[Dr Yau’s Health Insights] Understanding the causes and symptoms of gout: The latest biologic treatments and prevention strategies!
Health2026-10-16
8 Mins Read
When people think of gout, they often picture lavish meals, seafood and beer, or the so-called "disease of affluence" associated with wealthy lifestyles. In reality, however, gout affects a far broader group of people than many realise. Young professionals, vegetarians of healthy weight, and even people who never drink alcohol can all develop gout.
The causes of gout are complex. To prevent and manage the condition effectively, it is important to understand why uric acid levels become elevated, recognise the warning signs your body may be sending, and learn about the latest treatment options available. Beyond conventional therapies, what new hope do biologic treatments offer? Let's take a closer look.
Q1: What is the main cause of gout?
A: Gout is primarily caused by elevated uric acid levels in the blood. It may result from excessive uric acid production, reduced uric acid excretion, lifestyle factors, or a combination of these causes.
Q2: Is gout always caused by eating too much seafood or organ meat?
A: Not necessarily. While diet is one of the risk factors for gout, it is not the only cause. Most uric acid in the body is produced through the body's own metabolic processes rather than directly from food. Even with careful dietary control, some people may still develop hyperuricaemia due to genetic factors, kidney function, medications or metabolic abnormalities.
Q3: Which joint is most commonly affected by gout?
A: The joint most commonly affected is the big toe joint (the first metatarsophalangeal joint). However, gout can also affect the ankles, knees and other joints.
Q4: Can gout be cured?
A: With effective long-term management and good control of blood uric acid levels, most patients can significantly reduce the frequency of gout attacks and, in some cases, prevent recurrences altogether.
What is gout?
Medically, gout is an inflammatory condition caused by the deposition of monosodium urate crystals. Simply put, when uric acid levels in the blood become too high, urate crystals can form in the joints and surrounding soft tissues. These crystals are recognised by the immune system as "foreign invaders", triggering an inflammatory response that leads to intense joint inflammation and pain. This is the underlying mechanism behind a gout attack.
Where does uric acid come from? Many people assume that uric acid is entirely the result of what we eat, but that is not the case. Only part of the body's uric acid comes from the breakdown of dietary purines (exogenous sources), while most is produced through the body's own purine metabolism (endogenous sources). In other words, even with strict dietary control, uric acid levels may still become elevated if the body's metabolic processes are disrupted. As a result, some patients may require medication to help manage their uric acid levels.
What causes gout?
Why do uric acid levels become elevated? In most cases, the causes fall into three broad categories:
1. Excessive uric acid production
- Excessive consumption of high-purine foods: Such as organ meats, shellfish and rich meat broths.
- Metabolic abnormalities: Genetic factors or certain medical conditions, such as myeloproliferative disorders, can disrupt purine metabolism and increase uric acid production.
2. Reduced uric acid excretion (the most common cause)
- Impaired kidney function: The kidneys are less able to remove uric acid efficiently from the body.
- Medication-related effects: Certain medications, including diuretics and aspirin, may reduce uric acid excretion.
- Inadequate fluid intake: More concentrated urine results in reduced uric acid elimination.
3. Triggering factors
- Alcohol consumption: Beer, spirits such as baijiu and rice wine can reduce uric acid excretion while also increasing uric acid production.
- High-fructose drinks and sugary foods: Fructose can directly raise uric acid levels during metabolism.
- Metabolic syndrome: People with obesity, hypertension or diabetes have a significantly increased risk of developing gout.
- Other triggers: Exposure to cold, joint injuries, surgery and excessive fatigue may all precipitate an acute gout attack.
Gout is rarely caused by a single factor alone. More often, it results from the combined effects of multiple risk factors. This also helps explain why some people continue to experience recurrent gout attacks even after carefully restricting their diet. The underlying issue may lie in the body's metabolic processes rather than food choices alone.
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Warning signs and common symptoms of gout
One of the most challenging aspects of gout is that it often strikes suddenly, particularly during the night. Many patients describe being awakened by intense pain in the middle of the night, with the affected joint feeling as though it is being cut by a knife or burned by fire. Even the light touch of a bedsheet can become unbearable.
However, gout does not always develop without warning. If you notice any of the following early signs, it is important to pay attention:
- Warmth, redness or swelling around a joint, often appearing before significant pain develops
- Unexplained fatigue or a general feeling of being unwell
- Intermittent stabbing or tingling pain in a joint
- Mild discomfort or an unusual sensation in the big toe joint (first metatarsophalangeal joint), particularly when walking
Once an acute gout attack develops, symptoms can become severe:
- Sudden onset, often occurring at night and waking the patient from sleep
- Pain typically peaks within about 12 hours
- Severe pain that may feel like tearing, cutting or burning
- Redness, swelling and warmth of the affected joint, with marked tenderness to touch
- Symptoms may last from several days to up to two weeks before improving on their own
Important: If early warning signs appear, seek medical attention promptly rather than waiting until severe pain develops. Earlier intervention generally leads to better control of a gout flare.
What should you do during an acute gout attack?
When an acute gout attack occurs, the primary goal is simple: to control inflammation and relieve pain as quickly as possible.
First-line treatment options
1. Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are usually the first-line treatment for an acute attack. Common examples include indometacin, ibuprofen and etoricoxib. These medications can rapidly reduce inflammation and pain, although gastrointestinal side effects should be considered.
2. Colchicine
Colchicine is a long-established treatment for gout-related inflammation. Current treatment guidelines recommend a low-dose regimen, which provides similar effectiveness while significantly reducing side effects such as diarrhoea. Patients should not increase the dosage without medical advice.
3. Corticosteroids
When NSAIDs or colchicine are unsuitable or ineffective, doctors may consider a short course of corticosteroids to control inflammation.
Three key principles for managing an acute attack
- Do not initiate a new urate-lowering therapy during an acute flare: Sudden changes in uric acid levels may worsen inflammation. Urate-lowering treatment is usually started after the acute attack has settled.
- Act within the first 24 hours: Treatment is most effective when started within 24 hours of symptom onset.
- Combine medication with supportive measures: Rest the affected joint, elevate the affected limb and apply ice packs to help reduce pain and swelling.
Remember, the priority during an acute gout attack is to control inflammation and relieve pain. Lowering uric acid levels becomes the focus after the acute inflammation has resolved.
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Long-term management of gout
After an acute gout attack has passed, the real challenge begins: preventing the next flare-up.
Treatment targets
- Most patients: Maintain a blood uric acid level of < 360 μmol/L
- Patients with tophi or frequent gout attacks: Maintain a blood uric acid level of < 300 μmol/L
This "360 rule" is central to preventing gout recurrence. Only when blood uric acid levels are maintained below 360 μmol/L over the long term can urate crystals gradually dissolve and the frequency of attacks genuinely decrease.
Common urate-lowering medications
- Reduce uric acid production: Allopurinol, febuxostat
- Increase uric acid excretion: Benzbromarone
Three principles of urate-lowering therapy
- Start with a low dose and increase gradually until the target uric acid level is reached, helping to avoid sudden fluctuations in uric acid levels.
- Begin urate-lowering therapy only after the acute inflammation has settled, usually one to two weeks after the flare.
- Continue treatment long term and do not stop medication without medical advice. Gout is a chronic condition, and uric acid levels can rebound quickly after treatment is discontinued.
New biologic treatment options
For patients who respond poorly to conventional treatments or experience recurrent gout attacks, biologic therapies have emerged in recent years as a new treatment option.
What are biologic therapies?
Biologic therapies are monoclonal antibody medications that target specific inflammatory pathways. Unlike traditional anti-inflammatory drugs, which broadly suppress inflammation throughout the body, biologic therapies are designed to specifically target interleukin-1 (IL-1), a key driver of gout-related inflammation.
Think of it this way: if conventional anti-inflammatory drugs are like spraying water everywhere with a fire engine, biologic therapies are more like identifying the source of the fire and extinguishing it precisely.
Firsekibart
According to the Guidelines for Anti-inflammatory Treatment of Gout (2025 Edition), IL-1 inhibitors can significantly reduce the risk of gout recurrence compared with conventional corticosteroids. In June 2025, Firsekibart (brand name: Jinbeixin®) was officially approved in Chinese mainland for the treatment of acute gout flares. As one of the drugs within the IL-1 inhibitor class, it can rapidly relieve pain and swelling during acute gout attacks, providing patients with another targeted anti-inflammatory treatment option.
In terms of availability, the treatment has not yet been registered or officially launched in Hong Kong. Patients who may be suitable candidates can discuss treatment options available in Chinese mainland with their doctor, based on their medical condition and individual needs. The current cost is approximately RMB 7,500 per injection.
Other emerging therapies
- URAT1 inhibitors (such as dotinurad): A newer class of medications that promotes uric acid excretion.
- Next-generation xanthine oxidase inhibitors: Currently under clinical investigation.
The emergence of biologic therapies provides a new option for patients whose gout remains poorly controlled despite conventional treatment or who continue to experience recurrent attacks. However, due to their relatively high cost, these treatments are currently most suitable for patients with more severe disease or those who have not responded adequately to standard therapies.
Your Health Tomorrow. Mastered Today.
AXA's comprehensive healthcare protection spans from prevention and diagnosis to treatment and recovery, with our extensive medical network providing complete coverage across all locations. Whether protecting yourself or safeguarding your loved ones, AXA has prepared the answers for every step of your life journey.
Diet and lifestyle recommendations for gout
While medication plays a key role in controlling gout, dietary and lifestyle management should not be overlooked. The following practical guide may help reduce the risk of future gout attacks.
Foods to avoid (purine content >150 mg/100 g)
- Organ meats (such as liver, intestines, heart and kidneys)
- Certain types of seafood (including sardines, anchovies and shellfish)
- Rich meat gravies and meat broths (long-simmered soups are particularly high in purines)
- Beer and spirits
Limit during remission and avoid during acute attacks (purine content 25-150 mg/100 g)
- Red meat (beef, lamb and pork)
- Most types of fish
- Legumes and soy products
Generally lower-purine foods (purine content <25 mg/100 g)
- Most vegetables
- Fruits
- Eggs, milk and dairy products
- Grains and cereals
Other lifestyle recommendations
- Avoid alcohol, particularly beer, which both contains purines and reduces uric acid excretion.
- Limit sugary drinks and foods high in fructose, as fructose can contribute to elevated uric acid levels.
- Stay well hydrated by drinking sufficient water throughout the day. A minimum of eight glasses daily is often recommended to support uric acid excretion.
- Maintain a healthy body weight, as obesity is a major risk factor for gout.
- Engage in regular physical activity to support metabolic health and weight management.
- Take medications as prescribed by your doctor. Even if symptoms improve, treatment should not be stopped without medical advice.
Controlling diet alone is unlikely to eliminate gout completely. While dietary habits can influence uric acid levels, a significant part of uric acid production is determined by the body's own metabolic processes. Dietary modification should therefore be viewed as a supportive measure rather than a replacement for medical treatment. Early control of uric acid levels is important not only for preventing permanent joint damage but also for protecting kidney function. In fact, the long-term effects of persistent hyperuricaemia on the kidneys may be even more serious than the joint pain associated with gout.
Gout is not simply a minor condition that can be ignored until it passes, nor is it merely a "disease of affluence". It is a chronic disease caused by disturbances in uric acid metabolism, and repeated attacks can lead to irreversible damage to both the joints and kidneys. If you are at higher risk, for example due to obesity, a family history of gout, heavy alcohol consumption or metabolic syndrome, regular monitoring of your uric acid levels is advisable. If you experience symptoms suggestive of gout, seek medical attention promptly rather than delaying treatment. The good news is that gout is both manageable and preventable. The key is to recognise it, understand it and take action early.
The above content is reviewed by Dr Yau - Chief Medical Officer of AXA Hong Kong and Macau.
Information and materials provided is general in nature and does not constitute medical or health advice from AXA Hong Kong and is on an “as is” and “as-available” basis without representation and/or warranty of any kind, either express or implied. While AXA Hong Kong has taken reasonable care in providing such information and materials, they are not specific to your investment objective, financial situation, health or medical conditions or particular needs. No warranty or responsibility is assumed by AXA Hong Kong and our related or holding companies regarding non-infringement, security, accuracy, completeness, adequacy, reasonableness, fitness for a purpose or free from computer viruses in connection with the information and materials provided. AXA Hong Kong and our related companies and holding companies do not accept any liability for any loss, damage, cost or other expense, whether wholly or partially, directly or indirectly, arising from any error, inaccuracy or omission of the information and materials to the extent that such liability is not excluded by law.
Reference:
1. Yip, R.M., Cheung, T.T., So, H. et al. The Hong Kong Society of Rheumatology consensus recommendations for the management of gout. Clin Rheumatol 42, 2013–2027 (2023). https://doi.org/10.1007/s10067-023-06578-9
2. Peng K, Chan SCW, Wang Y, et al. Cost-Effectiveness of Biosimilars vs Leflunomide in Patients With Rheumatoid Arthritis. JAMA Netw Open. 2024;7(6):e2418800. doi:10.1001/jamanetworkopen.2024.18800
3. 《痛风抗炎症治疗指南（2025版）》.Retrieved from https://rs.yiigle.com/cmaid/1610040#R67B (Chinese Only)
4. 東莞東華醫院。《藥品價格公示》. Retrieved from https://www.dgtungwah.com/openview/1965.html (Chinese Only)
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