What is gout?

Gout is a painful condition that usually affects the large joint of the big toe, but can also affect other joints in the body. It occurs when there are high levels of a chemical substance called uric acid in the blood, which forms when your body breaks down certain foods and drinks. When uric acid is collected in high enough concentrations, it can cause crystals to form in some joints. This results in inflammation and causes the affected joints to become painful and swollen.

Gout can affect anyone, but people who have family members with gout are more likely to develop the condition. Gout is also more common in people who are over the age of 40, are obese or consume too much alcohol.   

The treatment for gout involves medication to reduce pain and joint inflammation, and diet and lifestyle changes to prevent getting gout again in the future. There are also some medications that can reduce the amount of uric acid in the blood and can help prevent episodes of gout.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

Joint

A connecting surface or tissue between two bones.

Uric acid

A chemical that is a by-product of the digestion of proteins. It is filtered from the blood and excreted from the body as part of the urine.

Causes

Uric acid is a substance created when your body breaks down certain foods and drinks. Gout is a condition that occurs when uric acid builds up in the bloodstream, which results in urate crystals forming in the joints. The crystals can cause joint inflammation, which leads to swelling and extreme pain.

Several factors can lead to high uric acid levels in your blood. It can occur as a result of your kidneys not filtering uric acid out of your body fast enough. It can also be caused by a condition called hyperuricaemia, a hereditary condition that causes people to have very high levels of uric acid in their blood. Some medications may also result in higher-than-normal levels of uric acid. For example, diuretics, which are medications that promote the production of urine, can lead to increased levels of uric acid in the blood.

Foot affected by gout with urate crystal formation and bone erosion around the big toe joint.Formation of urate crystals in gout. 

Diuretics

A substance that promotes the production and excretion of urine.

Hereditary

Inherited by an offspring from their parent/s.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

Joints

A connecting surface or tissue between two bones.

Uric acid

A chemical that is a by-product of the digestion of proteins. It is filtered from the blood and excreted from the body as part of the urine.

Risk factors

Anyone can get gout, but there are some factors that can increase your chance of developing it. You are more likely to get gout if you:

  • Have family members with gout;
  • Are obese;
  • Are over 40 years old;
  • Are male;
  • Take certain types of medication, such as diuretics;
  • Have kidney disease;
  • Become dehydrated regularly; 
  • Consume too much alcohol, and;
  • Are receiving chemotherapy for certain cancers.

You also have an increased chance of developing gout if you have a diet that is high in purines which, when broken down during digestion, form uric acid. Foods that contain a lot of purines include liver, anchovies, dried beans and peas.

Very sugary drinks, such as fruit juices and soft drinks, may also increase the risk of gout. Fructose, a simple sugar within such drinks, causes the liver to produce high levels of uric acid.

Reducing or avoiding intake of these foods and beverages may help in the treatment and prevention of gout.

Chemotherapy

A medication-based treatment, usually used in the treatment of cancers. There are numerous, different types of chemotherapy drugs that can be prescribed by a specialist. These can commonly be used alongside other cancer treatments such as surgery and radiotherapy.

Dehydrated

The state of insufficient hydration; excessive loss of water; requiring more water in order to function normally.

Diuretics

A substance that promotes the production and excretion of urine.

Uric acid

A chemical that is a by-product of the digestion of proteins. It is filtered from the blood and excreted from the body as part of the urine.

Signs and symptoms

The main symptom of gout is intense pain in the large joint at the base of the big toe. Gout can sometimes affect other joints, including those in the knees, hands and wrists. Affected joints can be red and swollen and tender to touch. The symptoms of gout usually occur at night and come on very suddenly. After the initial pain goes away, people with gout may feel a dull ache in their affected joint, which can last from a few days to a few weeks.

Foot affected by gout with red, swollen big toe joint.Gout causes intense pain in the large joint of the big toe. 

Joint

A connecting surface or tissue between two bones.

Methods for diagnosis

To work out whether you have gout, your doctor may give you a physical exam and do some tests. They may do a joint fluid test, using a needle to collect some fluid from the affected joint. They will then send the fluid to the laboratory where it will be examined to see if the sample contains uric acid crystals, the main cause of gout.

Sometimes a sample of blood or urine will also be tested to measure uric acid levels. However, these tests are not always useful because some people with gout may not have abnormally high levels of uric acid, especially during an attack.

Joint

A connecting surface or tissue between two bones.

Uric acid

A chemical that is a by-product of the digestion of proteins. It is filtered from the blood and excreted from the body as part of the urine.

Types of treatment

An attack of gout is usually treated with medication to control the associated inflammation and pain. There are also medications available that may help to prevent future episodes of gout. Some of the common types of medication used to treat gout include:

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) are medications used to reduce the inflammation and pain of gout. Some over-the-counter NSAIDs include ibuprofen and naproxen. If you have severe symptoms, your doctor may prescribe some stronger NSAIDs, such as indomethacin. People who have asthma, kidney disease or a history of stomach or bowel ulceration may not be able to take NSAIDs.

Colchicine

Colchicine is a type of pain reliever that can reduce gout pain. This treatment may be recommended as a first line of treatment, or if you are not able to take NSAIDs. Colchicine works well at relieving pain, but can have some unpleasant side effects, such as nausea, vomiting and diarrhoea. In recent years, the effective recommended dose of colchicine has been lowered and has been shown to be better tolerated in regards to side effects.

Corticosteroids

Corticosteroids, such as prednisolone, can also be used to control the inflammation and pain of gout. Corticosteroids may be given to you as a tablet, or injected into your joint. As there are some side effects associated with using corticosteroids, they are usually only prescribed if you are unable to take the other types of medication commonly used to treat gout.

Corticosteroids

A medication that resembles the cortisol hormone produced in the brain. It is used as an anti-inflammatory medication.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

Joint

A connecting surface or tissue between two bones.

NSAIDs

Non-steroidal anti-inflammatory drugs are commonly used to manage arthritis-related pain and inflammation and other musculoskeletal disorders. NSAIDs include aspirin and ibuprofen.

Ulceration

The formation of an ulcer, which is an open sore in the skin or mucous membranes, such as those of the stomach lining, intestine or mouth.

Potential complications

In some people, gout may lead to other serious conditions, including:

Recurrent gout

Some people will only experience gout once, while others can get the symptoms again and again. This is called recurrent gout.

Advanced gout

If left untreated, gout may cause uric acid crystals to collect under the skin in lumps or nodules called 'gouty' tophi. The lumps can appear on your fingers, hands, feet, elbows or the back of your ankle. The lumps are not usually painful. However, they can swell up and become tender during episodes of gout. This condition is called advanced gout.

Kidney stones

If you have gout, the high concentration of uric acid in your blood can also increase your chance of developing kidney stones. Kidney stones are small, solid masses made up of uric acid crystals that form in the kidneys. As they make their way out of the body through the urine, they can get stuck in the thin tube that connects the kidneys to the bladder and cause extreme pain.

Nodules

A small growth or lump of tissue.

Uric acid

A chemical that is a by-product of the digestion of proteins. It is filtered from the blood and excreted from the body as part of the urine.

Prevention

An episode of gout can last for about a week but, with proper treatment and lifestyle changes, symptoms can be effectively managed and often prevented. In some cases without treatment, gout can return again and again, increasing the risk of developing advanced gout or complications such as painful kidney stones.

Lifestyle factors

Lifestyle factors that may help prevent gout include:

  • Maintaining a healthy body weight;
  • Drinking lots of water;
  • Avoiding or cutting down your alcohol intake, and;
  • Avoiding foods and drinks that contain high amounts of purines, which break down into uric acid.

Medication

If you have recurrent gout, your doctor may prescribe medication, such as allopurinol, which can block the production of uric acid. Other medication, such as probenecid, can be prescribed to improve the kidney function to remove uric acid from your body. Lowering uric acid levels on a long-term basis can reduce the number of recurrent attacks and the risk of progressing to advanced gout.

Uric acid

A chemical that is a by-product of the digestion of proteins. It is filtered from the blood and excreted from the body as part of the urine.