokchaikarn
Internist specializing in Rheumatology and Joint Diseases
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Gout is caused by genetics and excessive intake of certain proteins. When proteins are broken down into uric acid and accumulate as deposits in the joints, it can cause acute inflammation in the joints or surrounding tissues.

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Gout: Causes, Symptoms, and Appropriate Treatment

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