What are Gout and Hyperuricemia?
Hyperuricemia is a condition where blood uric acid levels are above 7.0 mg/dL, a common disease said to affect approximately 20-25% of Japanese men. If left untreated, it can lead to gout attacks, kidney damage, and urinary tract stones, and further increases the risk of cardiovascular disease and stroke.
Gout is a disease where uric acid crystals accumulate in the joints due to hyperuricemia persisting for many years, causing sudden and severe inflammation. It typically manifests as sudden, intense pain at the base of the big toe, and is called gout because the pain is so severe that it "hurts even if the wind blows."
Our clinic provides care from acute attacks to chronic management
We offer consistent support from acute treatment of attacks to subsequent uric acid level control and lifestyle guidance. We welcome transfers and continued prescriptions for patients currently receiving treatment at other clinics.
Typical Symptoms of a Gout Attack
| Feature | Content |
|---|---|
| Onset | Sudden, especially at night or in the early morning |
| Common sites | Base of the big toe (approx. 70%), followed by ankle, knee, and wrist |
| Nature of pain | Severe pain (hurts even with touch of clothes or sheets) |
| Inflammatory signs | Redness, swelling, warmth, induration |
| Duration | Without treatment: naturally resolves in 1-2 weeks / With treatment: a few days to 1 week |
| Premonitory signs | May include tingling or discomfort |
| Systemic symptoms | May be accompanied by mild fever and fatigue |
| Monoarticular | Almost always monoarticular initially, becomes polyarticular with recurrence |
Classification of Hyperuricemia
| Type | Characteristics | Key Lifestyle Guidance Points |
|---|---|---|
| Uric acid underexcretion type (most common, approx. 60%) | Reduced excretion from kidneys | Fluid and alcohol restriction |
| Uric acid overproduction type (approx. 10%) | Too much uric acid produced in the body | Purine restriction |
| Mixed type (approx. 30%) | Both mechanisms | Comprehensive lifestyle improvement |
Risk Factors for Gout and Hyperuricemia
- Men and postmenopausal women (male to female ratio approx. 20:1)
- Obesity and metabolic syndrome
- Alcohol (especially beer)
- Foods high in purines (liver, dried fish, cod roe, meat extracts)
- Fructose (sugary drinks, sweets)
- Co-occurrence of hypertension, diabetes, dyslipidemia
- Dehydration
- Strenuous exercise, fasting, rapid dieting (rapid uric acid increase)
- Diuretics, low-dose aspirin, and other medications
- Genetic predisposition
Treatment during a Gout Attack
The Three Main Medications for Attacks
| Medication | Characteristics and Usage |
|---|---|
| NSAIDs (Loxoprofen, Naproxen, etc.) | First choice, start as early as possible after onset, caution with kidneys and stomach |
| Colchicine | Effective if taken within premonitory signs to 12 hours of onset, use small doses |
| Steroids (oral, intra-articular injection) | When NSAIDs cannot be used, or in severe cases |
Do not start uric acid-lowering drugs during an attack
Rapidly lowering uric acid levels during an attack can destabilize uric acid crystals in the joints, potentially worsening or prolonging the attack. Uric acid-lowering drugs should generally be started only after the attack has completely subsided. If you are already taking them, continue as prescribed without stopping.
First Aid during an Attack
- Cool the affected area (ice pack wrapped in a towel)
- Elevate the affected area (above the heart)
- Keep the affected area still and rest
- Drink plenty of fluids
- Strictly no alcohol
- Massage or applying heat can worsen inflammation
- Do not compress with socks or shoes
Chronic Treatment (Uric Acid Level Control)
Criteria for Starting Drug Treatment
The following individuals are candidates for drug treatment:
- History of gout attacks
- Uric acid levels of 8.0 mg/dL or higher + complications (kidney damage, urinary tract stones, cardiovascular disease)
- Uric acid levels of 9.0 mg/dL or higher (even if asymptomatic)
- Presence of tophi
Types of Uric Acid-Lowering Drugs
| Classification | Representative Drug | Characteristics |
|---|---|---|
| Uric acid production inhibitors | Allopurinol (Zyloprim) | Classical, 1-3 times a day, inexpensive, risk of rash |
| Uric acid production inhibitors (new generation) | Febuxostat (Uloric) | Once a day, easy to use in cases of reduced kidney function, powerful |
| Uric acid production inhibitors (new generation) | Topiroxostat (Uradec) | Twice a day, similar effect to Febuxostat |
| Uric acid excretion promoters | Benzbromarone (Urinorm) | For underexcretion type, caution with urinary tract stones |
| Uric acid excretion promoters | Dotinurad | New drug, less liver damage |
Treatment Goal
Target uric acid level below 6.0 mg/dL
For those with a history of attacks or tophi, the goal is to achieve and maintain uric acid levels below 6.0 mg/dL. Achieving this goal may take several months, but consistent treatment significantly reduces the frequency of attacks.
Recurrence Prevention Period
- The period from starting to lower uric acid levels for several months is a high-risk period for recurrence
- During this period, it is recommended to use low-dose colchicine (0.5mg/day) concurrently
- After achieving the goal and stabilization, continued medication prevents attacks
- Do not stop medication on your own judgment
Diet and Lifestyle Improvement
Foods High in Purines (to be consumed sparingly)
- Organ meats (liver, cod roe, monkfish liver)
- Dried fish (dried sardines, bonito flakes)
- Fish eggs, crustacean extracts
- Rich soups, hot pot broth
- Excessive intake of meat and fish
Alcohol Measures
Alcohol itself raises uric acid
While beer is high in purines, alcohol itself increases uric acid production in the liver and hinders excretion from the kidneys. The same applies to shochu and whiskey if consumed in large quantities.
- Goal: Male 20g/day, female 10g/day or less (equivalent to 1 medium bottle of beer or 1 go of sake or 0.5 go of shochu)
- At least 2 alcohol-free days per week
- No alcohol during or immediately after an attack
Hydration
- Ensure urine output by drinking 2L or more of water daily
- Water and tea are basic (avoid sugary drinks)
- Be especially mindful during exercise or hot weather
Dietary Tips
- Actively consume vegetables, dairy products, and eggs (less likely to raise uric acid)
- Moderate meat and fish intake is acceptable, avoid excessive consumption
- Limit fructose (fruits, sugary drinks)
- Coffee (2-3 cups a day) has a uric acid-lowering effect
- Reports suggest vitamin C intake lowers uric acid levels
- Low-calorie, balanced diet
Exercise
- Aerobic exercise (walking, light jogging, swimming) is recommended
- Be cautious with intense anaerobic exercise as it can cause a rapid increase in uric acid
- Weight loss can lower uric acid levels
Complications and Related Diseases
Hyperuricemia is not just a joint problem but a systemic disease, and its strong connection to other diseases requires attention.
| Complication | Content |
|---|---|
| Gouty kidney | Uric acid crystals accumulate in the kidneys, leading to kidney function decline |
| Urinary tract stones | Uric acid crystallizes in urine, causing renal colic attacks |
| Tophi | Chronic accumulation leads to uric acid nodules on ears, elbows, fingers, etc. |
| Hypertension | Strong correlation with hyperuricemia |
| Arteriosclerosis and cardiovascular disease | Increased risk of myocardial infarction and stroke |
| Metabolic syndrome | Co-occurs with diabetes and dyslipidemia |
| Chronic kidney disease (CKD) | Accelerates progression |
Examination and Testing at Our Clinic
Response during an attack
- Confirmation of onset conditions and medical history
- Visual inspection and palpation to check for joint inflammation
- Differential diagnosis if necessary (to rule out septic arthritis, pseudogout)
- Administration of NSAIDs, colchicine, or steroids
- Guidance on cooling and rest
Chronic Phase Examinations
| Test | Purpose |
|---|---|
| Blood test (uric acid level) | Measurement of serum uric acid level, determination of treatment target |
| Kidney function (Cr・eGFR) | Gouty kidney, drug selection |
| Liver function | Reference for drug selection |
| Lipids・Blood sugar | Evaluation of complications |
| Urinalysis | Confirmation of uric acid, protein, crystals |
| Urinary uric acid excretion amount | Reference for disease type classification |
| Abdominal ultrasound | Confirmation of urinary tract stones (if necessary) |
Consult us if you have these symptoms
- You were told your uric acid level was high during a check-up
- Sudden, severe pain at the base of your big toe
- You have experienced a gout attack in the past
- You have obesity, hypertension, diabetes, or dyslipidemia concurrently
- You have a habit of drinking beer or sake daily
- History of urinary tract stones or hematuria
- Reduced kidney function
- Family members with gout or kidney stones
Features of Gout and Hyperuricemia Treatment at Our Clinic
- Immediate response to acute attacks with prescriptions for NSAIDs, colchicine, and steroids
- Same-day blood tests (uric acid levels, kidney function, etc.) available
- Handles new generation uric acid-lowering drugs such as Febuxostat and Dotinurad
- One-stop management of co-existing diseases such as hypertension, diabetes, and dyslipidemia
- Lifestyle guidance on diet, alcohol, and exercise
- Evaluation of urinary tract stones and gouty kidney, referral to urologists or nephrologists if necessary
- No appointment needed, same-day consultation OK / Open daily from 9 AM to 9 PM / 1 minute walk from Jujo Station
Continue treatment even after an attack subsides
Many people stop seeing a doctor when the pain subsides, thinking they are "cured," but if uric acid levels remain high, recurrence is certain. Long-term management is the true path to being free from gout.
