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 joints, kidneys and your quality of life.

Key points

  1. Gout is a painful form of arthritis that can be well managed and effectively treated. 
  2. Gout is caused by a build-up of uric acid in your blood, which forms sharp crystals in the joints. The key to effective gout management is getting uric acid levels below 0.36 mmol/L.
  3. Gout is caused more by your genes than your diet. While common in Maori and Pacific men, gout is not normal – see your doctor.
  4. If you have more than two attacks of gout per year, your doctor may prescribe a medication that will prevent further attacks by lowering uric acid levels.
  5. Gout won't go away unless you take your medications regularly and follow the 5 steps for preventing gout.

What causes gout?

Gout results from uric acid building up in your body

  • Uric acid comes from the breakdown of chemicals called purines.
  • Normally, your kidneys filter uric acid from the blood and flush it out of the body in urine.
  • When uric acid levels in the blood are high, uric acid crystals form in the joint. At any time these crystals can cause sudden inflammation.

What causes high uric acid in your body?

  • The most common cause of high uric acid is due to your body not getting rid of it properly. This could be because of:
    • your genes
    • your weight
    • kidney problems.
  • Sometimes, high uric acid is caused by what you eat and drink.

Who is at risk of getting gout?

People most at risk of having a gout attack have a high uric acid level in their blood. Risk factors for this include:

  • Genetics – the risk of having high uric acid levels and gout tends to run in some families.
  • Ethnicity – rates of gout in New Zealand are very high for Maori and Pacific men due to a range of genetic and lifestyle factors.
  • Increasing age – in about 90% of cases, gout affects men aged over 40 years and women after menopause.
  • Being overweight.
  • Having high blood pressure (hypertension).
  • Taking certain medicines, eg, water or fluid tablets (diuretics) for high blood pressure or heart failure.
  • Existing kidney problems and some other diseases.
  • High alcohol intake.
  • High intake of sugary drinks.
  • Diet too rich in purines, eg, liver, meat, seafood.

If you are prone to having high uric acid levels, 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.

Symptoms of gout

The symptoms of gout include severe pain in one or more joints, usually those at the end of your arms and legs such as your big toe. The pain can develop very fast and often at night. This is because the uric acid crystals in the joint cause sudden inflammation. It usually lasts for 5 to 10 days but can continue for weeks. The joint will also feel warm and look red and swollen.

Diagnosis of gout

Your doctor can diagnose gout based on your symptoms, blood tests showing high levels of uric acid and urate crystals in joint fluid (which is 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 cartilage and bones.

Treating acute gout attacks

  • For an acute gout attack, one of the non steroidal anti-inflammatory drugs (NSAIDs) such as naproxen (Naprosyn) or diclofenac (Voltaren) can be very effective.
  • To gain the best results the drug should be taken as soon as possible at the first sign of an attack, and continued until the pain and swelling go down.
  • If you are unable to take NSAIDs, medication such as colchicine or prednisone can help reduce the pain of gout.
  • Rest and elevate the inflamed joint if you can.
  • Cold packs can also reduce the pain.
  • Also drink 4 or 5 extra glasses of water a day. 

Seek medical advice early. With effective treatment the attack may be controlled within 12-24 hours and treatment need not be continued after a few days.

Managing gout long-term

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

  • You can get rid of most of uric acid by taking uric acid medication everyday. Accumulation of uric acid may cause kidney problems. This is another important reason for controlling uric acid levels with medications.
  • You can also:  
    • eat less seafood and meat
    • avoid drinking beer, fizzy drinks and orange juice
    • drink water
    • be active – walk, swim, go to the gym
    • keep within a healthy weight range.

Read more about treatment for gout and 5 steps you can take to prevent gout

Learn more

Arthritis New Zealand 
Gout section NHS Choices website, UK

References

  • 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]
  • 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: by Assoc Prof Peter Gow. Reviewed By: Assoc Prof Nicola Dalbeth on behalf of the Maori Gout Action Group & Northern Region Clinical Pathways