What is gout?

Gout is a condition that can cause attacks of a type of arthritis (joint inflammation).

The big toe is the joint most affected by gout. But gout can affect any joint in your body, including your:

• feet
• ankles
• knees
• wrists
• elbows

Over time, recurrent attacks of gout can cause permanent damage to your joints.

Gout is more common in males than females. It's more common in older people and is rare in females who have not reached menopause.

What are the symptoms of gout?

The first symptoms of gout are usually:

• sudden severe pain and swelling in a joint
• warmth and redness of the skin over the affected joint
• restricted movement of the joint
• the joint is very sore to touch

These symptoms usually develop quickly and can last for 1 to 2 weeks.

Sometimes, more than one joint is affected.

What causes gout?

Gout can happen when there is a build-up of a chemical called urate (uric acid) in your body. Urate is a normal waste product that comes from the breakdown of cells and the food and drinks you have.

Uric acid builds up either because:

• your kidneys do not excrete (remove) it quickly enough
• too much urate is being made in your body

Excess urate can form needle-like crystals in your joints. The crystals form slowly, over months or years, usually without symptoms.

Gout occurs when these crystals cause sudden and severe inflammation, which is triggered by your immune system.

What are the risk factors for gout?

You are more likely to develop gout if you:

• have increased urate levels in your blood
• take certain medicines, such as aspirin or diuretic medicines
• are male
• are older than 65 years
• have close family members who have had gout

Lifestyle factors that may increase your risk of gout include:

• eating a diet that includes a lot of meat and seafood
• drinking a lot of alcohol, especially beer and spirits
• drinking a lot of drinks that are high in sugar or fructose (such as soft drinks, sodas and concentrated juices)
• going on a crash diet or fasting (where you go without enough food for long periods and lose weight quickly)

Conditions that may increase your risk of gout include:

• overweight
• dehydration
• chronic kidney disease
• high blood pressure
• type 2 diabetes
• high cholesterol

Gout can also affect people receiving chemotherapy treatment for some cancers and those with:

• leukaemia
• multiple myeloma
• severe psoriasis

When should I see my doctor?

See your doctor if you have one or more joints that suddenly become:

• painful (and do not improve with pain-relief medicines)
• swollen
• stiff
• inflamed

Also see your doctor if you have a fever or feel generally unwell and can't function at home normally.

If you have had gout before and develop new symptoms, you should also see your doctor.

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How is gout diagnosed?

Your doctor will ask about your symptoms and health in general. They will check your medicines and ask about your diet and family history.

Your doctor will examine your painful joint. They will also look for other signs and complications of gout.

Tests for gout

Your doctor may take a sample of fluid from your painful joint. They will use a thin needle and send the fluid to a laboratory for tests. If you have gout, the laboratory will report urate crystals in the fluid.

Your doctor may also recommend a blood test to check your urate or uric acid levels.

An ultrasound scan of your painful joint may be recommended.

X-rays aren't usually used to diagnose gout. If you have recurrent attacks of gout, your doctor may refer you for an x-ray to see if any damage has been done to your joints

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How is gout treated?

Treatment for an attack of gout includes:

• self-care
• medicines for gout

Self-care for an attack of gout

You can get relief from gout symptoms and reduce pain by:

• applying an icepack or a cold pack for 10 to 15 minutes at a time
• resting your joint

Medicines for gout attacks

Pain-relief medicines for an acute attack of gout usually include non-steroidal anti-inflammatory medications (NSAIDs). Aspirin is not recommended.

In some cases, your doctor may prescribe other medicines to quickly relieve the pain and reduce the swelling and redness. These may include:

• corticosteroids (as tablets or an injection into a joint)
• colchicine (a medicine that can help with gout attacks but commonly has side effects including nausea, vomiting and diarrhoea)

Read more about medicines for gout.

Can gout be prevented?

People with gout need treatment to prevent further attacks and complications. This treatment involves:

• prescription medicines to lower your urate levels
• lifestyle changes

Medicines to help prevent gout

Medicines to prevent gout work by lowering the urate levels in your blood.

The most often used medicine is allopurinol. This helps to lower urate levels by reducing how much urate your body makes.

Read more about medicines for gout.

Lifestyle changes

You can also help reduce your chance of having further attacks of gout by:

• reducing your alcohol intake — in particular, avoiding binge drinking
• reducing your intake of sweetened drinks
• gradually losing weight if you are overweight, while avoiding fad diets
• eating a healthy, balanced diet
• drinking enough water, especially when you are at risk of dehydration (such as when you are sick)
• quitting smoking if you smoke or vape

Gout and diet

Limiting the amount of foods you eat that are rich in purines may be recommended. Purines are converted into urate in your body.

Foods with high levels of purines include:

• red meat and offal such as liver, kidneys and heart meat
• seafood, especially shellfish, scallops, mussels, herring, mackerel, sardines and anchovies
• foods containing yeast such as Vegemite and beer

While there is little proof that avoiding these foods will reduce gout attacks, it's still a good idea to avoid or reduce foods that you've noticed may trigger gout attacks.

It's best to seek the advice of your doctor or dietitian before making any changes to your diet. Most people find that a healthy, balanced diet — along with medicine — is enough to manage their gout.

Complications of gout

High levels of urate in your blood can also cause:

• kidney stones
• kidney damage
• 'tophi' — solid lumps of urate crystals

Tophi are most often found on your:

• elbows
• knees
• Achilles tendon (back of your heel)
• backs of your hands or feet
• outside of your ears

Resources and support

Speak with your doctor if you are worried about gout. You can also:

• Visit Arthritis Australia or call the Arthritis Infoline on 1800 011 041.
• Arthritis Australia also has information sheets on gout in languages other than English.
• Call the Musculoskeletal Australia Help Line on 1800 263 265 to speak with a nurse about gout.
• Find an accredited practising dietitian on the Dietitians Australia website or by using the healthdirect service finder.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.