Be wary of gout during the Lunar New Year season.

Many people will be surprised, wondering what gout has to do with Tet (Lunar New Year), or if Tet itself causes gout. In reality, while these days don't typically trigger gout, it's a particularly difficult time for gout patients, both those already diagnosed and those yet to be diagnosed.

In the days leading up to Tet (Lunar New Year), people are busy preparing for the holiday while also attending year-end parties and welcoming the new year. Among those who participate in these lavish parties with beer, wine, and all kinds of snacks, some may suddenly experience severe pain and swelling in their big toes, ankles, or knees that evening or the following day. Upon examination, the doctor will explain that it is gout.

What is gout?

Gout (goutte in French) belongs to the group of diseases involving the deposition of crystals, specifically monosodium urate crystals in the joints due to high levels of uric acid in the blood. This causes peripheral arthritis attacks in the limbs, especially the big toe. This inflammation is caused by white blood cells – likened to the body's soldiers – clearing away the urate crystals. An acute gout attack can last for several days or weeks and may resolve spontaneously, but if left untreated, it will recur more frequently, causing joint deformity and disability. High uric acid levels in the blood are due to the kidneys' inability to excrete it, or the body producing too much (due to diet, medical conditions such as lymphoma, hemolytic anemia, psoriasis, etc.), or abnormalities in the uric acid production cycle.

Methods for diagnosing gout

The clinical presentation of an acute gout attack is quite characteristic, so it can often be diagnosed simply through taking a medical history and examining the patient. Typically, it presents as inflammation of the metatarsophalangeal joint of the big toe accompanied by high blood uric acid levels. While clinical diagnosis is reasonably accurate, it is not conclusive unless uric acid crystals are present. Elevated blood uric acid levels, while valuable for diagnosis, are not specific.

Blood uric acid levels are often high, >7 mg/dL. While not everyone with high uric acid in their blood develops gout, the longer and more persistently high uric acid levels persist, the greater the likelihood of developing gout. Some patients may have normal uric acid test results (possibly due to prior medication) but still experience knee swelling, and knee arthroscopy reveals uric acid crystals deposited inside the joint, causing inflammation of the knee capsule.

The best way to confirm a gout diagnosis is to aspirate fluid from the affected joint and examine it under a microscope to see needle-shaped monosodium urate crystals or tophi. However, in practice, this method is only performed when absolutely necessary.

Additionally: Gram staining and joint fluid culture are recommended because gout is often associated with infection. X-rays of the joint may show subchondral bone fibrosis or, in later stages, tophi. Blood glucose and lipid tests are also necessary, as gout is often associated with hyperglycemia and hyperlipidemia.

Disease progression

The disease usually begins with an acute gout attack. An acute gout attack is defined as arthritis with the deposition of urate crystals in the joints, leading to acute inflammation and ultimately tissue damage that destroys the joint and causes disability. Acute gout attacks can be managed with medication and dietary changes. However, this is an incurable disease; patients must follow a diet and monitor the condition for life. If left untreated or if gout attacks occur repeatedly, it will cause joint destruction leading to disability and requiring joint reconstruction surgery.

Patients who experience recurrent or persistent acute gout attacks for many years will develop chronic gout accompanied by tophi. Tophi are often considered a late complication of gout. These are nodules found under the skin at the joints, synovial sacs, cartilage, and bones in many parts of the body, formed by the deposition of urate crystals. Tophi may rupture through the skin, releasing white or pale yellow to white blood.

Complications

Approximately 20% of gout patients develop kidney stones due to the deposition of urate crystals (which are a component of gout) as well as calcium crystals. These stones can obstruct the urinary tract, leading to urinary tract infections and potentially causing kidney failure, urinary tract infections, and other life-threatening conditions.

For gout patients, on Tet (Vietnamese New Year), they can raise a glass for fun, but should not consume too much beer or alcohol.

For gout patients, on Tet (Vietnamese New Year), they can raise a glass for fun, but should not consume too much beer or alcohol.

Reduced glomerular filtration rate. The severity of gout is also related to the incidence of ischemic heart disease. Disability due to severe joint damage.

Preventive treatment

To combat acute gout attacks and prevent their recurrence, medications such as colchicine (which has analgesic and anti-inflammatory effects and is used to treat and prevent acute gout attacks), allergens (which inhibit uric acid formation), non-steroidal anti-inflammatory drugs (NSAIDs), and other pain relievers can be used.

Dietary restrictions include avoiding foods high in purines, such as meat, organ meats, some seafood, oatmeal, and soy; a small amount of alcohol is acceptable (at least 3 days of complete abstinence each week), but avoid strong dark beer; drink plenty of water and alkalinize urine with sodium bicarbonate; quit smoking; exercise; and lose weight.

Monitor uric acid levels regularly. However, avoid excessive dietary restrictions as medication can be used to speed up uric acid excretion.

Arthroscopic surgery plays a role in cleaning the joint and removing excess synovial membrane when repeated inflammation causes thickening and restricts joint movement. When the joint is completely damaged, it can be replaced with an artificial joint.

According to Family.net