Gout — Symptoms, Medications, & Causes | Musculoskeletal Australia

gout

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
Gout can be successfully managed with healthy lifestyle choices and medical treatment.

Gout is a common form of arthritis characterised by repeated attacks of extreme joint pain, swelling and redness.

The most commonly affected joint is the big toe, but gout can affect your feet, ankles and knees, elbows, wrists and fingers.

It generally develops earlier in men (often between 30 and 45 years) than in women (usually after age 55). And it’s common in people over 65 regardless of their gender.

Cause

Gout occurs when uric acid, a normal waste product, builds up in your bloodstream and forms urate crystals in a joint.

Your body makes uric acid when it breaks down purines, a substance found in your body and in some foods.

Uric acid normally dissolves in your blood, is processed by your kidneys and leaves your body in urine.

If your body makes too much uric acid, or your kidneys can’t clear enough of it out, it builds up in your blood. This is called hyperuricaemia.

Having hyperuricaemia doesn’t mean you’ll develop gout – in fact most people with hyperuricaemia don’t go on to develop gout. Because of this it’s thought that other factors such as your genes may be involved.

Similar attacks to gout 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

You’re more likely to have a gout attack if you:

have a family history of gout
have high levels of uric acid in your blood
drink too much alcohol (especially beer)
eat a diet high in purines such as meat, sweetbreads, offal, shellfish, and fructose
are overweight
use diuretics
become dehydrated
crash diet or fast.

Symptoms

An attack of gout usually happens suddenly, often overnight. Symptoms include:

intense joint pain
joint swelling
skin over the joint may look red and shiny
affected joint may be hot to touch
tophi (lumps of crystals that form under the skin) may occur in people who have repeated attacks.

Diagnosis

Gout is diagnosed using a number of tests including:

medical history
physical examination
blood test to measure urate levels – although this cannot confirm gout
removing a sample of fluid from the joint; if you have gout, uric acid crystals can be seen under a microscope – this is the most definitive test for gout
ultrasound scan can identify early crystal formation in the fluid between your joints.

Early diagnosis and treatment is very important. The main goal for everyday management of gout is to reduce the level of uric acid in your blood so it can’t form crystals in the tissues or joints and cause joint damage.

Treatment

The first step in treating your gout is getting the pain and inflammation under control. This may involve medication (e.g. anti-inflammatories, analgesics), cold packs on the swollen joint, and rest.

Once the painful attack is under control, your doctor may prescribe medications that lower the levels of uric acid in your blood. This will depend on things such as:

how often you’re having gout attacks
if you’ve developed tophi or kidney stones
other health conditions you may have (e.g. kidney disease).

Self-management

During a gout attack, you can reduce pain and swelling by applying an ice pack to the painful joint for short periods of time, and protecting and resting the joint.

Other things you can do to prevent future attacks:

take your medication as prescribed.
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.
drink alcohol in moderation and avoid binge drinking.
avoid, or eat in moderation, foods that are high in purines. Talk with a dietitian for tips and advice.
drink plenty of water and stay hydrated.
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
Your rheumatologist
Dietitian
Musculoskeletal Australia
National Arthritis and Back Pain+ Help Line 1800 263 265

How we can help

Call our Help Line and speak to our nurses. Phone 1800 263 265 or email helpline@msk.org.au.

We can help you find out more about:

gout and other musculoskeletal conditions
ways to live well with these conditions
managing your pain
- read our A-Z guide to managing pain
- watch our excellent videos on pain, your brain and how you can retrain your pain system.
  - Pain, the brain and your amazing protectometer – Lorimer Moseley
  - Treating pain using the brain – David Butler
upcoming webinars, seminars and other events.

More to explore

Download this information sheet (PDF).

Watch the recording of our webinar.

Diagnosing and managing gout, presented by Dr Tina Racunica.
This webinar provided information on gout, therapies that can offer relief, new treatments and dietary intervention.
Recorded on 26 February 2020.

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This information has been produced in consultation with and approved by: Musculoskeletal Australia.