What is gout? Your guide to this painful condition

Painful and debilitating, the number of people suffering from gout is on the rise – but what exactly is it and how can it be managed?

Gout is a form of arthritis that causes severe pain, redness and joint tenderness.

According to a study by the Kolling Institute of Medical Research, Australian cases have increased by up to 20 per cent in the past two decades – making Australia the second most prevalent country in the world for gout behind New Zealand.

In the study, lead researcher Dr Emma Smith said the trend of increasing gout cases is likely to continue as the ageing population rises.

“Attempts to lessen the disease onset and future burden of gout require better awareness, especially of risk factors and early diagnosis and treatment,” wrote Dr Smith in the study report.

What causes gout?

Gout occurs when urate builds up in the blood and forms crystals in a joint.

Our body usually eliminates urate through the kidneys and passes it in the urine.

But when we make too much urate, or if we have too much in our diet, it may form the crystals that can trigger a sudden attack of gout that may last a few days to a few weeks.

Gout most often affects the big toe, but can also affect the feet, ankles, knees, elbows, wrists and fingers.

What are the symptoms of gout?

Severe joint pain, swelling and redness and the joint feeling hot are signs of gout.

“Gout is still probably under-diagnosed,” says Adelaide rheumatologist Dr David Bursill, of Arthritis Australia.

“Because it is episodic, people don’t always seek treatment. But it is a chronic disease.

“People think it flares up and relapses but if you’ve had one flare of gout, you have gout, and unless you take something to dissolve the crystals, they remain in the joint causing damage.”

Who it at risk of gout?

While anyone can be affected by gout, it is more common in men, and more likely in older people.

A UK study found having a parent with gout doubles your risk of getting the disease, while other factors that may increase risk of gout include using diuretics, being overweight or obese, and having kidney disease.

Dr Bursill says artificially sweetened soft drinks can substantially increase urate levels and lead to crystal formation and gout.

“The association with cardiovascular risk factors like high blood pressure and type 2 diabetes is increasing,” says Dr Bursill.

“I think lifestyle issues have been driving the rise in cases although the connection isn’t well known.”

He adds some heart medications and diuretics also increase urate levels in the blood, as do foods such as red meat, shellfish, offal and beer.

How is gout treated?

A doctor will be able to confirm a gout diagnosis and recommend the best course of treatment.

Some medications can help manage pain and swelling caused by gout, while others are prescribed to lower uric acid levels and reduce further attacks.

However, Dr Bursill says preventative treatments may take some time to take effect so it’s important to stay with the program.

“A week or two after starting medication a patient may have a worse flare, think the medication isn’t working and stop it,” he says.

“It’s important for patients to understand this may happen for the first few months but eventually those flares peter out.”

Can diet help prevent and manage gout?

A long-term study comparing the DASH – or Dietary Approaches to Stop Hypertension – diet and a western diet found the DASH diet was linked to lower risk for gout.

The DASH diet includes a high intake of fruits, vegetables, nuts, legumes, low-fat dairy products and whole grains and lower amounts of salt, sweetened drinks and red and processed meats.

Maintain a healthy body weight and lose weight slowly if you need to – rapid weight loss can increase uric acid levels, according to Musculoskeletal Australia.

The organisation also recommends drinking plenty of water and exercising for at least 30 minutes on most days of the week.

Eating foods with lower purine levels – as purines help form urates – may help manage gout, too, so foods to avoid include beer, red meat, offal, shellfish and artificial sweeteners, says Dr Bursill.

Written by Sarah Marinos.