Severe pain in the joints

by | July 1, 2013

A form of arthritis, gout is a concern to many seniors. Learn how to manage this condition.

BY: Esther Low


The big toe isn't the only part that could be affected from gout, other parts of the body include the hands, heels and ankles.

Gout is an acute, chronic form of arthritis that is characterised by sudden bouts of severe pain in the joints, especially that of the big toe though it could affect the hands, heels and ankles. Swollen joints, excruciating pain, reddened skin, burning sensation, stiffness … all these are familiar to gout sufferers. This inflammatory condition results from the deposit of uric acid crystals around the joint, due to a high level of uric acid in the blood. Though it is a lifelong condition, it is treatable and easily managed with the right diet and medication.

Dietitian Cindy Shea from Tan Tock Seng Hospital sheds light on this condition – what to look out for and how to manage it:


What is the normal level of blood uric acid?

Normal serum (blood) uric acid levels range from 2.4 mg/dL to 6.0 mg/dL for females, and 3.4 mg/dL  to 7.0 mg/dL for males. Uric acid is a natural result from the breakdown of purines – nitrogen-containing compounds – in the body and hence, it is only when serum uric acid levels rise above 7.0 mg/dL that the threat of condition may present itself. Elevated uric acid levels (hyperuricaemia) is often linked to kidney stone formation and gout.


How can seniors measure their blood uric acid levels and monitor their condition/risk?

There are home test kits available for measuring serum uric acid levels, however, it is best to see a qualified medical practitioner to interpret the results.


Are certain people predisposed to developing gout?

Gout tends to occur more frequently in men than in women as men generally have higher uric acid levels than women. However, after menopause, women’s uric acid levels approach that of men, which increases their risk of developing the signs and symptoms of gout.

Certain diseases/conditions such as diabetes or high blood pressure can also increase the likelihood of developing gout. Likewise, certain medications, such as diuretics used to control high blood pressure, or low-dose aspirin, can lead to the development of gout over time too, hence caution must be exercised in taking such medication, especially if one has a history of gout.

A family history of gout puts one at a higher chance of developing the condition too. Having had an organ transplant, especially a kidney transplant, also puts one at a higher risk of developing gout.

That being said, gout is strongly associated with lifestyle, and hence the lifestyle choices and changes one makes, such as the type and the amount of food and (alcoholic) drinks consumed, have a great impact on the likelihood of developing gout, or the recurrence of gout attacks.


Are there any symptoms to look out for with respect to one’s risk of developing gout?

Gout can be asymptomatic (meaning the disease does not present any symptom), or it can be symptomatic. In symptomatic cases, the first signs are often sudden and severe pain, swelling, tenderness and reddened skin at and around the affected joint. The affected joint is typically the big toe, though the feet, ankles, knees, fingers and elbows can be affected as well. In many cases, the pain often strikes at night.

One should suspect gout when one has such bouts of arthritis that come and go. Over time, if left untreated, gout could lead to joint damage. This would lead to reduced flexibility in that joint. Without treatment, other joints could become affected as well and kidney stones could develop.


Sardines get a bad reputation when it comes to gout as it is considered high in purine.

What are some common triggers (food/drinks, lifestyle, etc) that gout sufferers should take note of to minimise their risk of gout attacks?

Gout occurs when there is an accumulation of uric acid. Generally, gout sufferers are able to

minimise their risk of gout attacks by following the dietary advice below:

  • Aim to achieve/maintain weight within your ideal body weight range. Obesity or being overweight is often associated with gout. It is advised to gradually lose weight and avoid crash dieting as rapid weight loss can lead to increased risk of gout attacks.
  • Consume adequate fluids (aiming six to eight glasses per day).
  • Avoid excessive intake of alcohol.
  • Consume moderate amounts of protein.

Foods that contain moderate amounts of purine (i.e. 50mg to 150mg per 100g food) such as meat (beef, lamb, pork), fish, seafood, legumes and vegetables (asparagus, mushroom, cauliflower and spinach) are still allowed to be eaten, however, in moderate amounts.

  • Limit intake of foods that are high in purine.

Foods that are high in purine (i.e. contains more than 150mg purine per 100g food) produce more uric acid in our blood. This leads to an increased risk of having a gout attack. Some examples of foods high in purine include: Anchovies, sardines, offal (e.g. brain, liver, heart and kidney), mussels, meat extract, soybean and related products, and goose.


Does eating particular food/fruits help to ease gout (for example, cherries), or is the best method of prevention or recovery from a gout attack still is cutting back on purine-rich food?

There are limited clinical studies shown that eating particular food or fruits is able to assist in reducing gout attacks. The best method of prevention or recovery from a gout attack is to not only avoid taking high purine foods but to have a healthy balanced diet and maintaining within an ideal body weight range. You can refer to the Healthy Diet Pyramid recommended by the Health Promotion Board as a guide to help you achieve a healthy balanced diet.


What are some treatments for gout sufferers?

There are basically two types of medication for those with gout – first, for when attacks occur and to reduce inflammation and pain, and second, for prevention of future attacks and to reduce the level of uric acid in the blood, or improve excretion of uric acid. For the first type, it would be NSAIDs (non-steroidal anti-inflammatory drugs), Colchicine and steroids. The second type would include Allopurinol and Probenecid.


(* PHOTO CREDIT: Sardines, nyuszika, stock.xchng)



  1. Stephen Teng

    From personal experience, whenever I have yearly gout onset (tenderness & redness around the big toe), I find relief within 48 hrs with Devil’s Claw plus Lithium Aspartate. It works every time over past 5 yrs already. Any reason for this?

    PS: The first time I was given Colchicine and steroids by a polyclinic doctor, when my gout was tested to be around 8.0 mg/dL but I did not take the doctor’s prescription drugs. I prefer the supplements extract from nature.

    • agelessadmin

      Hi, Stephen, thanks for your comments. I will check with the dietitian if she is able to answer this.


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