"I can’t even put my foot on the ground."
Gout patients say it often, and the pain can be so intense that the old line about it hurting even when a breeze brushes by does not feel like an exaggeration. Because the Korean name includes the character for “wind,” some people confuse it with stroke, but gout is a different disease caused by abnormal uric acid metabolism.
Gout was once called the “emperor’s disease” or a “rich man’s disease,” because it was common among royals and aristocrats who could afford plentiful meat and alcohol. Fatty foods and frequent drinking were once symbols of privilege, and gout was seen as a byproduct of that lifestyle.
That has changed. With Westernized diets, drinking culture and increased fructose intake, gout is no longer limited to any one group and can affect anyone.
The number of patients has risen. According to the Health Insurance Review and Assessment Service, the number of gout patients in South Korea increased by more than 18% to about 500,000 in 2022 from about 430,000 in 2018. The fastest growth rate was among people in their 20s and 30s, with analyses linking the increase to heavy drinking and high-fat, high-protein diets among younger adults.
Gout begins with uric acid. After food is metabolized, uric acid is produced and is usually excreted in urine through the kidneys. When the kidneys cannot filter enough of it, the concentration of uric acid in the blood rises.
When blood uric acid exceeds a certain level, it can no longer stay dissolved and turns into sharp, needle-like crystals. These crystals can deposit in areas with slower circulation, such as the big toe, ankle and knee. The immune system treats them as foreign material, triggering inflammation and severe pain.
Uric acid does not stay in the foot. It can spread to multiple joints, including the knee, wrist and fingers, and can also affect the kidneys and blood vessels, raising the risk of kidney disease.
Lee Ju-ha, a professor of rheumatology at Seoul St. Mary’s Hospital at the Catholic University of Korea, said gout mainly occurs in the big toe or ankle but can later appear in the upper body as well. If high levels of uric acid crystals persist, she said, visible lumps of uric acid crystal deposits can sometimes be seen.
Another problem is the belief that gout is a brief, one-off illness. When medication eases the pain, many people assume treatment is over. But gout is a chronic disease that requires ongoing management. It often recurs and is closely linked to other metabolic conditions such as hypertension and diabetes.
Misconceptions are common. One is the idea that avoiding beer is enough, or that switching from beer to soju is safe. While beer yeast contains many purines, alcohol increases uric acid regardless of type. What matters is not the kind of alcohol but how much is consumed.
Cutting back on alcohol is not the only concern. Liquid fructose in sodas and juices can promote uric acid production as the liver metabolizes it. One study found that people who drink two or more sugary beverages a day had about an 85% higher risk of gout than those who do not.
There is also confusion about pain relief. If you are unsure whether to use cold or heat, remember: cold compresses during an acute flare. When a joint is swollen and warm, cold is the rule because it constricts blood vessels and can help reduce inflammation. Ice should be wrapped in a towel and used for no more than 15 to 20 minutes. Heat during this period can worsen inflammation. After swelling subsides in the chronic phase, warm compresses may help circulation.
If gout is not caused by other medications or diseases, Lee said, patients need sustained management, including maintaining a healthy weight and limiting foods that increase uric acid production. Exercise and dietary control to keep an appropriate weight can help, she said.
Diet choices can also matter. Foods low in purines may help, but not all vegetables are low in purines. Spinach, asparagus and mushrooms are relatively high among vegetables. Oats, often considered a health food, are not an exception. For uric acid management, white rice may be less burdensome than brown rice or oats. Foods known to be high in purines include organ meats, oily fish and shellfish.
* This article has been translated by AI.
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