Gout patients are advised to steer clear of high-purine foods, as per the knowledge from Medicines and Pharmacy Chulalongkorn University. Gout is a prevalent form of chronic arthritis, affecting approximately 1-2 percent of the population, with males being 10 times more susceptible than females.

    The onset of gout-related arthritis is attributed to elevated levels of uric acid in the blood (above 7 mg/dL in males and above 6 mg/dL in females), which eventually crystallize into urate deposits in the joint fluid, leading to irritation and inflammation. Gout symptoms often appear suddenly and intermittently.

    Anti-inflammatory medications are used to treat gout during the arthritic phase, followed by medications that lower uric acid levels in the blood.

    Individuals with gout need to exercise caution when consuming foods high in purine. Purines are naturally occurring substances found in plants and animals, which convert into uric acid when ingested. However, different types of purines exist in animals and plants. Any food containing more than 150 milligrams of purine per 100 grams falls into the high-purine category.

    Offal, such as liver, lungs, heart, spleen, brain, and gizzards, is classified as high-purine food. Additionally, catfish, mackerel, canned sardines, as well as legumes and nuts, fall into this category. Interestingly, bone broth and stock are also high in purines.

    Gout is a chronic condition, and if left untreated, uric acid salt crystals can accumulate in the joints, leading to deformities and subsequent disabilities. It is crucial to control the intake of high-purine foods.

    Apart from the mentioned foods, alcoholic beverages like liquor, beer, and wine should also be avoided, as they are high in purines. It is often observed that gout patients experience relapses after consuming alcohol at social gatherings.

    To reduce the risk of gout exacerbation, apart from reducing and avoiding high-purine foods, it is important to limit the consumption of sweetened fruits and beverages containing fructose. Maintaining a healthy body weight within the normal range is essential, as being overweight is a risk factor for arthritis.

    Individuals who are overweight or obese should gradually work towards weight loss, as intense exercise can trigger gout attacks. Additionally, staying adequately hydrated by consuming at least 2 liters of water per day facilitates waste excretion. It is crucial to adhere to medication schedules and regularly visit the doctor.

    Allopurinol is a commonly prescribed medication to regulate blood uric acid levels in gout patients. However, it has been observed that some patients may experience severe allergic reactions. Those with allergies may develop severe skin rashes. It is recommended to assess the allergic risk by testing for the presence of the HLA-B*58:01 gene. Individuals carrying this gene have a significantly higher risk of severe drug allergies, approximately 300 times greater than those without the gene. The doctor will evaluate the need for testing and may discontinue treatment if necessary.

    In summary, individuals with gout, particularly during a gout attack or those in remission with high blood uric acid levels, should avoid consuming high-purine foods and diligently follow the prescribed medication regimen. It is essential to continue medication even after the arthritis symptoms subside. Although medication use carries the risk of severe allergic reactions, the screening of risk genes can aid in the safe selection of drugs.

Assoc. Prof. Dr. Nattada Areepiam and Asst. Prof. Dr. Bodin Tiwasuwan

Faculty of Pharmacy Chulalongkorn University