NCD Watch

Gout : No Longer the Disease of Kings

24 Jun 2019 (Mon)

Gout : No Longer the Disease of Kings Gout is one of the oldest joint diseases known to humans, first identified by the Egyptians as far back as 2640 BC. Gout is once described as “a disease of kings”, typically afflicting the kings and aristocrats, the wealthy and powerful people in the old days for their overindulgence in rich foods and copious drinking. Today gout has become a disease of many men and women, primarily due to social change and population ageing, shifts in diet and lifestyle as well as increasing rates of obesity.

In Hong Kong, prevalence of gout rose continuously over the past decade. In 2016, a population study, analysed clinical data of over 2700 000 patients who attended out-patient clinics or emergency departments of the Hospital Authority, showed that the crude prevalence of gout was 2.9%, which was similar to the rates in Western developed countries.

Gout is caused by sustained asymptomatic hyperuricaemia (i.e. increased uric acid levels in blood). Uric acids come from the breakdown purines which are substances naturally found in body’s tissues (as cells die, they release purines) and in many foods. Normally, the body excretes most (about 70%) uric acids through the kidney in the urine and the rest through the gut. However, uric acids can build up in the blood as a result of overproduction or under-excretion. When crystalised in the form of needle-like urates and deposited in the joint or surrounding tissues, they would induce inflammation and trigger gout attack.

Many people with gout falsely think “no pain, no problem”, without realising that urate crystal deposition may continue in the joints, soft tissues or kidneys silently during the time between acute attacks. If hyperuricaemia is not well managed, it can cause irreversible damage to the joints and lead to other complications. Thus, gout patients should work in partnership with family doctor and other healthcare professionals, follow the treatment plan including adherence to prescribed meal plans and medications (such as urate lowering agents and anti-inflammatory drugs), and adopt a healthier diet and lifestyle that helps keep uric acids in the blood at optimal levels, to reduce the risk of gout attacks and maintain overall health, including:-

  • Eat a balanced diet and limit the intake of high purine foods;
  • Avoid alcoholic beverages and sugar-sweetened drinks high in fructose;
  • Stay well-hydrated and plain water is the best;
  • Maintain an optimal weight; and
  • Be physically active.

In 2018, the Hong Kong SAR Government launched “Towards 2025: Strategy and Action Plan to Prevent and Control Non-communicable Diseases in Hong Kong”. Of the 9 local targets to be achieved by 2025, many are related to the prevention and control of gout and its complications, including Target 2: To reduce the prevalence of alcohol drinking among adolescents and adults, and Target 7: To halt the rise in obesity (and diabetes). The Government will step up efforts in promoting healthy diet and physical activity participation, enhancing public awareness about the importance of primary disease prevention, as well as working with the community in building a health-enhancing environment.