[Kim Jaeho's Life Story]<174> Managing Gout

The number of patients suffering from gout, a condition so painful that even a breeze can cause pain, is rapidly increasing. It is said that the name "gout" comes from the fact that patients experience intense pain even from the wind caused by someone passing by, and feel heat throughout their body. In 2018, there were 430,000 gout patients in South Korea, accounting for 9.2% of all joint disease patients, making it the second most common after osteoarthritis. This represents a 40% increase compared to 2014. Male patients outnumber female patients by about twelve times.

When gout occurs, one joint?usually the big toe, ankle, or knee?suddenly becomes red and swollen, with the big toe joint being particularly susceptible. The pain is so severe that even touching the area is unbearable, wearing socks is impossible, walking properly is difficult, and sleep is often disturbed at night. Fever and chills may also accompany the symptoms. Initially, the symptoms usually subside on their own after a few days and appear normal, but recurrence is common over time.

The mechanism behind gout is relatively well understood, and by understanding it and responding appropriately, existing gout can be treated, and recurrence can be prevented or avoided altogether. To understand gout, it is necessary to know how two substances in our body?purine and uric acid?are produced and excreted.

Purine is a fundamental component of DNA and RNA, which make up the cells of all plants and animals. It performs important functions within cells and contributes to energy metabolism and signal transmission as part of enzymes. In short, purine plays a crucial role in the growth, division, and survival of all cells. It does not exist naturally in the environment but is synthesized by living organisms when needed and broken down when no longer necessary, with the waste products expelled from the body.

When purine is broken down, nitrogen contained in purine produces uric acid as a waste product. Uric acid, which dissolves well in water, is mostly filtered by the kidneys from the blood and excreted in urine. Just as carbon dioxide and water produced from the breakdown of carbohydrates and fats are expelled from the body, uric acid causes no problems when excreted normally.

However, if too much uric acid is produced in the body or the kidneys’ ability to filter uric acid weakens, leading to excessive uric acid in the blood (called hyperuricemia), the blood, which should maintain a slightly alkaline state, becomes acidic. Liquid uric acid then transforms into sharp, needle-like urate crystals in the joints or surrounding tissues, causing pain, inflammation, and swelling. When these crystals accumulate in the joints, gout develops; when they accumulate in the kidneys, kidney stones form.

Gout can be treated with medications that lower uric acid levels in the blood, but without lifestyle improvements, it easily recurs. Therefore, understanding the causes of gout and improving lifestyle habits that lead to uric acid accumulation in the body is advisable. First, reduce the intake of foods high in purine; second, create an environment that allows the kidneys to function well and maintain kidney health to help excrete uric acid efficiently.

People with gout or frequent recurrences should limit foods high in purine. This includes various meats such as beef, pork, and lamb, which are rich in fat and protein, as well as seafood including fish. Excessive consumption of sugar, syrup, and sugary beverages should also be avoided. Attention should be paid to medications and supplements such as aspirin, vitamin B₃, diuretics, immunosuppressants, and chemotherapy drugs.

It is also important to consume more foods that help lower uric acid levels. Reducing refined and processed foods and increasing intake of whole fruits, whole grains, and foods rich in dietary fiber is recommended. Although not food, improving conditions such as obesity, hypertension, metabolic disorders, and diabetes?which raise insulin levels in the blood and increase uric acid?is also beneficial.

Improving the environment for kidney function to help excrete uric acid effectively (see Life Story episode 135) is also important. Alcohol increases dehydration and hinders uric acid excretion, so it should be especially avoided. Drinking plenty of water to promote uric acid excretion is recommended. Proper exercise, sufficient sleep, quitting smoking, and managing stress well also help reduce inflammation and promote uric acid excretion.

Jaeho Kim, Independent Researcher

This content was produced with the assistance of AI translation services.