Gout is a common form of arthritis. Pain often occurs in the big toe joint, knee, ankle, elbow and other joints. A gout attack is sudden and painful. Gout is caused by a build-up of a waste product, uric acid, in the bloodstream. Excess uric acid settles in joints causing inflammation, pain and swelling. Alcohol, overeating, dieting and dehydration can trigger a gout attack.
Gout is a common form of arthritis characterised by recurrent attacks of extreme pain, swelling and redness. Gout is more common in men, and often several men of the one family can be affected by gout.
While most other types of arthritis develop slowly, an attack of gout happens suddenly, often overnight. The most commonly affected joint is the big toe, but gout may be experienced in the feet, ankles and knees, and less commonly in the elbows, hands and other joints. For some people, even the weight of a bedsheet can cause intolerable pain.
Causes of gout
Gout occurs when uric acid builds up in the bloodstream and deposits urate crystals in the joint. The build-up of uric acid is most commonly caused by under-excretion of uric acid by the kidneys, but may also be caused by the overproduction of uric acid by the body.
Some people have higher levels of uric acid in their bloodstream when compared to others. This condition is called hyperuricaemia and can be hereditary. Other causes of gout can include the use of diuretics (fluid tablets) which can cause the retention of too much uric acid.
Risk factors of gout
A person with gout is more likely to have an attack when they:
- have elevated levels of urate in the blood
- consume too much alcohol (particularly beer)
- consume a diet high in ‘purines’ such as meat, sweetbreads, offal, shellfish, and fructose (found in fruit juices)
- are obese
- use diuretics
- injure a joint
- become dehydrated.
Dealing with an attack of gout
Without treatment the attack usually resolves within one or two weeks, however with medications the attack can be resolved within several days.
If you have not had an attack of gout before, your doctor will look for elevated urate levels in your blood and may aspirate (remove a sample of fluid from the joint) to make a definite diagnosis. If you have gout, uric acid crystals can be seen in large numbers under a microscope.
Once the diagnosis is confirmed, your doctor will consider the following treatment options:
- non-steroidal anti-inflammatory drugs (NSAIDs)
- corticosteroids injections or tablets.
The methods of managing an acute attack of gout differ from the ongoing methods for managing gout. The primary goal in everyday management is to reduce the level of uric acid in the blood so it cannot form crystals in the tissues or joints. The benefits of reducing uric acid in the blood long term include:
- slowing the progress or risk of kidney disease which may be caused by deposits of urate in the kidneys
- possibly reducing the risk of heart disease.
If you have frequent episodes of gout your doctor may prescribe medications to reduce the formation of uric acid and increase the excretion of uric acid.
Changes to lifestyle can help in the long term
If you suffer from gout you will benefit in the long term from healthy changes to your lifestyle. Suggestions to assist in the lifestyle management of gout include:
- Maintain a healthy body weight. If you do need to lose weight, ensure your weight loss is gradual as ‘crash’ diets can increase uric acid levels
- Cut down on alcohol consumption and avoid binge drinking
- Keep hydrated – drink plenty of water
- Consult a dietitian to get advice on a diet that limits the purines that are thought to cause gout
- Exercise regularly
- Manage high blood pressure
- Work closely with your doctor to prevent further attacks and actively manage your condition.
Where to get help
- Your doctor
Things to remember
- Gout is a type of arthritis caused by too much uric acid in the bloodstream.
- Excess uric acid settles in joints and causes pain and swelling.
- Healthy lifestyle choices combined with a correct treatment program should mean that gout can be successfully managed.
You might also be interested in:
- Arthritis and diet.
- Arthritis and exercise.
- Knee replacement surgery.
- Rheumatoid arthritis.
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Last reviewed: July 2012
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