Gaining an Understanding of Gout

Gout affects nearly 1% of Australians with severe episodes of pain and swelling that can often occur without any warning.

Gout is a common type of inflammatory arthritis that causes sudden flares of pain, swelling and redness in the joints. Symptoms have a much quicker onset than other forms of arthritis, and attacks often occur overnight (Better Health Channel 2018).

Gout generally affects joints in the limbs - usually one at a time - such as feet, ankles, knees, elbows, wrists, fingers and toes (especially the big toe) (Arthritis Australia 2017).

What Causes Gout?

Gout is caused by an excess of uric acid; a byproduct that is normally excreted through urine. When there is excess uric acid in the blood, either because the kidneys can not excrete it quickly enough or too much has been produced, it forms crystals (‘urate’) in the joints. These crystals cause painful inflammations (Harvard Health Publishing 2019; Healthdirect 2018).

Hyperuricaemia is the term used to describe high levels of uric acid in the blood. This condition alone is not necessarily a prerequisite to gout and can be present without symptoms, suggesting that gout is instead the result of a combination of factors (Better Health Channel 2018).

Risk Factors for Gout

The following risk factors apply for a person being diagnosed with gout:

• Gender (males are more at risk than females);
• A family history of gout;
• Excessive levels of uric acid in the blood;
• High level of alcohol consumption (especially beer);
• Diets high in purines (e.g. foods such as meat, offal, shellfish);
• Those who are overweight or obese;
• Those consuming diuretics;
• People who have type two diabetes, high blood pressure or high cholesterol;
• People with kidney disease;
• Those who crash diet or fast.

(Better Health Channel 2018)

How Common is Gout?

According to self-reported data, 187,000 or 0.8 per cent of Australians have gout. 87% of these people are male (AIHW 2019).

Signs and Symptoms of Gout

• Joint pain, often severe;
• Joint swelling and tenderness;
• Red, shiny skin and warmth over the joint;
• Impeded movement of the affected joint; and
• ‘Tophi’ - lumps of crystals that form over the skin and may occur in those who have experienced repeated cases.

(Musculoskeletal Australia n.d.; Healthdirect 2018)

Gout attacks usually last for around a week (untreated) and symptoms may then disappear for long periods of time (possibly months or years). However, if gout is not managed properly, flares may become more severe and frequent, leading to permanent damage.

If repeated attacks occur, it may become a chronic condition (Arthritis Australia 2017; AIHW 2019).

Chronic gout symptoms may include:

• Constant mild pain and inflammation of the joint;
• Tophi; and
• Kidney stones.

(Arthritis Australia 2017)

Diagnosing Gout

A combination of medical tests may be conducted to determine if someone has gout, but the most definitive method of diagnosis is to take a sample of fluid from the joint and look for uric acid crystals under a microscope (Better Health Channel 2018).

A blood test can measure urate levels in the body but does not necessarily indicate gout (Better Health Channel 2018). Urate levels may even be normal or lower than usual during an attack (Arthritis Australia 2017).

Treating Gout

The first step to treating gout is generally to manage the attack by alleviating any pain and inflammation. This may involve medication and rest (Musculoskeletal Australia n.d.).

If you are experiencing recurring attacks, medication may be prescribed to lower the level of uric acid in your blood (Healthdirect 2018). You may also be encouraged to make lifestyle changes such as reducing alcohol intake, losing weight and maintaining a balanced diet (Healthdirect 2018).

Managing Gout

You may be able to prevent future attacks through self-management including:

• Taking medication that has been prescribed;
• Maintaining a healthy body weight (and if weight loss is suggested, doing so gradually);
• Drinking alcohol in moderation;
• Eating in moderation;
• Staying hydrated;
• Exercising regularly (at least 30 minutes per day, most days of the week); and
• Working with your doctor to manage future attacks.

(Musculoskeletal Australia n.d.)

Additional Resources

• Arthritis Australia, Gout information sheet, https://arthritisaustralia.com.au/wordpress/wp-content/uploads/2017/09/ArthAus_Gout_1705.pdf
• Australian Institute of Health and Welfare, Gout web report, https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/gout/contents/treatment-and-management-of-gout
• Musculoskeletal Australia, Gout information sheet, https://www.msk.org.au/wp-content/uploads/2020/02/Gout.pdf

References

• Australian Institute of Health and Welfare 2019, Gout, Australian Institute of Health and Welfare, viewed 5 March 2020, https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/gout/contents/what-is-gout
• Better Health Channel 2018, Gout, Better Health Channel, viewed 5 March 2020, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/gout
• Arthritis Australia 2017, Gout, Arthritis Australia, viewed 5 March 2020, https://arthritisaustralia.com.au/wordpress/wp-content/uploads/2017/09/ArthAus_Gout_1705.pdf
• Harvard Health Publishing 2019, All About Gout, Harvard Health Publishing, viewed 5 March 2020, https://www.health.harvard.edu/newsletter_article/all-about-gout
• Healthdirect 2018, Gout, Healthdirect, viewed 5 March 2020, https://www.healthdirect.gov.au/gout
• Musculoskeletal Australia n.d., Gout, Musculoskeletal Australia, viewed 5 March 2020, https://www.msk.org.au/gout/

(Answers: a, c, b)