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Gout Treatment in Singapore

A/Prof Leong Keng Hong - Senior Consultant Rheumatologist
A/Prof Leong Keng Hong Senior Consultant Rheumatologist MBBS (S'pore), MRCP (Int Med) (UK), MMed (Int Med) (S'pore), FAMS (Rheumatology) (S'pore), FRCP (Int Med) (UK), MD (S'pore)

Gout is often associated with middle age, but it can affect adults at different stages of life. In Singapore, cases have been reported in people as young as their 20s, while gout remains particularly common among men and becomes more likely with age.

Regardless of when gout develops, recurring attacks can affect daily life and may lead to complications if the underlying condition is not managed. Gout treatment aims to relieve acute attacks, manage uric acid levels and reduce the risk of future flares and long-term joint problems.

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What Is Gout?

Gout is a type of arthritis caused by high levels of uric acid, resulting in the accumulation of urate crystals in the joint. Characterised by sudden intense pain, swelling, tenderness, warmth, redness and stiffness of the joint, this condition can attack anyone. It typically develops at the joint at the base of the big toe, though the joints in the wrists, elbows, fingers, ankles and knees can be affected as well.

Gout is a very common illness recorded throughout history. It often points to the inability of the body to process uric acid. An abnormality in handling uric acid not only triggers gout attacks but also other medical conditions such as permanent joint damage and kidney complications.

It is most common in men, though women are found to be more likely to develop the disorder after menopause.

What Causes Gout?

Uric acid is a waste product that forms when the body breaks down substances called purines. Purines occur naturally in the body and are also found in certain foods and drinks.

Normally, the kidneys remove uric acid from the blood, and it leaves the body in urine. However, uric acid can build up in the blood if the body produces too much of it or, more commonly, if the kidneys do not remove enough.

Having a high level of uric acid in the blood is known as hyperuricaemia. Over time, the excess uric acid can form sharp crystals in and around the joints. These crystals can cause inflammation, pain and swelling, resulting in a gout attack. Not everyone with high uric acid levels develops gout. Some people have hyperuricaemia without ever experiencing gout symptoms.

What Are the Risk Factors for Gout?

Several medical, genetic and lifestyle factors may increase the likelihood of developing hyperuricaemia and gout. Having one or more risk factors does not necessarily mean you will develop the condition. Common risk factors include:

Age and Gender
Age and GenderGout is more common in men, while the risk in women increases after menopause. The likelihood of developing gout also generally increases with age.
Family History and Genetics
Family History and GeneticsHaving close family members with gout may increase your risk. Genetic differences can affect how the body produces and removes uric acid.
Excess Body Weight
Excess Body WeightBeing overweight or obese is associated with a higher risk of hyperuricaemia and gout. Weight management may form part of a broader gout management plan where appropriate.
Diet and Alcohol
Diet and AlcoholExcessive alcohol consumption and diets high in certain purine-rich foods may contribute to elevated uric acid levels and gout risk.
Medical Conditions
Medical ConditionsGout is associated with conditions including chronic kidney disease, hypertension, diabetes and metabolic disorders. Reduced kidney function can make it more difficult for the body to remove uric acid.
Certain Medications
Certain MedicationsSome medicines can raise uric acid levels. These include certain diuretics and other medications that affect uric acid handling by the kidneys. Do not stop prescribed medication without first discussing it with your doctor.

Certain occupational or environmental exposures, such as chronic lead exposure, have also been associated with an increased risk of hyperuricaemia and gout.

What Can Trigger a Gout Attack?

A gout flare occurs when urate crystals in a joint trigger a sudden inflammatory response. Some people find that attacks follow particular events or changes, although triggers vary between individuals. Possible triggers include:

  • Excessive alcohol intake
  • Dehydration
  • Large meals containing high levels of purines
  • Acute illness
  • Surgery or physical trauma
  • Sudden changes in uric acid levels
  • Changes to certain medications

Identifying possible triggers may help with gout management, but avoiding triggers alone may not adequately control gout when uric acid levels remain persistently elevated.

Ankle inflammation during a gout attack

What Are the Signs and Symptoms of Gout?

Gout attacks often develop rapidly, sometimes overnight. Symptoms can become severe within hours and usually affect one joint during the early stages of the condition. Common signs and symptoms include:

  • Sudden Joint Pain

    Gout can cause intense pain in the affected joint. The pain is often most severe during the first several hours of a flare.
  • Lingering Discomfort

    Severe pain may gradually improve, but discomfort can continue after the most intense stage of the attack has passed.
  • Swelling and Inflammation

    The affected joint may become swollen, red, warm and extremely tender. Even light pressure on the area may be uncomfortable.
  • Reduced Joint Movement

    Pain and swelling can make it difficult to move the affected joint normally. When gout affects the foot, ankle or knee, walking may become difficult.

    • A painful, red and swollen joint can also occur with other conditions, including a joint infection. Seek prompt medical assessment if joint symptoms are accompanied by fever or if infection is suspected.

    How Does Gout Progress Over Time?

    Gout can progress over time, particularly when uric acid levels remain elevated. Its course is commonly described in the following stages:

    Stage What Occurs
    Asymptomatic Hyperuricaemia Uric acid levels are elevated, but there are no gout symptoms. Not everyone with asymptomatic hyperuricaemia will develop gout.
    Acute Gout Flare Urate crystals trigger joint inflammation, causing sudden pain, swelling, redness and tenderness. Symptoms may persist for several days before gradually settling.
    Intercritical Gout This is the symptom-free period between attacks. Although the joint may feel normal, urate crystals can remain and another flare may occur.
    Chronic Gout Long-standing, poorly controlled gout can lead to urate deposits known as tophi, frequent attacks, persistent inflammation and progressive joint damage.

    Appropriate gout treatment and long-term control of uric acid can help reduce recurrent attacks and the risk of disease progression.

    What Happens If Gout Is Left Untreated?

    Repeated gout attacks can become more frequent or affect additional joints when the underlying condition is not adequately controlled. Over time, persistent urate crystal deposits may lead to:

  • Recurrent or increasingly frequent gout attacks
  • Permanent joint damage and reduced mobility
  • Tophi, which are deposits of urate crystals that can form around joints and other tissues
  • Chronic joint pain and inflammation
  • Kidney stones in some individuals

    • Early diagnosis and appropriate long-term gout management can help reduce the risk of these complications.

    How Is Gout Diagnosed?

    Gout can resemble other joint conditions, so diagnosis involves assessing your symptoms, medical history and the affected joint. Further tests may be recommended to confirm the diagnosis, assess uric acid levels and rule out other causes.

    Test What It Assesses
    Joint Aspiration A small sample of joint fluid is examined for monosodium urate crystals to help confirm gout and rule out other causes, including joint infection.
    Blood Tests Assess uric acid levels and kidney function. Repeat testing may be recommended after an acute flare, as uric acid levels can sometimes fall during an attack.
    X-ray Assesses joint damage and other possible causes of pain or swelling, particularly when gout has been present for longer.
    Ultrasound Identifies urate crystal deposits and other changes associated with gout in and around the joints.
    Dual-Energy CT Scan Detects and maps urate crystal deposits and may be considered when the diagnosis remains uncertain.

    What Are the Treatment Options Gout in Singapore?

    Gout treatment has two main aims:

    1. Controlling pain and inflammation during an acute attack

    2. Lowering uric acid over the longer term when appropriate to reduce future flares and complications.

    The most suitable treatment depends on factors including the severity and frequency of attacks, kidney function, other medical conditions and current medications.

    Treatment How It May Help
    Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Help reduce pain and inflammation during an acute gout attack. They may not be suitable for everyone, particularly those with certain kidney, stomach or cardiovascular conditions.
    Corticosteroids May be given orally or by injection to control inflammation when other treatments are unsuitable or ineffective. Their use depends on individual medical circumstances.
    Urate-Lowering Medication Helps maintain appropriate uric acid levels to prevent future attacks, reduce crystal deposits and lower the risk of joint complications. Treatment may include monitoring uric acid and adjusting medication as needed.

    Treatment is usually individualised and may involve monitoring serum uric acid and adjusting medication to reach and maintain an appropriate target.

    How Can Gout Be Managed Long Term?

    Long-term gout management combines appropriate uric acid control with regular monitoring and lifestyle measures to help prevent future attacks and complications. Depending on your condition, management may include:

  • Taking prescribed urate-lowering medication consistently
  • Attending regular medical follow-ups
  • Limiting excessive alcohol consumption
  • Working towards a healthy body weight where appropriate
  • Monitoring serum uric acid levels
  • Maintaining adequate hydration
  • Following a healthy, balanced diet
  • Managing associated conditions such as kidney disease, hypertension and diabetes

    • These measures can support long-term prevention of gout attacks, although lifestyle changes may not replace urate-lowering medication when it is clinically indicated.

    When Should You See a Gout Specialist

    Gout can often be managed effectively with appropriate treatment, but specialist assessment may be helpful when symptoms are severe, recurrent or difficult to control. A rheumatologist can confirm the diagnosis, identify contributing factors and recommend treatment to manage gout and help prevent future attacks. Consider seeking medical assessment if you:

  • Experience your first episode of sudden, severe joint pain and swelling
  • Experience severe or persistent gout pain
  • Develop lumps around the joints that may be tophi
  • Continue to experience attacks despite treatment
  • Have recurrent or increasingly frequent gout attacks
  • Have difficulty walking or using the affected joint
  • Have gout together with kidney disease or other medical conditions
  • Are unsure whether your symptoms are caused by gout

    • Prompt assessment is particularly important for a hot, red and swollen joint accompanied by fever, as a joint infection can cause similar symptoms and requires urgent treatment.

    Other Services We Provide

    There are more than 100 different types of rheumatic disorders. Our team works together to diagnose and treat the full spectrum of these disorders, including autoimmune diseases, such as lupus, rheumatoid arthritis and psoriatic arthritis, as well as other forms of arthritis, such as osteoarthritis and gout. Treatments for the various conditions may include lifestyle changes, medication and surgery. A/Prof Leong will tailor each treatment plan to effectively manage the condition in each patient.

    Click on each service to find out more

  • Arthritis
  • Rheumatoid Arthritis (RA)
  • Systemic Lupus Erythematosus (SLE)
  • Ankylosing Spondylitis (AS)
  • Psoriatic Arthritis
  • Sjogren's Syndrome
  • Joint Pain
  • Scleroderma, Systemic Sclerosis
  • Gout

    • FAQs About Gout in Singapore

    Does walking make gout worse?

    During an acute gout attack, walking or putting weight on the affected joint may worsen pain and discomfort. Resting the joint can help while symptoms are severe. Once the attack has settled, gradually returning to regular physical activity can support mobility, general health and weight management.

    Is there a cure for gout?

    Gout is a long-term condition, but it can often be managed effectively. Keeping uric acid at an appropriate level can help prevent gout attacks, reduce urate crystal deposits and lower the risk of complications such as long-term joint damage.

    Can gout go away on its own?

    The pain and swelling from a gout attack may settle even without treatment, but this does not mean the underlying gout has resolved. Urate crystals can remain in the joints, and further attacks may occur if uric acid levels remain elevated.

    Can gout affect your kidneys?

    Gout and kidney health can be closely related. High uric acid levels can contribute to certain kidney stones, while reduced kidney function can make it harder for the body to remove uric acid. Your doctor can consider kidney function when assessing and managing gout.

    Do you need to avoid all purine-rich foods if you have gout?

    Not necessarily. Dietary changes generally focus on limiting excessive intake of foods and drinks that may raise uric acid levels rather than eliminating all sources of purines. Your doctor can advise on dietary changes appropriate for your overall health and gout management.

    Can gout be mistaken for other joint conditions?

    Yes. Gout can cause sudden pain, redness and swelling that may resemble other conditions, including joint infections and other forms of inflammatory arthritis. Medical assessment and, where appropriate, further tests can help determine the cause and guide appropriate treatment.

    Meet Our Gout Specialist in Singapore

    A/Prof Leong Keng Hong - Senior Consultant Rheumatologist

    A/Prof Leong Keng Hong

    Senior Consultant Rheumatologist

    MBBS (Singapore) · MMed (Singapore) · MD · MRCP (UK) · FAMS (Singapore) · FRCP (Edinburgh)

    A/Prof Leong Keng Hong is a senior consultant rheumatologist with more than 25 years of experience in rheumatology, having been in private practice at Gleneagles Medical Centre since 1997. His clinical interests include gout and other rheumatic conditions affecting the joints and connective tissues. He is also an Adjunct Associate Professor at the Yong Loo Lin School of Medicine, National University of Singapore, and previously served as the inaugural Chairman of the Chapter of Rheumatologists at the Academy of Medicine, Singapore.

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