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Gout

Gout is a condition that causes pain and swelling in joints, usually in one or more joints of the arms or legs, especially in the hands and feet.

About gout 

Gout is an arthritic condition, meaning that it causes inflammation of your joints. This leads to pain and swelling, often in one joint in your body – commonly your big toe. However, it can affect any of your joints, including those in your:

  • Heels
  • Insteps (arches of your feet)
  • Ankles
  • Knees
  • Fingers
  • Wrists
  • Elbows.

Gout significantly affects around 70,000 people in Australia. It's more common in men, particularly those aged 40 to 50, and in older people. Top of page »

Causes of gout 

Gout is caused by abnormal ‘crystals’ forming in a joint. You can develop gout if you have too much uric acid (also called urate) in your body. Uric acid is a chemical that everyone has in their blood (it's a waste product formed from substances called purines, which are found in every cell in your body and certain foods).

Excess uric acid is usually passed through your kidneys and out of your body in your urine. However, the level of uric acid in your blood can rise if you produce too much, take too much in or can’t remove it quickly enough through your kidneys.

If the level of uric acid in your body is too high, it can form tiny crystals (called tophi) that collect in your tissues, particularly in and around your joints. This is what causes the swelling and pain. These crystals form more easily at relatively cooler temperatures, which is why gout is common in your fingers and toes.

Not everyone with high levels of uric acid gets gout and some people get gout but don't have high levels of uric acid. It's not known why some people develop gout and others don't. However, there are certain factors that can increase your likelihood of getting gout. You're more likely to have gout if you:

  • are a man aged 40 to 50
  • are a woman who has been through menopause, although women are much less likely to develop gout than men
  • drink too much alcohol
  • have a tendency to gout and eat a diet that contains high levels of purines, commonly found in red meat and seafood. Uric acid is formed in your body when the purines in foods you eat and old cells in your body are broken down
  • tend to crash diet or fast
  • take certain medicines, such as some diuretics ('fluid tablets') which increase the flow of urine from your body, or particular types of cancer medicines
  • have a family history of gout
  • have kidney disease meaning that your kidneys don't pass enough uric acid out in your urine
  • are overweight
  • have a medical condition such as psoriasis (itchy, dry and flaky skin), which can sometimes cause your body to produce too much uric acid
  • have high blood pressure
  • injure a joint.

An attack of gout often occurs for no clear reason, but may be triggered by drinking too much alcohol, an illness, injury, or eating foods high in purines such as oatmeal, lentils, liver, kidney, seafood (especially oily fish such as mackerel, sardines and anchovies) and certain vegetables (asparagus, cauliflower, mushrooms, and spinach). Top of page »

Symptoms of gout 

The symptoms of gout include:

  • severe pain in one or more joints of your body
  • swelling and warmth around the joint
  • red and shiny skin around the joint
  • mild fever
  • firm, white lumps beneath your skin (caused by uric acid crystals).

If you have these symptoms, see your GP.

You will usually have an attack of gout for a period of up to two weeks and then it will go away, even without treatment. With treatment, this can be reduced to less than a week. You may only ever have one attack of gout in your lifetime, but for many people it returns.

Complications of gout

It's uncommon for gout to cause any further problems but you may develop:

  • gout affecting several of your joints (called polyarticular gout)
  • inflamed tophi (deposits of uric acid crystals formed under your skin), which can cause discomfort. In addition, people with gout, especially if it is untreated, can sometimes suffer:
  • kidney stones (if uric acid crystals collect in your urinary tract)
  • Kidney damage (if uric acid crystals collect in your kidney tissue). Top of page »

Diagnosing gout 

Your GP will ask about your symptoms and examine you. It is often the first thing thought of for a middle aged male presenting with a very painful red swelling of the joint at the base of the big toe. To confirm, he or she will usually take a sample of your blood, which will be sent to a laboratory to measure the levels of uric acid.

Treatment is generally straightforward and will be managed by your GP. However if this is proving difficult or the presentation is less typical, your GP may refer you to a rheumatologist (a doctor specialising in conditions that affect the joints) for further tests.

Occasionally your doctor may remove some fluid from your swollen joint with a needle. This usually causes no more discomfort than a blood test. If uric acid crystals can be seen in the fluid under a microscope, you have gout. If calcium crystals are seen, you have a similar condition called pseudogout. The crystals formed when you have pseudogout aren't uric acid crystals – they are made of a calcium salt called calcium pyrophosphate.

You may need to have an X-ray taken of your joint in order to rule out other conditions, but this is less common. Top of page »

Treating gout 

Self-help

For an acute attack of gout there are a number of steps you can take to reduce the pain and swelling. Left untreated, attacks of gout may become more frequent and last for longer.

  • Raise and rest the affected joint. You shouldn't do any vigorous physical activity. Sometimes your doctor may give you a splint to wear, to stop you moving your joint.
  • Keep your joint cool and don't cover it. Apply ice wrapped in a towel to your joint for about 20 minutes to help reduce swelling. You shouldn't apply ice directly to your skin as it can damage your skin. If you need to repeat this, let your joint return to its normal temperature first.

See also the section on preventing gout.

Medicines

Medicines that relieve the symptoms of gout

There are some medicines your doctor can prescribe to help ease the pain and swelling of an attack of gout.

The commonly used painkiller medications for gout are non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, which may relieve pain and inflammation. If you have a heart condition, high blood pressure, kidney disease, lung disease or if you're over 65, these medicines may have undesirable effects as well or even be harmful so you should talk to your doctor or pharmacist about taking them.

If NSAIDs aren't suitable or effective for you, your doctor may prescribe a medicine called colchicine. Colchicine is derived from the Autumn crocus plant. It is not a painkiller, but it works by reducing the build-up of uric acid in your body and reducing the formation of the microcrystals that inflame the joint lining (synovium). This helps to reduce some of the inflammation and pain associated with a gout attack.

Colchicine can be an effective treatment for gout. However, it should be used at low doses as in some people it can have side effects including nausea or diarrhoea. So it is important to follow the recommended dose. For most people this means taking 2 tablets initially followed by 1 tablet an hour later, with no more than 3 tablets during a course of treatment for an acute gout attack.

Aspirin is not advised for pain relief during an attack of gout. The high doses required to give you pain relief may increase your blood uric acid levels and make your gout worse. If you are taking low-dose aspirin for a medical condition (eg for heart attack or stroke prevention), this can usually be continued, but confirm this with your doctor or pharmacist first. Your doctor may prescribe corticosteroid tablets or recommend an injection instead, if you have gout in a large joint (such as your knee).

Medicines that help prevent attacks of gout

If you have repeat attacks of gout, there are medicines you can take to help to prevent it. These medicines aren't used to treat an acute attack of gout and are usually prescribed once an attack is over.

Your doctor may prescribe a medicine called allopurinol for you to take daily. This medicine prevents gout by stopping the formation of uric acid. Allopurinol may actually cause an attack of gout when you first start taking it. This is because the level of uric acid in your body will rise a bit before it falls. To help prevent this happening, your doctor may prescribe NSAIDs, colchicine or corticosteroid tablets for you to take alongside allopurinol for up to three months. Make sure you drink enough fluids when taking these medicines.

Your doctor may prescribe a medicine such as probenecid to increase the amount of uric acid that is removed from your body in your urine, although probenecid is not as commonly used as once it was.

Always ask your doctor for advice and read the consumer medicines information leaflet for your medicine. Top of page »

Preventing gout 

Identifying anything that brings on an attack of gout and not doing these things is very important.

For example, don’t:

  • eat foods that are very high in purines, such as oatmeal, lentils, liver, kidney and seafood (especially oily fish such as mackerel, sardines and anchovies), and certain vegetables (asparagus, cauliflower, mushrooms, and spinach) – ask your doctor or a dietitian for more advice.
  • drink too much alcohol – especially beer, stout, port and fortified wines.

Do:

  • eat a well-balanced diet and do regular physical activity to maintain a healthy weight.
  • drink enough water or non-alcoholic (and preferably unsweetened) fluids. This helps ensure the concentration of uric acid and the consequent formation of gouty crystals are not increased by “relative” dehydration.

Further information 

Arthritis Australia
www.arthritisaustralia.com.au

Australian Rheumatology Association
www.rheumatology.org.au

Top of page »

Sources 

Arthritis Australia. [online] [accessed 19 Jul 2011] Available from: www.arthritisaustralia.com.au

Better Health Channel. Gout. [online] Melbourne, VIC: State Government of Victoria. [Accessed 19 Jul 2011] Available from: www.betterhealth.vic.gov.au

Clinical Knowledge Summaries. Gout [online] London: National Institutes for Health and Clinical Excellence. 2009 [Last updated Feb 2012, accessed Jan 2013] Available from: http://www.cks.nhs.uk

MyDr from MIMS. Gout. [online] St Leonards, NSW: UBM Medica Australia. [Accessed 19 Jul 2011] Available from: www.mydr.com.au

NHS Choices. Gout. [online] Whitehall, London: NHS Choices. [Last reviewed 20 Mar 2012, accessed 7 Jan 2013] Available from: www.nhs.uk

NPS. Colchicine for acute gout: updated information about dosing and drug interactions. RADAR. May 2010. [Accessed 19 Jul 2011] Available from: from www.nps.org.au

Pharmaceutical Society of Australia (PSA). Gout. NSW: PSA. 2010.

Rheumatology Expert Group. Therapeutic guidelines: rheumatology. Version 1. Melbourne: Therapeutic Guidelines Limited. 2006.

Rossi S (ed). Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd. 2010.

Simon C Everitt H Kendrick T. Oxford Handbook of General Practice. 3rd ed. Oxford: Oxford University Press, 2010: 528.

Top of page »

Last published: 31 January 2013

Tags: gout, arthritis, bones and joints

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