Gout in Malaysia: symptoms, uric acid levels, foods to limit and treatment

What is gout?

Gout happens when uric acid, a waste product the body makes when it breaks down substances called purines, builds up in the blood and forms needle-like crystals in a joint. The immune system attacks the crystals, causing sudden, intense inflammation.

There are no national figures on how common gout is in Malaysia. Hospital studies show it usually starts between the ages of 30 and 60 and mostly affects men. Specialists say they are seeing more young adults with gout, linked to rising obesity, and nearly half of Malaysians are overweight.

Gout symptoms: what an attack feels like

• Sudden, severe pain in one joint, often starting at night and peaking within 24 hours. Many people describe it as throbbing, burning or like being stabbed.
• The joint becomes red, hot and swollen, and too painful to touch, even with a bedsheet.
• The big toe is the most common site, followed by the midfoot and ankle. Knees, wrists, hands and elbows can also be affected.
• Some people have a fever during an attack.

Attacks usually settle within a week or two, but without treatment they tend to come back more often and affect more joints. Over time, firm white or yellow lumps called tophi can form under the skin, at the toes, ears, elbows and fingers.

What your uric acid level means

Reference ranges vary slightly between laboratories, so check the range printed on your report.

• A high level isn’t the same as gout. Many people with high uric acid never get an attack, and Malaysian guidelines don’t recommend treating high uric acid without symptoms.
• The level can be normal during an attack. Doctors may repeat the test two or more weeks after the attack settles.

What causes gout, and foods to limit

Things that raise the risk of gout, according to the Ministry of Health’s gout guidelines:

• Being overweight
• Alcohol, including beer
• Sugar-sweetened drinks and fruit juice
• Red meat, organ meats and some seafood, such as anchovies, sardines and shellfish
• Some medicines, including diuretics (“water pills”) and some blood pressure medicines
• Kidney disease, diabetes, a family history of gout, and being male or past menopause

Foods that may help: dairy products are linked to a lower risk, and purines from plant foods such as beans and vegetables don’t raise it. Cherries may lower the chance of attacks, but the evidence is limited. Losing weight, drinking enough water and cutting alcohol and sweet drinks all help.

Don’t stop any prescribed medicine, including low-dose aspirin for your heart, without talking to your doctor. They can switch blood pressure medicines if needed.

Treating gout

During an attack: your doctor may prescribe colchicine, an anti-inflammatory painkiller (NSAID), or a steroid. Rest the joint, raise it, and apply an ice pack wrapped in a towel for up to 20 minutes. Start treatment as early as you can.

Preventing attacks: painkillers treat the pain, but not the cause. People with repeated attacks, tophi or kidney stones usually need long-term uric acid-lowering medicine, most often allopurinol, to bring the level below the target.

• It is started at a low dose and increased slowly, with regular blood tests.
• Doctors often add a low-dose anti-inflammatory for the first 3 to 6 months, as attacks can briefly increase when treatment starts.
• Keep taking it during an attack, and long term. Stopping is the most common reason treatment fails. In one Malaysian clinic, only about a third of patients reached their target.
• Rarely, allopurinol causes a serious skin reaction. Stop it and see a doctor at once if you get a rash, blisters or mouth sores.

Gout or pseudogout?

Pseudogout (calcium pyrophosphate deposition disease) causes similar sudden, painful, swollen joints, but it is caused by calcium crystals, not uric acid. It is more common in people over 60, most often affects the knee, and attacks last 1 to 2 weeks. It doesn’t respond to uric acid-lowering medicine. A doctor can tell them apart by testing fluid from the joint, or from X-ray findings.

Why gout needs long-term care

Untreated gout can lead to permanent joint damage, tophi, kidney stones and kidney disease. People with gout also have higher rates of heart disease, diabetes and high blood pressure, so a check of your blood pressure, blood sugar, cholesterol and kidney function is part of good gout care.

Where to get gout treated

Most gout is diagnosed and managed by GPs, who can treat attacks, check your uric acid and kidney function, and start long-term treatment. Our directory lists GP clinics across Kuala Lumpur, Selangor and other states, including clinics open late and at weekends.

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Frequently asked questions