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Gout

Gout is a common, painful form of arthritis (joint inflammation) that can come on over hours. It causes swollen, red, hot and stiff joints and often affects the big toe, ankles, heels, knees, wrists, fingers and elbows.


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Key Messages for gout sufferers and their families:

  1. Gout is a painful form of arthritis that can be well managed or effectively 'cured' with the right treatment
  2. With delayed or no treatment, gout can cause serious damage to joints and kidneys
  3. Gout is caused by a build-up of uric acid in your blood, which forms sharp crystals in the joints
  4. If you have more than 2 attacks of gout per year, ask your doctor for preventive medication
  5. Find out what your uric acid level is and aim for below 0.36 mmol/l
  6. Gout is caused more by your genes than your diet
  7. While common in Maori and Pacific men, do NOT accept gout attacks as 'normal' - see your doctor!
  8. Keep to a healthy weight or lose weight if above healthy range

What is gout?

Gout is a common type of arthritis (joint inflammation). It causes sudden bouts of pain and swelling, usually in just one or two joints (the ball of the foot is commonly involved), and which, left untreated, last from days to weeks. These bouts of acute gouty arthritis are also called gout attacks.

  • Gout affects men (middle-aged generally) much more often than women.
  • In New Zealand, high rates of gout are seen in Maori and Pacific Island people (especially men).
  • Gout is closely linked with the body's level of uric acid - a normal breakdown product of digesting certain foods. High uric acid levels and gout attacks can be treated by your doctor.

Uric acid

Gout results from uric acid building up in your body.

  • Uric acid comes from the breakdown of substances called purines.
  • Purines are in your body's tissues and in foods, such as liver, dried beans and peas, and anchovies.
  • Normally, uric acid dissolves in the blood, is filtered by the kidneys and flushed out of the body in urine.
  • Sometimes uric acid can build up and form needle-like crystals in your joints (very painful) or kidney stones.

Sometimes people can have high levels of uric acid in the blood (hyperuricaemia) but have no joint pain, and other people who have gout attacks can have near-normal uric acid levels.

Accumulation of uric acid may also cause kidney problems, and this is another important reason for controlling uric acid levels with medications.

Acute gouty arthritis (gout attacks)

When uric acid crystals form in a joint they cause a painful arthritis called a gout attack.

  • This often occurs overnight and within 12 to 24 hours there is severe pain, which usually lasts five to 10 days, but can continue for weeks.
  • The pain is accompanied by joint inflammation (it appears red and swollen, and feels hot and extremely sensitive even to light touch).

Gout commonly strikes the big toe where it joins the ball of the foot, but other joints can be affected, including the instep, ankle, knee, kneecap, wrist, tip of the elbow and fingers. It can also cause inflammation of the tendons and the fat pads of the feet.

How can I avoid a gout attack?

If you are predisposed to high uric acid levels, or have had a gout attack before, there are changes you can make to reduce the risk of an attack:

  • avoid or restrict foods high in purines (eg, liver, kidneys, tongue, sardines, anchovies, shellfish, fish roe, peas, lentils, beans and food extracts like marmite and vegemite)
  • avoid eating large amounts of red meat
  • reduce alcohol intake and drink alcohol only in moderation (one to two drinks per day for men)
  • drink plenty of water and non-alcoholic fluids (at least five glasses a day) - dehydration can be a trigger for an attack of gout
  • avoid or limit sugary drinks such as fruit juices and soft drinks
  • do not overeat or starve (aim for regular meals)
  • aim to have low-fat dairy products each day
  • keep to a healthy body weight (talk to your doctor if you are overweight because unsupervised weight loss may also cause gout)

TIP: ask your doctor whether you need to change any medications you take for other health problems.

Chronic (long term) gout

After one gout attack you may not have another for months or years, but if your uric acid levels remain high the chances increase, and chronic gout is also more likely.

In chronic gout the affected joints are persistently painful and the uric acid crystal deposits result in joint damage which can stiffen and limit joint motion. The larger deposits can form tophi (which appear as yellow-white nodules under the skin covering the joints and, sometimes, around the outer ear).

Am I at risk of developing gout?

The strongest predictor for gout is a high uric acid level. Risk factors include:

  • Genetics can influence the body's handling of uric acid. This the risk of having high uric acid levels and gout tends to run in some families.
  • Increasing age. In about 90% of cases, gout affects men aged over 40 years and women after the menopause.
  • Being overweight
  • Having high blood pressure.
  • Certain medications e.g., 'water tablets' or diuretics, for high blood pressure or heart failure.
  • Existing kidney problems and some other diseases.
  • High alcohol intake
  • Diet too rich in purines.  For example: liver, dried beans and peas, and anchovies

Testing

Your doctor can diagnose gout based on your symptoms, blood tests showing high levels of uric acid and, most reliably, the presence of urate crystals in any joint fluid or the overlying bursa (cushions) if this has been obtained.

In the early stages of gout, x-rays are not usually helpful in diagnosis, but in chronic (long term) gout, x-rays can show damage to cartilage and bones caused by tophi.

Treating a gout attack

You may not always be able to avoid gout attacks, but medications and self-care can help reduce your symptoms.

Non-steroidal anti-inflammatory drug (NSAID): can be very effective pain relievers. To gain the best results, the dose should be adequate and the drug taken at the first sign of an attack. Hence, medical advice must be sought early.

  • With effective treatment the pain and inflammation can be controlled within 12 to 24 hours and treatment discontinued after a few days.
  • NSAIDs are not suitable for some people, however, and your doctor will take into account individual factors such as whether you have other medical conditions or take other medicines.

Other drugs such as colchicine, or corticosteroids (given as tablets or by injection into the joint), can also be used for a short period to control gout.

People with gout pain should avoid medications containing aspirin as these can make gout worse. Drugs used for gout attacks have no effect on reducing uric acid levels.

Medications to lower uric acid levels

If your uric acid level remains high and attacks continue or become more frequent, your doctor will usually recommend long term use of the drugs allopurinol (this lowers uric acid production) or probenecid (this helps the kidneys remove uric acid).

These drugs will not relieve your pain immediately but it is important to keep taking them as advised (even when feeling well) because the benefits of controlling your uric acid levels will occur over years. Drugs for reducing uric acid levels must be taken as advised by your doctor as side effects may occur - your doctor will explain all of this to you.

High uric acid levels and recurrent gout are often associated with high blood pressure, which also needs to be checked and treated as required. This combination of health problems can cause kidney damage if they are not controlled with supervision from your doctor.

Self-care during gout attacks

  • seek help from your doctor as early as possible, take any medications prescribed by your doctor and continue taking them for as long as advised
  • rest and try to keep the weight of any bedclothes off the painful joint
  • try using ice or a heat pack on the joint (stop if the pain worsens)
  • maintain an adequate fluid intake (at least five glasses per day), and avoid alcohol.

Further information and support

Talk to your doctor, and a dietitian can give further help with your diet. Arthritis New Zealand also offers support and advice.


Original material provided by everybody. Reviewed by Health Navigator, April 2014.

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VideoGout - brief video explaining what it is, treatments and more NHS Choices3 - 4 mins
  
pdfNZ Gout Booklet - 2008 PHARMAC19 Pages
  Multiple Languages
htmlGout Clinical Knowledge Summaries - NHS
  
htmlMultiple links & sub-topics MedlinePlus
 Page has links to interactive tutorials, videos & more
htmlWhat is gout? - Samoan & Tongan Healthpoint
  Multiple Languages

Symptoms, Tests & Diagnosis

Gout often comes on overnight and causes severe pain and swelling in the affected joint It usually affects only one or two joints at a time - most often the feet and ankles. The most common site is the ball of the big toe, but many other joints are also involved. It causes severe pain, tenderness, swelling and heat in the affected joint(s). Often the skin over the joint looks red and shiny.
htmlGout e-booklet Arthritis Research UK
 (includes useful diagrams)
htmlWhat typically happens? Best Health - UK
 Gout seems to be more common than in the UK
htmlSymptoms Best Health - UK
  
htmlUric acid test Lab Tests Online
  

What can I do? - Self help measures

What you eat, drink and do makes a BIG difference to managing your gout.
  • Gout can be triggered by a range of factors - talk with your doctor or nurse about these
  • Exercise and keeping active is very important and worth the effort
  • Useful factsheet about eating well with gout
htmlAttend a self management programme Health Navigator NZ
  
htmlThings you can do to help yourself Health Navigator NZ
  
pdfNZ Gout Booklet - 2008 PHARMAC19 Pages
  Multiple Languages
htmlExercise tips for people with arthritis Arthritis NZ
  
htmlSelf-help during an attack of gout Best Health - UK
 Easy to Read
pdfGout & Diet UK Gout Society
  

Treatments & Medication

In this section you will find links to information about treating acute attacks of gout and preventing further gout.

pdfAllopurinol patient card Counties Manukau District Health Board2 Pages
 excellent chart to help you prevent gout attacks
htmlWhat treatments work for gout? Best Health - UK
 Easy to Read
htmlTreatments to prevent gout Best Health - UK
  
htmlTreatments for an acute attack Best Health - UK
  
htmlTreatment Health Navigator NZ
  
htmlComplementary medicines in arthritis Arthritis Research UK
  
htmlAcute gout - clinical pathway Healthpoint
 developed by Auckland GAIHN group
htmlGout prevention - clinical pathway Healthpoint
 developed by Auckland GAIHN group
htmlTreatment of Gout - Hit the target - 2007 BPAC & Best Practice Journal
  
pdfGout and its management NZFP 4 pages
 Article by Prof Peter Gow - 2005
htmlManagement of Gout in UK Patient UK
 good list of references
htmlUK Guideline - 2007 British Society of Rhematology - 2007
  
pdfGenes, fructose, allopurinol and gout - Nov 2010 BPAC & Best Practice Journal3 pages
  
pdfUpdate on management of gout BPAC & Best Practice Journal
  

Support

Untreated, gout can impact the whole family, your work and social activities. There are a wide range of community services, groups and people willing to help you take positive steps to reduce the impact and be gout free.

VideoYour stories - living well with gout Health Navigator NZ
  
htmlJuice - magazines Arthritis NZ
  

Want to Learn More?

This section provides some additional references, articles and resources.

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Date last reviewed [Date Reviewed]