Gout

Gout is a common and painful form of arthritis. It causes severe joint pain and swelling, especially in your toes, knees, elbows, wrists and fingers. If left untreated, gout can cause serious damage to your joints, kidneys and quality of life.

 Key points

  1. Gout is caused by a build-up of uric acid in your blood. The uric acid forms crystals in your joints.
  2. High uric acid levels are mainly due to genetic factors. While common in Māori and Pasifika men, gout is not normal – see your doctor if you have the symptoms.
  3. If you have more than two attacks of gout per year, your doctor may prescribe a medication to prevent further attacks by lowering your uric acid levels. The key to preventing gout attacks is getting uric acid levels to below 0.36 mmol/L.
  4. If left untreated gout can cause permanent damage to your joints and harm your kidneys.
  5. With effective treatment, a gout attack may be controlled within 12–24 hours. Medication and lifestyle changes can help prevent gout attacks. 

Gout in New Zealand

Discover how Mr Tupotahi manages gout.

(Auckland University of Technology, NZ, 2010)

What causes gout?

Gout is caused by a buildup of uric acid  in your body

  • gout - footUric acid mostly (two-thirds) comes from the breakdown of cells in your body. The remainder (one-third) comes from chemicals called purines that are in your food.
  • Normally, your kidneys filter uric acid from your blood and flush it out of your body in urine (pee).
  • When uric acid levels in your blood are high, uric acid crystals form in  your joints. These crystals cause pain, inflammation and lumps (called tophi).

What causes high uric acid?

  • The most common cause of high uric acid is due to your body not getting rid of it properly. 
  • This is mainly due to genetic factors. Other factors can include certain medications and other health conditions.

Who is at risk of getting gout?

High uric acid levels are caused by the following factors:

  • Genetics – some Māori and Pasifika people have genes that make it harder to get rid of uric acid from their bodies.
  • Being overweight – carrying extra weight slows down the removal of uric acid by your kidneys.
  • Increasing age – in about 90% of cases, gout affects men aged over 40 years and women after menopause.
  • What you eat and drink – you increase your risk if you drink a lot of sugary drinks or alcohol, or eat too much food that is rich in purines, such as liver, meat or seafood.
  • Having high blood pressure (hypertension).
  • Taking certain medicines, such as water or fluid tablets (diuretics) for high blood pressure or heart failure.
  • Existing kidney problems and some other conditions.

In people with known gout, there are changes you can make to reduce the risk of developing gout.

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

What are the symptoms of gout?

The symptoms of gout include severe pain in one or more joints. In most cases, gout affects one joint at a time.

  • The joint most commonly affected is the large toe. Other sites include your forefoot, instep, heel, ankle and knee. Gout is uncommon in the upper body, but it can affect your fingers, wrists and elbows.
  • Gout attacks are very painful. A gout attack usually begins suddenly, often at night. Within hours, the joint becomes red, swollen, hot and painful. This is due to uric acid crystals in the joint causing sudden inflammation.
  • The pain and tenderness can be so severe that even gentle pressure from bedding is a problem. Even though only one small joint is affected, the inflammation can be intense enough to cause fever, muscle aches and other flu-like symptoms.
  • An attack usually lasts for 5 to 10 days but in rare cases, it can continue for weeks. 

How is gout diagnosed?

Your doctor can diagnose gout based on your symptoms, blood tests showing high levels of uric acid and urate crystals in joint fluid (from a sample taken through a small needle put into your joint).

In the early stages of gout, x-rays are not usually helpful in diagnosis, but in advanced gout x-rays can show any damage to your cartilage and bones.

How are gout attacks treated?

See your doctor as soon as you have an attack. With effective treatment the attack may be controlled within 12–24 hours and treatment need not be continued after a few days. There are also things you can do to help relieve the pain:

  • rest until your symptoms improve
  • raise the inflamed joint and put an ice pack on it
  • do not exercise during an acute attack
  • take pain relief medicines, for example non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen (Naprosyn) or diclofenac (Voltaren) can be very effective in reducing pain and inflammation. If you are unable to take NSAIDs, medication such as colchicine or prednisone can help reduce the pain of gout. 
  • to get the best results, take your NSAIDs as soon as possible at the first sign of an attack, and continue until the pain and swelling goes down.

Read more about medicines for gout

What happens if gout is left untreated?

If gout is not treated, it can cause permanent damage to your joints and harm your kidneys. Attacks will happen again and more joints will be affected. Lumps (tophi) can grow on your elbows, hands and feet. The lumps can become sore and swollen and they may cause skin ulcers. The natural padding between the bones will start to wear away and the joints will become sore and stiff. Kidney stones can form and cause pain and damage to your kidneys.

Preventing gout attacks

To prevent gout attacks and damage to your joints, your doctor may start you on long-term gout medication, called urate lowering medicines. They are most likely to do this if you:

  • get two or more gout attacks per year
  • already have evidence of damage from gout on joint x-rays
  • have tophi, chronic kidney disease or kidney stones.

Urate lowering medicines

Urate lowering medicines lower your body's level of uric acid. Examples of these medicines are allopurinol, probenecid, benzbromarone and febuxostat. Allopurinol is most commonly used.

  • The aim of these medicines is too keep your uric acid level below 0.36 mmol/L. This will help to prevent gout attacks, joint damage and kidney stones and will make your gouty lumps smaller.
  • You need to take uric acid medicines every day, even if you are having a gout attack.
  • When you start taking your urate lowering medicine you might get a gout attack, as your body is getting rid of the extra uric acid. Your doctor will prescribe additional medication such as a low-dose non-steroidal anti-inflammatory (NSAID) or colchicine to reduce the chances of these attacks.

Read more about medicines for gout

Lifestyle changes

  • Being overweight can increase your risk of gout – carrying extra weight slows down the removal of uric acid by your kidneys. If you are overweight, gradual weight loss can help to lower your uric acid levels and reduce your risk of gout attacks.
  • Cutting out sweetened foods and drinks from your diet and avoiding eating too much food high in purines can help to prevent gout attacks.

Read more about diet and weight loss for gout and 5 steps you can take to prevent gout.

Learn more

Are you at risk of gout? Workbase Education Trust, 2014
To stop gout Ministry of Health, NZ
Out with gout Pharmac, NZ
Gout Pharmac, NZ

References

  1. An update on the management of gout BPAC, NZ 2013
  2. A conversation about gout BPAC, 2014
  3. Winnard D, Wright C, Jackson G, Gow P, Kerr A, McLachlan A, Orr-Walker B, Dalbeth N. Gout, diabetes and cardiovascular disease in the Aotearoa New Zealand adult population: co-prevalence and implications for clinical practice. NZ Med J. 2012 Jan 25;126(1368):53-64. [Abstract]  [Full article]
  4. Batt C, Phipps-Green AJ, Black MA, et al. Sugar-sweetened beverage consumption: a risk factor for prevalent gout with SLC2A9 genotype-specific effects on serum urate and risk of gout Ann Rheum Dis 2014;73:2101–2106 [abstract]  [full pdf]
Credits: Editorial team. Reviewed By: Professor Lisa Stamp, Rheumatologist, University of Otago Christchurch Last reviewed: 03 May 2018