Gout (Gouty Arthritis)

What are the symptoms of gout?

An "attack" of gout can develop suddenly and can very quickly involve excruciating pain.³

Common gout symptoms include:^3,4

Swelling in the legs or feet

Pain in the joints, decreased range of motion, tenderness and swelling

Mild fever, chill and a general unwell feeling

Gout attacks, or flares, can last for days or weeks, often starting at night

What causes gout?

Gout is triggered by a condition known as hyperuricemia.⁵ This is where there are increased levels of uric acid in the blood (a substance your body naturally creates when breaking down purines).⁴ The high level of uric acid leads to the accumulation of uric acid crystals in joints and surrounding tissues.^3-5 The body's immune system is alerted to the high level of uric acid crystals, resulting in persistent inflammation and pain.^3-5

Hyperuricemia is associated with certain risk factors which increase the chances of developing gout, these include obesity, poor diet and some medical conditions:⁶

• Poor diet, consisting of food and drinks containing high level of purines, is a risk factor associated with hyperuricemia. During digestion, purines are broken down and converted into uric acid, therefore contributing to the development of gout^3-6
  • Foods with high level of purines include processed foods, red meat and seafood^3,6
  • Alcohol, particularly beer, also has a high level of purines^3,6
• Obesity is a known risk factor in developing gout as it increases the rate of uric acid production^3,6
• Hypertension, also known as high blood pressure, can lead to hyperuricemia as the body is unable to remove as much uric acid as it needs to⁶
• Diabetes can also lead to increased blood levels of uric acid⁶

What are the long-term effects of gout?

If left untreated, gout can get progressively worse. Long-term effects of gout include:

• The formation of tophi, which are small hard lumps of uric acid crystals that appear under the skin⁶
• Joint damage and wearing away of the joint³
• Increased risk of cardiovascular disease and chronic kidney disease. In some cases, chronic kidney disease can result in renal stones or kidney failure^6,7

It's important to note that gouty arthritis is one of the most well-understood and manageable forms of arthritis.⁶
Early intervention and treatment can prevent progression to advanced symptoms.⁶

What to do if you are experiencing the symptoms of gouty arthritis

If you are displaying any symptoms of gouty arthritis, it is important you speak to your doctor to obtain an accurate diagnosis.

How is gouty arthritis diagnosed?

A small joint fluid sample is taken by a healthcare professional — often by a bones and joints specialist known as a rheumatologist. This sample is studied under a microscope to look for uric acid crystals.^4-6

Imaging methods such as x-rays, ultrasounds and CT scans are also used to visualize uric acid crystals, tophi and bone damage caused by the gout.^3,6

Living with gout

Gouty arthritis can have a huge impact on quality of life due to the pain, frequency of gout attacks and their intensity, as well as the number of joints in the body affected.⁹ It is also common for gouty arthritis to occur alongside other conditions, such as cardiovascular disease and kidney disease.⁹

A gout diagnosis can be overwhelming. We hope the information on this page will help to answer questions you may have about living with the disease.

How is gout treated?

It is important to manage gouty arthritis to treat the pain and inflammation associated with gout attacks and prevent further build-up of uric acid crystals.⁶ Gout is usually treated with anti-inflammatory drugs to reduce the severity of a gout attack. Examples of these include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) - medicines that are widely used to relieve pain and reduce inflammation^3,5
• Colchicine can be prescribed to treat inflammation^3,5
• Corticosteroids may be given via injection or oral tablet to control inflammation and pain^3,5

Lifestyle changes can also help to bring gouty arthritis attacks under control, including:⁶

• Diet modification
• Weight-loss for obesity
• Increased exercise

There are a range of treatment options that can be discussed with your doctor or specialist.^7,10

References

1. Schlesinger N. Difficult-to-treat gouty arthritis: a disease warranting better management. Drugs. 2011;71:1413-39.
2. Safiri S, Kolahai AA, Cross M, et al. Prevalence, Incidence, and Years Lived With Disability Due to Gout and Its Attributable Risk Factors for 195 Countries and Territories 1990-2017: A Systematic Analysis of the Global Burden of Disease Study 2017. Arthritis Rheumatol. 2020;72:1916-1927.
3.  Mayo Clinic. Diseases & Conditons -Gout [online]. Available from: https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897. [Last accessed: May 2022].
4.  CDC. Arthritis Gout [online]. Available from: https://www.cdc.gov/arthritis/basics/gout.html. [Last accessed: May 2022].
5. Pillinger MH and Mandell BF. Therapeutic approaches in the treatment of gout. Seminars in Arthritis and Rheumatism. 2020;50.
6. Ragab G, Elshahaly M and Bardin T. Gout: An old disease in new perspective - A review. J Adv Res. 2017;8:495-511.
7. Dehlin M, Jacobsson L and Roddy E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol. 2020;16:380-390.
8.  Gonzalez E. An update on the pathology and clinical management of gouty arthritis. Clin Rheumatol. 2012;31.
9.  Chandratre P, Roddy E, Clarson L, et al.  Health-related quality of life in gout: a systematic review. Rheumatology (Oxford). 2013;52:2031-40.
10. So A, De Meulemeester M, Pikhlak A, et al. Canakinumab for the treatment of acute flares in difficult-to-treat gouty arthritis: Results of a multicenter, phase II, dose-ranging study. Arthritis Rheum. 2010;62:3064-76.