[Kok! Health] Painful 'Gout' Even When Touched by Wind... Beware of 'Goyosanhyeoljeung' First

[Asia Economy Reporter Lee Chun-hee] "Gout" is named because even a breeze touching the skin can cause pain. It is a disease whose number of patients in Korea has steadily increased due to frequent drinking and Westernized eating habits.

According to the Health Insurance Review and Assessment Service on the 28th, the number of gout patients increased by 24.6% over five years, from 395,154 in 2017 to 492,373 last year. Previously, it was mainly known as a disease common in men over their 40s, but recently, due to changes in lifestyle habits, the incidence rate among the 20s and 30s age group is rapidly increasing, requiring careful attention regardless of age.

Gout is a disease in which uric acid that is not excreted accumulates excessively in the blood, forming urate crystals that deposit in tissues and cause pain. Uric acid is a metabolic waste product of purine, a substance contained in food. Normally, it is excreted through feces and urine, but when it is not excreted, it accumulates in joint cartilage, tendons, kidneys, blood vessels, and other areas. This causes hyperuricemia, an abnormally high level of uric acid in the blood, and pain occurs as the body mistakes it for bacteria or viruses and attacks it.

Factors that interfere with uric acid excretion include kidney disease, aspirin, and diuretic use. However, the main causes of the recent increase in gout patients are excessive alcohol consumption and intake of foods high in fat or protein. Alcohol and foods high in fat and protein contain large amounts of purine, high-fat foods reduce uric acid excretion, and alcoholic beverages simultaneously increase uric acid production and decrease excretion. In particular, beer contains the highest amount of purine among alcoholic drinks and should be consumed with caution. Other risk factors for gout include consumption of carbonated drinks and fruit juices high in fructose, lack of exercise, excessive stress causing kidney function decline, underlying diseases, and genetic factors.

The symptoms of gout progress through four stages: asymptomatic hyperuricemia → acute gouty arthritis → intermittent gout → chronic tophaceous gout. The initial symptom, asymptomatic hyperuricemia, is characterized by elevated uric acid levels without symptoms, making it difficult to notice. Major symptoms of gout include sudden inflammation, heat, swelling, and severe pain in the big toe, top of the foot, ankle, or knee. If a joint such as the big toe is red or hot without injury, if pressing a reddened joint causes unbearable pain or difficulty walking, or if nodules are present on joints, ears, elbows, fingers, or tendons, early symptoms of gout may be suspected.

If gout symptoms appear and appropriate treatment is not received, gouty tophi may form around the joints. Continuous accumulation of gouty tophi can cause chronic joint pain, damage to joint tissues, and deformities. Additionally, as time passes, the frequency of pain episodes increases, and joint damage and kidney stones may lead to chronic kidney disease, so it is important to promptly visit a hospital for diagnosis and treatment.

Treatment methods vary slightly depending on the stage of progression. During the acute phase with severe joint pain, anti-inflammatory drugs are used, and during the stable phase, allopurinol is used to suppress uric acid levels, helping to control hyperuricemia and acute pain by normalizing blood uric acid concentration.

Allopurinol is recommended as the first-line treatment for gout. However, some patients may experience severe cutaneous adverse reactions (SCAR) after use, so caution is necessary. Generally, adverse drug reactions are influenced by genetic factors, and the occurrence of SCAR caused by allopurinol is known to be associated with the HLA-B*5801 genotype. Notably, about 12% of Koreans carry the HLA-B*5801 genotype, which is higher than Westerners (1-6%).

Therefore, for gout patients who are to be administered allopurinol, an HLA-B*5801 genetic test, which can predict the risk related to allopurinol, is recommended. The test is performed by collecting a small amount of blood. Results are usually available within two weeks. There are two testing methods: polymerase chain reaction (PCR) and sequencing analysis. Among these, since August last year, PCR testing has been covered by insurance for all patients requiring allopurinol before the first administration, reducing the burden on patients.

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