Gout: Symptoms, Causes, and Treatments

Gout is a common form of arthritis characterised by repeated attacks of extreme joint pain, swelling, and redness¹. It occurs when uric acid, a normal waste product, builds up in your bloodstream and forms crystals in a joint¹.

Gout mainly affects men over 40 years of age². It’s usually found in the big toe but can affect the hands, fingers, wrists, knees, feet, ankles, elbows or any other joint².

What causes gout?

Gout occurs when uric acid builds up in your bloodstream and forms urate crystals in a joint. Your body makes uric acid when it breaks down purines, a substance that’s found in your body and some foods¹.

Uric acid usually dissolves in your blood, is processed by your kidneys and leaves your body in urine¹; however, if your body makes too much uric acid or your kidneys can’t process enough of it, it builds up in your blood. Excess uric acid can form urate crystals in the joints which cause sudden and severe inflammation².

What are the symptoms of gout?

An attack of gout usually comes on very quickly, often overnight³. The affected joint will be red, swollen and extremely painful – often too sore to even touch³. The skin around the joint may look red and shiny and could be hot to touch.

Gout may be acute or chronic⁴. Acute gout is characterised by sudden attacks of the condition that may last for days or weeks and are followed by long periods without any symptoms. If these “flares” occur in the same joint over many years and the underlying excess of uric acid is not controlled, gout can become chronic⁴.

How is gout diagnosed?

If your doctor suspects you may have gout, they may take a sample of fluid from the affected joint to check for uric acid crystals under a microscope². Often, the diagnosis of gout is obvious, especially if you’ve had it before.

Early diagnosis and treatment is important so that the level of uric acid in your blood can be reduced so that it can’t form crystals in your joints¹.

What are the risk factors for gout?

According to the Victorian government, you’re more likely to have a gout attack if you¹:

• Are male
• Have a family history of gout
• Have elevated levels of uric acid
• Have type-2 diabetes, high blood pressure or cholesterol
• Are overweight or obese
• Drink too much alcohol (particularly beer)
• Use diuretics
• Crash diet or fast

Do certain foods cause gout?

There are many misconceptions about diet and gout – for example, many people believe that citrus foods cause gout, however there is no evidence that this is true⁵.

Several studies have shown that people who have gout are more likely to eat certain foods that contain high levels of purines (of which uric acid is a by-product). Purine-rich foods include⁵:

• Meat: particularly red meat and liver, kidneys, and heart
• Seafood: particularly shellfish, scallops, mussels, herring, mackerel, sardines, and anchovies
• Foods containing yeast such as Vegemite and beer

While people with gout have been found to be more likely to eat these foods, there’s little scientific evidence to suggest that avoiding these foods can reduce gout attacks⁵. In fact, you may miss out on important nutrients and vitamins if you cut these foods from your diet. For most people with gout, a healthy balanced diet and medication to reduce uric acid levels is all that’s required⁵.

Does drinking alcohol make gout worse?

Drinking alcohol can increase your risk of a gout attack as it can raise the level of uric acid in your blood⁵. If you suffer from gout, it’s sensible to reduce the amount of alcohol you drink and avoid binge drinking.

How common is gout?

Less than 1% of Australians have gout, with males making up 80% of the people with gout⁴.

How is gout treated?

The first step in treating gout is to get the pain and inflammation under control. This may include painkillers, icing, and rest.

Once your attack has subsided, your doctor may prescribe medications to reduce your pain and inflammation and lower the level of uric acid in your blood. These may include non-steroidal anti-inflammatory medications (NSAIDs), febuxostat, allopurinol or probenecid¹.

How can I avoid getting gout?

According to the Victorian government, you can reduce your chance of having a gout attack by¹:

• Losing weight if you are overweight
• Reducing your alcohol intake
• Eating a healthy balanced diet
• Exercising regularly
• Drinking plenty of water

What’s the relationship between gout and kidney stones?

Gout can cause kidney stones – rock-like masses of crystals that form in the kidneys⁶. They can block the flow of urine and cause infection, kidney damage or even kidney failure, and can vary in size and location¹.

There are four major types of kidney stones – uric acid stones are the variety associated with gout. If you think you may have kidney stones you should see your GP immediately.

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Sources:
1. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/gout
2. https://www.healthdirect.gov.au/gout
3. https://arthritisaustralia.com.au/types-of-arthritis/gout/
4. https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/gout/contents/what-is-gout
5. https://arthritisaustralia.com.au/managing-arthritis/living-with-arthritis/healthy-eating/gout-and-diet/
6. https://www.healthdirect.gov.au/kidney-stones