Gout

What is gout?

Gout is a painful joint inflammation caused by uric acid crystals.

How it develops

• The uric acid level in the blood becomes too high.
• Excess uric acid forms sharp, needle-like crystals inside the joint.
• The body’s immune system attacks the crystals, causing sudden, severe inflammation.
• Repeated attacks damage the joint and form hard lumps called tophi.

Risk factors

• Men above 40, and women after menopause
• High-purine diets — red meat, internal organs (offal), and seafood such as anchovies, prawns and shellfish
• Sugary drinks and alcohol, especially beer
• Obesity, high blood pressure, diabetes, kidney disease
• Some medicines, such as water pills (diuretics) and low-dose aspirin
• Not drinking enough water

Symptoms and signs

• Sudden, severe pain, often starting at night
• The big toe is most common; also the ankle, knee and wrist
• The joint is red, hot, swollen and very tender — even a bedsheet touching it hurts
• An attack usually settles in 7 to 10 days
• Tophi in long-standing gout, at the ear, elbow or fingers

Management plan

During an attack

• Rest, ice and raise the limb
• Anti-inflammatory tablets, colchicine or steroid (as prescribed)
• If you are already on allopurinol, continue it — do not stop

Long term

• Uric acid-lowering medicine (allopurinol or febuxostat) for repeated attacks or tophi
• Target uric acid below 360 µmol/L
• Reduce trigger foods and sugary drinks
• Drink plenty of water
• Lose weight
• Control blood pressure and diabetes