What causes gout?
Gout is caused by a build-up of uric acid, a normal waste product typically found in the blood. It comes from the breakdown of cells, DNA and the food and drinks you consume.
Uric acid can build up either because the kidneys do not excrete it quickly enough, or because too much is being produced. The excess can form crystals in the joints (known as ‘urate’). Gout occurs when these crystals cause sudden and severe inflammation of the joint.
Risk factors for gout include:
- taking medications that increase water excretion by the kidneys (diuretics)
- being overweight
- having kidney disease, high blood pressure, diabetes or abnormal levels of fat and cholesterol in the blood
- drinking a lot of alcohol, especially beer, port or spirits
- being of Maori or Pacific Islander origin, which can predispose a person to high uric acid levels
Gout is more common in men than in women, and among women it's more common after menopause. It's more likely to occur in older people, but can affect anyone.
What are the symptoms of gout?
The symptoms of gout include:
- pain in a joint, which can be quite severe
- swelling around the joint, which feels tender – even through clothing
- warmth and redness of the skin over the affected joint
- restricted movement of the joint
These symptoms usually develop rapidly and can last for 1 to 2 weeks.
A red, warm, painful and swollen big toe joint in a man aged over 40 usually points to gout. However, that could also indicate an infection in the joint or bone, or an unusual condition known as ‘pseudo-gout’.
How is gout diagnosed?
If your doctor suspects gout, they may take a sample of fluid from the joint with a thin needle and send it to a laboratory for tests. Urate (crystals) in the fluid might be seen with a microscope.
A blood test may also show elevated levels of uric acid (although you can have high uric acid blood levels but not have gout). While it's not usually used to diagnose gout, an x-ray may be used for people with recurrent gout to assess how much damage has been done to the affected joint.
Often, the diagnosis of gout is obvious, especially if you have had gout before. If you have not had gout before, or you are not sure what is causing your symptoms, see your doctor.
What is the treatment for gout?
The treatment of gout usually involves painkillers such as paracetamol (aspirin is not recommended) and non-steroidal anti-inflammatory medications (NSAIDs). In some cases, doctors may prescribe other medication to quickly relieve the pain and reduce the swelling and redness.
It is also important to rest the joint. Putting ice on it and elevating the joint can help ease the pain.
Getting treatment promptly will help relieve the discomfort and inflammation caused by acute gout, and help prevent irreversible damage to the joint and the nearby bone. Recurrent attacks can, over time, also cause kidney stones, kidney damage and ‘tophi’ — solid lumps of urate crystals often found in the ears, fingers, hands, forearms, knees and elbows.
How do I prevent gout?
Some people with gout experience recurrent attacks, which may be prevented by using prescription medications. These medicines work by lowering uric acid levels in the blood. The most commonly used is allopurinol. This helps to lower uric acid levels by reducing the body's production of uric acid.
You can also reduce your chance of having further attacks of gout by adopting some sensible lifestyle changes, such as:
- reducing alcohol intake — avoid binge drinking, in particular (see alcohol.gov.au for Australian Government guidelines on recommended alcohol intake)
- gradually losing weight if you are overweight, while avoiding fad diets
- eating a healthy, balanced diet
- drinking plenty of water, especially when at risk of dehydration (e.g. when you are sick or travelling in a plane)
There is no scientific evidence that particular foods cause gout, but some studies have shown that people who are prone to gout are more likely to eat foods rich in purines — a substance that's converted into uric acid within the body.
Foods with high levels of purines include:
- red meat and offal such as liver, kidneys and heart
- seafood, especially shellfish, scallops, mussels, herring, mackerel, sardines and anchovies
- foods containing yeast such as Vegemite and beer
It's best to seek the advice of your doctor or an accredited practising dietitian before making any changes to your diet. Most people with gout find that a healthy, balanced diet — along with medication — is enough to reduce their uric acid levels.
Where to seek help for gout
Last reviewed: September 2018