Gout is a disorder of purine metabolism characterized by elevated uric acid levels in the blood and the deposition of urate crystals in joints, kidneys, and soft tissues. If not detected and treated properly, the disease can lead to serious complications.

To better understand this condition, a reporter spoke with Dr. Nguyen Thi Nga, PhD, from the Center for Rheumatology, Bach Mai Hospital.

Reporter: Doctor, what exactly is gout?

Dr. Nguyen Thi Nga: Gout is a disorder of purine metabolism characterized by elevated uric acid levels and the deposition of monosodium urate crystals in the joints or surrounding tissues, which leads to episodes of severe acute inflammatory arthritis.

The joint most commonly affected is the big toe joint, though it may also involve the ankle or knee joints. If the disease progresses to the chronic stage, patients may develop tophi (chalky deposits around joints), kidney damage, urinary stones, and even kidney failure if not treated appropriately.

Reporter: What are the typical symptoms of gout?

Dr. Nguyen Thi Nga: The hallmark symptom is sudden, severe joint pain, often occurring at night. The affected joint becomes swollen, red, and warm. Many patients describe the pain as a burning sensation, severe enough to cause sleepless nights.

Common signs of an acute gout attack include:

Sudden joint pain, often at night
Swelling, redness, and warmth of the joint (90% occur in the lower limbs)
About 50% occur at the first metatarsophalangeal joint (big toe)
Sometimes accompanied by mild fever
Pain may last several days and then subside but often recurs
Without proper treatment, gout may progress to chronic gout, causing multiple joint inflammation and kidney damage.

Reporter: Who are the people most at risk for gout?

Dr. Nguyen Thi Nga: The highest-risk group is men aged 40–60, especially those who frequently consume alcohol.

Other risk factors include:

Obesity
Hypertension
Diabetes
Dyslipidemia
Family history of gout
Chronic kidney disease
Use of certain medications such as diuretics or low-dose aspirin
 
Reporter: How does gout usually progress?

Dr. Nguyen Thi Nga: Gout typically develops through four stages:

Asymptomatic hyperuricemia
Acute gout attack
Intercritical gout (the symptom-free period between attacks)
Chronic gout with complications
Many people underestimate the condition when there are no symptoms and therefore do not seek medical care. However, persistently elevated uric acid levels act like a “ticking time bomb”, potentially leading to complications at any time.

Reporter: Is gout treatment simply about relieving pain during acute attacks?

Dr. Nguyen Thi Nga: This is a common misconception. Many patients take medication only when the pain occurs and stop once the symptoms subside, which leads to frequent relapses and disease progression.

Gout treatment has two main goals:

Treatment of acute attacks:

Early treatment is essential. Common medications include colchicine, non-steroidal anti-inflammatory drugs (NSAIDs), or corticosteroids in certain cases.

Long-term management between attacks:

The goal is to maintain serum uric acid levels at:

Below 6 mg/dL (360 µmol/L)
Below 5 mg/dL (300 µmol/L) in patients with tophi
Common urate-lowering medications include allopurinol, febuxostat, and probenecid. Treatment should be maintained long-term, not just for a few weeks.

Lifestyle changes – a key factor in disease control

According to international recommendations, people with gout should adopt healthy lifestyle habits.

Recommended:

Drink more than 2 liters of water per day
Maintain a healthy body weight
Exercise regularly
Eat more vegetables and low-fat dairy products
Increase plant-based protein intake

Limit:

Red meat and organ meats
Seafood
Alcohol and beer
Sugary drinks containing fructose
Excessive protein intake
Gout is also closely associated with other conditions such as hypertension, diabetes, cardiovascular disease, and kidney disease. Therefore, controlling gout is also part of maintaining overall health.

Dr. Nga examining a patient with gout

Reporter: If someone has elevated uric acid but no symptoms, should they still receive treatment?

Dr. Nguyen Thi Nga: Not everyone with elevated uric acid requires medication.

Treatment is usually considered when:

Uric acid levels are above 700 µmol/L
There is a history of kidney stones or kidney damage
Or the patient has a high risk based on specialist evaluation
In many cases, lifestyle modification is the first recommended approach.

Reporter: What advice would you give to the public, especially those with gout?

Dr. Nguyen Thi Nga: Gout can be well controlled if patients understand the disease, adhere to treatment, and adopt healthy lifestyle changes.

Patients should:

Follow long-term treatment plans
Avoid prolonged self-medication with painkillers
Do not stop medication once symptoms improve
If sudden joint swelling and pain occur-especially in the big toe-people should visit a rheumatology specialist for timely diagnosis and treatment.

Reporter: Thank you very much, Doctor.