Gout

What is Gout?

Gout is a form of arthritis caused by the accumulation of uric acid crystals in one or more joints. This causes severe pain, swelling and tenderness in one or more joints. The most common place to get gout is where the joint for the big toe meets the foot. 

People will often experience sudden and intense and sudden swelling and pain in and around the joint known as a gout attack. People with gout will often describe gout pain as feeling like their foot is on fire. During this time, movement or any weight, even light weight, on the area can be excruciating.

Gout comes and goes meaning the condition will go through periods when the condition is active, known as a gout flare and periods where there are no symptoms. During the time when there are no symptoms it is important you implement strategies to prevent flares.

Australian government sources estimate up to 1.1 million Australians have gout. Of these almost 8 in 10 are men.

What Causes Gout?

Gout is caused by the accumulation of uric acid crystals in the joints. This occurs due to the build-up of uric acid in the blood which then accumulates in the affected joint. Uric acid is a normal waste product the body produces when it breaks down purines, a common substance in many foods. 

Uric acid will normally be removed from the blood by the kidneys however, when high levels of purine-rich foods are eaten, the body can struggle to remove the uric acid from the blood before it crystalises in a joint causing gout.

Not everyone who has a high uric acid level in the blood or enjoys a diet high in purines will experience gout, in fact, most won’t. The risk of developing the condition has multiple factors including:

• Genes (family history)
• Age
• Weight
• Alcohol intake
• Other medicines
• Medical conditions such as high blood pressure, diabetes and high cholesterol
• Kidney problems
• Ethnicity

Gout Symptoms

Gout often comes on suddenly and at night. During this time the affected joint will become severely inflamed. This can lead to the following symptoms:

• Severe pain - Gout pain is often most intense during the first day of the flare but often lingers for the full duration of the flare which can last a few days to a few weeks depending on the severity.
• Swelling and redness - The joint will become swollen, red and warm to the touch.
• Limited joint movement - During the attack, the joint will often become immobile or close to as the jagged crystals and resulting swelling limit how much the joint can move.

Gout Diagnosis

If you experience gout symptoms, it is important that you seek medical advice as soon as possible. Untreated gout may result in joint damage and unnecessary extension of intense pain.

There are a number of ways a doctor can diagnose gout. The most common is by physical examination and a series of diagnostic questions. This can be enough in some cases however the doctor may also decide to confirm the diagnosis with a test. These can include a joint fluid test, a blood test, ultrasound or x-ray.

Gout Treatment

Gout treatment can be split into two major types. The first focuses on helping with inflammation and pain during a gout attack while the other focuses on how to prevent any further flares.

Please note that Australian law prevents us from naming specific prescription treatments. After completing an assessment, you will be presented with the treatment options our doctors can prescribe.

Gout Relief

These medicines target the inflammation gout causes, lowering it to reduce the severity of the pain. The first of these agents is from the medicine class known as anti-gout agents. These medicines stop the process that causes swelling and other symptoms providing relief from gout pain.

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The second medicines for acute gout are nonsteroidal anti-inflammatory drugs or NSAIDs. As their name suggests these medicines lower inflammation in the body, providing a measure of relief from pain and swelling. These medicines should only be used short term as NSAIDs can cause side effects such as stomach pain and increased risk of stomach ulcers.

Lastly, corticosteroids in the form of either tablets or injections may be used to lower inflammation in the joint(s). These can be used for a short time at the beginning of a flare to lower the inflammatory response of the body.

Preventative Medicines

If you have gout often or you experience pain that is particularly severe, your doctor may consider prescribing preventative medicines. These medications lower your body’s level of uric acid by blocking the production of uric acid.

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Gout Prevention

Your lifestyle choices are one of the most important factors in preventing gout. The gout diet is often adopted by those with the condition as it can often limit purine intake enough to prevent flares.

The diet involves avoiding foods and drinks that are high in purines or result in an increased risk of a flare. These are diet choices such as:

• Avoiding the following foods: Tomatoes, red meat, liver, kidney, mussels, scallops, anchovies, sardines, shellfish.
• Avoiding the following drinks: red wine, beer or an excess of alcohol, high sugar drinks, tomato juice.

This does not mean you cannot eat these foods, simply that they should be enjoyed in moderation or in smaller portions. A healthy diet and exercise, in general, can improve your condition by limiting excess weight as a risk factor as well as potentially improving other risk factors such as diabetes, high blood pressure and high cholesterol. You should speak to your doctor or dietician about ways to assist with a diet and exercise plan for you and your conditions.

Gout Frequently Asked Questions

How do you treat gout?

During a gout attack, anti-gout agents and anti-inflammatory medicines are used to relieve pain and shorten the duration of the attack. When not experiencing an attack preventative measures can be taken such as diet modifications and exercise. If required, preventive medicines can be used to lower uric acid production in chronic gout suffers.

What does gout feel like?

Gout has been described as feeling like your joint is on fire. Suddenly appearing (usually overnight) severe pain, swelling, redness and warmth are the common symptoms.

How long does gout last?

Gout can last from a few days up to a few weeks depending on the severity of the flare and if treatments are administered.

Can gout be cured?

Gout will generally come and go, but cannot be permanently cured. Gout can be managed effectively with lifestyle changes, preventive medicines or management of risk factors, greatly reducing your chances of a gout flare.

Written by Clinical Pharmacist Tyson Wilkman