Gout is a common type of arthritis and has the unique distinction of being one of the most frequently recorded medical conditions throughout history. It is sometimes considered a ‘rich man’s’ disease because it is often associated with the intake of too much rich food and alcohol.
Gout occurs when there are abnormally elevated levels of uric acid in the blood and tissues. Uric acid is the end product of the metabolism of chemicals called purines that are found in many foods. Purines are also found naturally in the body. Normally, the body disposes of excess uric acid via the urine, but in people with gout uric acid accumulates in the body.
This can be due to reduced excretion of uric acid by the kidneys or to overproduction of uric acid by the body. This accumulation of uric acid may also cause kidney stones.
When uric acid accumulates in the blood and tissues it can crystallise out into a joint, forming a multitude of tiny, jagged, needle-shaped crystals. This triggers an intense inflammatory response that causes a painful arthritis attack called a gout attack.
This type of attack commonly strikes the base of the big toe, but other joints can be affected, including the instep, ankle, knee, wrist, elbow and fingers.
Symptoms of an attack include:
A gout attack usually strikes unexpectedly, but usually subsides in a few days with treatment. However, some people experience pain for several weeks. Gout attacks often re-occur and without the correct management, attacks may become more frequent.
You should contact your doctor if severe pain in a joint recurs or lasts more than a few days, especially if the pain is accompanied by chills or fever.
Some people may have high levels of uric acid in the blood (this is called hyperuricaemia), but have no arthritis pain. This sometimes happens to close relatives of gout sufferers. Many people with high levels of uric acid do not develop gout, while sometimes people with repeated gout attacks have normal or low levels of uric acid.
Gout is roughly 9 times more common in men than women and is most common in middle-aged men. It is strongly associated with being overweight and having high blood pressure. Gout can also occur in women, more commonly after menopause.
Maori and Pacific Islander peoples tend to have high uric acid levels and are predisposed to gout. In Australia, the type of individual most commonly affected by gout is an overweight man who drinks large amounts of alcohol, is a regular meat-eater and who may have high cholesterol and high blood pressure.
Uric acid is a by-product of the breakdown of certain foods in the body, and gout was once considered to be closely related to diet. It is now understood that inheriting it is the most common reason for gout to occur.
Certain medications, such as some types of diuretics, can also cause gout. Aspirin and niacin can also raise uric acid levels. Also, certain diseases can lead to an excessive production of uric acid in the body, including some leukaemias, lymphomas and some haemoglobin disorders.
Some studies have indicated an increased prevalence of abnormally low thyroid hormone levels (called hypothyroidism) in people with gout.
There are a number of conditions that can cause acute attacks of gout. These include:
Blood tests can be done to measure the amount of uric acid in the blood, although this may not be conclusive of gout.
Also, your doctor can insert a needle into the affected joint, remove some fluid from the area and examine this fluid for the uric acid crystals characteristic of gout. This can also exclude other problems (such as infection) being the cause of the painful swollen joint.
Preventing acute gout attacks is equally as important as treating the gout. Prevention of gout generally involves:
People experiencing gout attacks should, however, avoid medicines containing aspirin as these can make gout worse.
When the affected joint is a big toe, a box or cage to keep the bedclothes off the toe may be helpful.
Last Reviewed: 12 June 2009