Gout is a type of arthritis caused by the build-up of uric acid, which leads to painful inflammation in a joint. The big toe is most commonly affected, but gout can affect the hands, wrists, knees, ankles, elbows or any other joint.
What is gout?
Uric acid is a normal waste product mostly excreted by the kidneys. It is typically found in the blood, and comes from the breakdown of cells, DNA and the food and drinks you consume each day.
Sometimes, uric acid can build up in the blood, either because it's not excreted quickly enough or because too much is being produced. This excess can form crystals in the joints (known as ‘urate’). Gout occurs when these crystals cause sudden and severe inflammation of the joint.
Symptoms of gout
The symptoms of gout usually come on rapidly and can last 1 to 2 weeks. They 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
Who gets gout?
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. 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
Can certain foods trigger gout?
There is no 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
There is little scientific evidence that avoiding these foods will reduce the risk of a gout attack, and by doing so you may miss out on important nutrients and vitamins. It's also been claimed that fructose, a sugar found naturally in fruits and vegetables, can trigger gout but there is no evidence to support this either.
If you find that certain foods trigger your gout, you may benefit from reducing your intake of those foods. But 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.
How is gout diagnosed?
Often, the diagnosis of gout is obvious, especially if a person has had gout before. A red, hot, 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'.
If you have not had gout before, or you are not sure what is causing your symptoms, see your doctor. The doctor may take a sample of fluid from the joint with a thin needle and send it to a laboratory. Urate (crystals) might be seen in the fluid, under a microscope.
A blood test may also show elevated levels of uric acid in the blood (although it is possible to have high uric acid blood levels and 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.
Treatment of gout
The prompt treatment of gout will help relieve the pain and inflammation caused by acute gout, and help prevent irreversible damage to the joint and the nearby bone. Over time, recurrent attacks can also cause kidney stones, kidney damage and 'tophi' – solid lumps of urate crystals often found in the ears, fingers, hands, forearms, knees and elbows.
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 corticosteroids (taken by mouth or injected into an affected joint) or colchicine. These medications will quickly relieve the pain and reduce the swelling and redness.
It is also important to rest the joint. Putting ice on the joint and elevating it can help ease the pain.
Prevention of 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)
Where to seek help for gout
Last reviewed: September 2018