Gout (गाउट) and High Uric Acid: Meaning in Nepali, Symptoms, Diet and Treatment
By Dr. Krishna Adhikari, Consultant Rheumatologist
MBBS, MD (Internal Medicine), Fellowship in Clinical Rheumatology
Gout is a type of arthritis that causes sudden, severe joint pain. It happens when urate — what most people call uric acid — builds up over a long period and forms needle-shaped crystals in and around a joint. In Nepal it is grouped under बाथ रोग, but it behaves differently and is treated differently.
Gout meaning in Nepali
There is no old Nepali word for gout. It is written गाउट, and doctors explain it as a बाथ रोग (rheumatic disease) caused by युरिक एसिड (uric acid) collecting in the blood and settling as crystals in a joint. "High uric acid" is written रगतमा युरिक एसिड बढ्नु. This matters because in everyday speech every sore joint is called बाथ, and gout is not treated like others.
High uric acid does not always mean gout
A high urate level in the blood is called hyperuricemia. A person can have raised urate, and even crystals in the joint, without symptoms, and many people with high serum urate never develop gout. A high lab number is not a diagnosis on its own.
Normal uric acid level (युरिक एसिडको सामान्य मात्रा)
Uric acid is a chemical the body makes when it breaks down purines, natural substances found in the body's cells and in many foods. It normally leaves the body in urine.
Ranges differ slightly between laboratories, so first read the range printed on your own report. As a guide, the Arthritis Foundation (US) says uric acid is usually considered high when it is:
Women: over 6 mg/dL
Men: over 7 mg/dL
Some reports use µmol/L instead: 360 µmol/L equals 6 mg/dL.
Is 7.2 high? What does 9.5 mean?
With these limits, 7.2 mg/dL is high for women and men, and so is 9.5. But a high number alone is not a diagnosis: many people with high uric acid never get gout. In one estimate cited by the American College of Rheumatology, only about 1 in 5 people with a level above 9 mg/dL and no gout developed gout within 5 years. Without symptoms, treatment is usually not needed, although your doctor may keep an eye on it.
The target when you are treated for gout
With gout treatment, the American College of Rheumatology and NICE (UK) aim for below 6 mg/dL (360 µmol/L), and NICE suggests below 5 mg/dL (300 µmol/L) for some people, such as those with tophi. Your doctor sets your target.
Symptoms of high uric acid
High uric acid by itself does not cause symptoms; it is often found on a blood test done for another reason. Symptoms come from what it can lead to:
Gout attacks (see "Symptoms of a gout attack" below).
Tophi: hard lumps of urate crystals under the skin, usually on the ears, fingers or elbows, after years of untreated gout.
Kidney stones: severe pain in the side and lower back.
A sudden painful, swollen joint with a high temperature or shivering can mean an infection inside the joint. Get medical help straight away.
Uric acid can also be measured in urine, a different test used mainly to look into kidney stones. Show a urine report, including one that mentions uric acid crystals, to your doctor rather than comparing it with the blood levels above.
Symptoms of a gout attack
An attack brings sudden severe pain in one joint, usually the big toe, but it can strike the feet, ankles, hands, wrists, elbows or knees. The skin over the joint turns hot, swollen and red. Untreated, an attack usually lasts one to two weeks; between attacks there may be no symptoms.
Who is more likely to get gout?
Gout is more common in men than women and usually develops in middle age. Risk factors include being overweight or obese, drinking alcohol, eating a lot of purine-rich animal food, chronic kidney disease, a family history of gout, and some medicines including diuretics and low-dose aspirin. Never stop a prescribed medicine yourself over that last point.
How gout is diagnosed
A blood test can measure uric acid, but high levels do not always mean gout. The most definite test is taking fluid from the painful joint, a swollen bursa or a tophus and looking for urate crystals under a microscope.
Uric acid test
The uric acid test (serum urate) is a blood test. MedlinePlus advises no food or drink for 4 hours before it, unless you are told otherwise. Tell whoever orders it about all your medicines, because many, including aspirin, can change the result, but do not stop any on your own.
Timing matters in two cases:
During a gout attack: if the level is below 6 mg/dL but gout is still strongly suspected, the test is repeated at least 2 weeks after the attack settles.
On uric-acid-lowering medicine: the level is checked about monthly while the dose is adjusted, then less often, for example yearly.
Gout diet: what the evidence actually says
What raises the risk
The foods and drinks with real evidence behind them are animal-based and sugary. The ones to cut back on are red meat, organ meats such as liver, shellfish, and meat-based gravies and soups. Alcohol should be limited, especially beer, which is high in purines, and so should drinks high in sugar or fructose such as sodas and concentrated juices. Cold-water fish like tuna, salmon and trout also raise uric acid, though the Arthritis Foundation notes that the heart benefit of eating them in moderation may outweigh the risk of an attack.
Daal, spinach, cauliflower and mushrooms do not raise gout risk
You may have heard that people with gout should cut out daal (lentils), palungo (spinach), cauliflower and mushrooms because these foods contain purines. The research does not support that:
"On the other hand, purine-rich plant-based foods such as peas, beans, lentils, spinach, mushrooms, oats, cauliflower and broccoli were found to have little to no effect on the risk of a gout attack." — InformedHealth.org, NCBI Bookshelf
The Arthritis Foundation says the same: high-purine vegetables such as asparagus and spinach do not increase gout risk and are safe to eat. A published analysis found intake of purine-rich vegetables was not associated with plasma urate. Daal is an everyday source of protein in Nepal, so removing it has a cost and no proven benefit. If you have been told to stop eating daal, raise it with your doctor first.
What may help
Low-fat milk and dairy can reduce uric acid and the risk of an attack. Water helps flush uric acid out. Cherries and tart cherry juice may lower the risk of attacks, but the evidence is mixed — one review states there is no scientific proof that fruits help prevent gout. Losing weight through a reduced-calorie diet and exercise lowers urate and can reduce flares.
For everyday Nepali foods (daal, meat, fish, dahi, rakshi and more), see our guide Bath Rog and Uric Acid: K Khane, K Nakhane? A Nepali Food List.
How gout is treated
Treatment has two separate jobs. The first is settling the attack: a doctor may prescribe non-steroidal anti-inflammatory drugs, colchicine, or steroid tablets or joint injections, and colchicine works best taken as soon as symptoms appear. The second is lowering urate long term so attacks stop, using medicines that block uric acid production, such as allopurinol and febuxostat, or that help the kidneys remove urate. People with frequent attacks or high blood uric acid may need this. These are decisions for your doctor — do not start or stop them yourself.
Untreated gout does damage: over years, lumps of urate crystals called tophi can develop, causing bone and soft-tissue damage and misshapen joints, and high uric acid can cause kidney stones.
Uric acid medicine: who needs it, and why not to stop it
For people with gout, medicine to lower uric acid is usually advised if they have frequent or troublesome attacks, tophi, joint damage from gout or moderate or severe kidney disease, or take water tablets (diuretics). For high uric acid without gout, the American College of Rheumatology generally advises against it.
The usual first choices are allopurinol or febuxostat. Your doctor chooses which and the dose, starting low and raising it step by step, with a blood test about once a month, until the target is reached; some people also take colchicine meanwhile to prevent attacks.
Take it regularly as prescribed, even without pain: it keeps uric acid low rather than easing pain, and regular use is what prevents attacks. It is usually continued long term, often for life, so do not stop it without your doctor.
Can high uric acid be cured?
Usually it is controlled rather than cured. NICE calls gout a lifelong condition that benefits from long-term uric-acid-lowering treatment, which clears urate crystals and prevents attacks, and with treatment many people avoid attacks. High uric acid without symptoms usually needs only checking.
How to lower uric acid, and how fast
With frequent attacks or tophi, lifestyle changes alone are not enough: regular medicine is the main treatment. Lifestyle still helps: losing excess weight, drinking less alcohol (including non-alcoholic beer) and avoiding sugar-sweetened drinks can help reduce uric acid. For particular foods the evidence is weaker: NICE says there is not enough evidence that any specific diet lowers uric acid, and advises a healthy, balanced diet (see the diet section above).
How fast: with medicine, the dose is raised gradually and the blood is checked about monthly until the target is reached.
गाउट: नेपालीमा संक्षेप
गाउट भनेको रगतमा युरिक एसिड बढेर जोर्नीमा सुइजस्ता साना क्रिस्टल जम्दा हुने एक किसिमको बाथ रोग हो। प्रायः खुट्टाको बूढी औंलाको जोर्नी अचानक धेरै दुख्ने, रातो हुने र सुन्निने हुन्छ। रातो मासु, कलेजो र मृगौलाजस्ता आन्तरिक अंग, मदिरा (विशेषगरी बियर) र चिनीयुक्त पेयले जोखिम बढाउँछ। तर दाल, पालुङ्गो र काउलीजस्ता वनस्पतिजन्य खानाले गाउटको जोखिम बढाउँदैन भन्ने अध्ययनहरूले देखाएका छन्।
युरिक एसिडको लक्षण
युरिक एसिड भनेको शरीरले प्युरिन भन्ने पदार्थ पचाउँदा बन्ने रसायन हो, जुन सामान्यतया पिसाबबाट बाहिर निस्कन्छ। रगतमा युरिक एसिड बढेर मात्र प्रायः कुनै लक्षण देखिँदैन; धेरैलाई अर्कै कारणले रगत जाँच गर्दा थाहा हुन्छ। यसले यी समस्या ल्याएमा लक्षण देखिन्छन्:
गाउटको आक्रमण: एउटा जोर्नी, प्रायः खुट्टाको बूढी औंला, अचानक धेरै दुख्ने, तातो हुने, सुन्निने र रातो हुने
धेरै वर्ष उपचार नगरेमा कान, औंला वा कुहिनोमा छालामुनि कडा गाँठा (टोफाई)
मृगौलामा पत्थरी भएमा कोखा र ढाडको तल्लो भाग धेरै दुख्ने
जोर्नी अचानक दुखेर सुन्निएको छ र ज्वरो पनि आएको छ भने जोर्नीमा संक्रमण हुन सक्छ; तुरुन्तै डाक्टरलाई देखाउनुहोस्।
Arthritis Foundation का अनुसार महिलामा ६ mg/dL र पुरुषमा ७ mg/dL भन्दा माथि भए युरिक एसिड बढेको मानिन्छ, तर प्रयोगशालाअनुसार दायरा अलि फरक हुन्छ। गाउटको उपचारमा सामान्यतया ६ mg/dL भन्दा तल राख्ने लक्ष्य हुन्छ। डाक्टरले युरिक एसिड घटाउने औषधि दिनुभएको छ भने दुखाइ नभए पनि नियमित खानुहोस्; डाक्टरको सल्लाहबिना नछोड्नुहोस्।
When to see a rheumatologist
Get medical help straight away if a joint suddenly becomes red, hot, swollen and severely painful. See a doctor if attacks keep returning, if a blood test has shown high uric acid, if lumps have appeared around joints, or if you have kidney disease with joint pain. A rheumatologist can confirm whether it is gout rather than another arthritis or a joint infection. If you were diagnosed years ago and only take a painkiller when it flares, that is worth reviewing.
Rheumatology care in Kathmandu Valley
Rheumatology care at Tulsi Multi Speciality Clinic is provided by Dr. Krishna Adhikari, consultant rheumatologist and Lecturer in Internal Medicine at Patan Academy of Health Sciences (Patan Hospital), NMC No. 13049. He consults Sunday to Friday from 4:00 PM at AVM Chowk, Manbhawan, Lalitpur-5, Kathmandu Valley. See our rheumatology service and Dr. Krishna Adhikari's profile, book an appointment, or call +977-1-5914294. This article is general information, not a substitute for a consultation.
Sources
Rheumatology care at Tulsi Multi Speciality Clinic · Dr. Krishna Adhikari, consultant rheumatologist
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