Gout is a common form of inflammatory 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 bed sheet can cause intolerable pain.
Urate crystals can also collect outside the joints and may even be seen under the skin, where they form small, firm white lumps called tophi. These aren't usually painful but sometimes they break down and discharge fluid containing gritty white material – the urate crystals themselves
Causes of gout
Gout occurs when uric acid builds up in the bloodstream and deposits urate crystals in the joint. These crystals form slowly over months or years. 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.
Similar attacks can be caused by a condition called pseudogout (or acute calcium pyrophosphate arthritis). In this case, crystals of calcium (rather than urate) are deposited in joint cartilage and then shed into the joint space. This is likely to affect your knees and other joints more than the big toe and is most common in people with osteoarthritis.
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 and soft drinks sweetened with corn syrup)
- are overweight or obese
- use diuretics
- have type 2 diabetes, high blood pressure or high cholesterol – these conditions can mean that your kidneys are less able to flush out the urates
- Kidney disease
- injure a joint
- have an operation
- become dehydrated
- are unwell with a fever
- crash diet or fast.
Dealing with an attack of gout
Without treatment the attack usually resolves within one or two weeks, and with medication, it can be resolved within several days. However, the crystals still remain in the joint.
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 various treatment options including:
- non-steroidal anti-inflammatory drugs (NSAIDs)
- corticosteroids injections or tablets.
Some of these medications have side effects – your doctor will be able to advise the most appropriate treatment for you. In an acute attack, applying an ice pack to the painful joint for 10–15 minutes at a time and protecting or resting the joint can help to reduce pain.
Early diagnosis and treatment is very important. 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 and cause joint damage. 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.
If you've had attacks of gout before, be on the look-out for early signs of another attack and take the prescribed treatment as soon as possible. The earlier you can start treating an acute attack the better.
Changes to lifestyle can help in the long term
The methods of managing an acute attack of gout differ from the ongoing methods for managing gout. If you suffer from gout you will benefit in the long term from making healthy changes to your lifestyle.
Suggestions to help in the self-management of gout include:
- Maintain a healthy body weight. If you do need to lose weight, make sure 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 healthy and well balanced diet.
- Exercise regularly – aim to complete at least 30 minutes of physical activity most days of the week.
- Work closely with your doctor to prevent further attacks and actively manage your condition.
Where to get help
- Your doctor
- Arthritis and Osteoporosis Victoria Tel. (03) 8531 8000 or 1800 263 265
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.
This page has been produced in consultation with and approved by:
MOVE muscle, bone & joint health
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