Gout affects around 0.8% of Australians, causing severe episodes of pain and swelling that often occur without any warning (Better Health Channel 2018; AIHW 2020).

Gout is a common type of inflammatory arthritis that causes sudden flares of pain, swelling and redness in the joints. Symptoms have a much quicker onset than other forms of arthritis, and attacks often occur overnight (Better Health Channel 2018).

Gout generally affects joints in the limbs - usually one at a time - such as feet, ankles, knees, elbows, wrists, fingers and toes (especially the big toe) (Arthritis Australia 2017).

What Causes Gout?

Gout is caused by an excess of uric acid - a byproduct that is normally excreted through urine. When there is excess uric acid in the blood, either because the kidneys can not excrete it quickly enough or because too much has been produced, it forms crystals (‘urate’) in the joints. These crystals cause painful inflammations (Harvard Health Publishing 2019; Healthdirect 2022).

Hyperuricaemia is the term used to describe high levels of uric acid in the blood. This condition alone is not necessarily a prerequisite to gout and can be present without symptoms, suggesting that gout is instead the result of a combination of factors (Better Health Channel 2018).

Risk Factors for Gout

• Gender (males are more at risk than females)
• Family history of gout
• Excessive levels of uric acid in the blood
• High level of alcohol consumption (especially beer)
• Diets high in purines (e.g. foods such as meat, offal, shellfish)
• Being overweight or obese
• Use of diuretics
• Type 2 diabetes, high blood pressure or high cholesterol
• Kidney disease
• Crash diets or fasting.

(Better Health Channel 2018)

How Common is Gout?

According to self-reported data, 187,000 (0.8%) of Australians have gout. Among these individuals, 87% are male (AIHW 2020).

Signs and Symptoms of Gout

• Joint pain, which is often severe
• Joint swelling and tenderness
• Red, shiny skin and warmth over the affected joint
• Impeded movement of the affected joint
• Tophi - lumps of crystals that form over the skin and may occur in those who have experienced repeated flares.

(MSK 2022; Healthdirect 2022)

Gout attacks usually last for around one week (untreated) and symptoms may then disappear for long periods of time (possibly months or years). However, if gout is not managed properly, flares may become more severe and frequent, leading to permanent damage.

If repeated attacks occur, it may become a chronic condition (Arthritis Australia 2017; AIHW 2020).

Chronic gout symptoms may include:

• Constant mild pain and inflammation of the joint
• Tophi
• Kidney stones.

(Arthritis Australia 2017)

Diagnosing Gout

A combination of medical tests may be conducted to determine if someone has gout, but the most definitive method of diagnosis is to take a sample of fluid from the affected joint and look for uric acid crystals under a microscope (Better Health Channel 2018).

A blood test can measure urate levels in the body but does not necessarily indicate gout (Better Health Channel 2018). Urate levels may even be normal or lower than usual during a flare (Arthritis Australia 2017).

Treating Gout

The first step to treating gout is generally to manage an acute attack by alleviating any pain and inflammation. This may involve medication and rest (MSK 2022).

If the person is experiencing recurring attacks, medication may be prescribed to lower the level of uric acid in their blood. They may also be encouraged to make lifestyle changes such as reducing alcohol intake, losing weight and maintaining a balanced diet (Healthdirect 2022).

Managing Gout

Future flares may be prevented through strategies such as:

• Taking medication that has been prescribed
• Maintaining a healthy body weight (and if weight loss is suggested, doing so gradually)
• Drinking alcohol in moderation
• Eating in moderation
• Staying hydrated
• Exercising regularly (at least 30 minutes per day, most days of the week)
• Working with a general practitioner to manage future attacks.

(MSK 2022)

References