What is Gout?

Gout is an arthritis due to crystals, not the ‘new-age’ sort that you buy in shops (!), but rather crystals of uric acid which accumulate in the body. Uric acid is an insoluble compound that can become precipitated into tissues and joints as crystals. Gout used to be thought of as being an arthritis that affected overweight men who indulged in port, offal and prawns, or so the urban myth went! We don’t eat so much offal these days (thank goodness?!), yet gout is still very common….

Gout is a condition that results from the accumulation of excess uric acid in the body. Uric acid is an insoluble compound that can become precipitated into tissues and joints as crystals.

In Rheumatology, Gout is known as a ‘Crystal Arthropathy’ because it causes an arthritis due to the crystals of uric acid being deposited in the joint which trigger an immune response.

How can Gout affect you?

Gout can cause 3 things – but not everyone gets all 3.

Episodes of acute inflammation with red swollen and painful joints


Chronic long term arthropathy

Gout can cause what we call ‘acute flares’ where there is a sudden onset of very painful inflamed arthritis, affecting one or more joints. It can also result in the cumulative deposition of these crystals in the connective tissue, which are known as ‘tophi’.
What is a typical acute episode of Gout?

A typical episode of gout involves the sudden onset of a red, painful and swollen joint.

It usually affects the big toe, but can also involve other joints.

The affected joints are exquisitely painful and sensitive to touch

Usually one joint is affected, but multiple joints can also be involved.

What are Tophi?

Tophi are calcified chalky uric acid crystal deposits under the skin. They usually occur on pressure areas, but can also occur in the pulps of the fingers.

Common places are the olecranon area (tip of the elbow), ears, fingers and toes.
Are there any problems with long term Gout?

Long term gout, particularly not controlled, can cause some issues due to accumulated uric acid in the tissues. Things that can happen are:

Kidney stones – made from excess uric acid

Tendon and Joint damage from enlarging and eroding tophi

Painful and/or large tophi affecting the movement of joints

Not everyone gets affected by these things. In particular if gout is well controlled with medication complications are less likely.

Who gets Gout?

Gout is much more common in men than women. In fact, it is very rare in a woman who has not yet gone through menopause. Gout usually starts in the twenties and thirties for men.

About 3% of the population have gout and its incidence has increased since the 1970s.
What causes Gout?

Gout is caused by an accumulation of uric acid in the body. In brief, this can happen by:

  1. Too much uric acid being produced or consumed


  1. A problem removing uric acid from the body

The cause of that can be genetic – with enzyme deficiencies.

Other causes of Gout:

  1. Too much uric acid produced – eg Hematological malignancies
  2. Poor excretion of uric acid – such as in kidney failure
  3. High purine diet
  4. Some medications such as:
    1. Aspirin (regular)
    2. Some chemotherapy drugs
    3. Some diuretics
    4. Cyclosporin
  5. Rapid weight loss
  6. Alcohol – in particular beer, which has a high purine content.
  7. Hypertension
  8. Unknown

Often, we don’t completely understand why it happens. Some food and lifestyle choices contribute to an excess build up of uric acid. Common things are alcohol, high fructose diet, and a high purine content in the diet. eg eating too much red meat and seafood. Acute attacks can be ‘triggered’.

How do we diagnose Gout?

Gout is mainly a clinical diagnosis, based on the pattern of the clinical problems, ie joint swellings and tophi. Tests that are done are usually to confirm the diagnosis.

Common tests are Uric Acid, inflammatory markers such as ESR and CRP.

Sometimes a needle will be placed in an affected joint to take out fluid if there is any doubt about the diagnosis. This fluid can be examined for the presence of uric acid crystals.

Are there common 'triggers' for a Gout flare?

There are some things that commonly trigger gout, but they are not the same for each person.

The best way to know is to see what your body responds to. Common things that people report trigger their gout attacks are:



High purine meals such as red meat or seafood

It is now thought that fructose is an important part in triggering a gout attack. The best thing is to observe what happens with your own body, as what happens for others may not be what makes a difference for you.

How do we treat gout?

We treat gout in different stages.

  1. Dealing with the acute attack
  2. Preventing further attacks of gout.

When there is an acute flare, it needs to be treated to settle down the inflammation and pain

and then we need to see if we can

Prevent further attacks from happening.

Treating an acute flare of Gout:

Each treatment is tailored to you, your needs, and your responses to medications as everyone is different. The following steps are considered:

  • Drugs: drugs used to treat an acute flare can include:
    Colchicine, NSAIDs, prednisolone.
    Which of these agents are used and their dose will be determined under the guidance of your Rheumatologist as each person is different.
  • Stop what triggered your gout!
    Eg alcohol, excess meat etc
  • Drink Water!!
    Staying well hydrated helps the kidneys to remove uric acid from the body.

Preventing further attacks of Gout:

  • Remove the things that contribute to gout
    eg alcohol, high levels of fructose etc
  • Take medications as needed to reduce the level of uric acid in the body.
    Common medications are: Allopurinol, Probenecid and newer agents such as Febuxostat

Your Rheumatologist is the best person to advise you and guide you on the best management of your gout.

What is the long term outlook with Gout?

These days, we have excellent treatments for gout. If the gout is well controlled with medication and lifestyle, it is less likely to get long term problems such as the accumulation of tophi. People with normal kidney function and no tophi seem to do better in the long term with it being likely to have the disease well controlled with medications.

Its important to note that high levels of uric acid are associated with what is known as ‘The Metabolic Syndrome’.

This is an association with:

  • Obesity
  • Diabetes
  • Hypertension
  • And subsequently an increased rate of cardiovascular disorders

Its important to see your GP if you have high uric acid to be evaluated for Metabolic Syndrome and have appropriate treatment.

Take Home Messages about Gout

Gout is an arthritis cause by excess uric acid.

It is more common in men than women and can come on early in life.

Both lifestyle changes and medications are important to control the disease and prevent further episodes.