Gout (गाउट) and High Uric Acid: Meaning in Nepali, Symptoms, Diet and Treatment

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.

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.

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.

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.

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।

When to see a rheumatologist

See a doctor if a joint suddenly becomes red, hot, swollen and severely painful, 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. Adhikari's profile, book an appointment, or call +977-1-5914294. This article is general information, not a substitute for a consultation.

Sources

• NIAMS — Gout
• NIAMS — Gout: Diagnosis, Treatment, and Steps to Take
• NHS — Gout
• NHS — Gout: Symptoms
• American College of Rheumatology — Gout
• Arthritis Foundation — Gout Diet Dos and Don'ts
• Arthritis Foundation — Foods to Avoid With Gout
• InformedHealth.org (NCBI Bookshelf) — Gout: Learn More, Does diet help?
• PMC — Diet and plasma urate: purine-rich vegetables and urate levels