Gout Te porohau
Gout is a form of arthritis caused by a build up of uric acid. Gout attacks cause severe pain and swelling in the joints and can lead to complications if left untreated.
Cause of gout
A lot of people think that gout is caused by food and drink such as seafood, meat, and beer. However, what you eat and drink only makes a small difference to your uric acid (also called urate).
High uric acid is mainly affected by your genes (passed on by your parents), your kidneys, and your weight.
Your kidneys usually filter out extra uric acid which then comes out in your wee (urine).
If you do not get rid of enough uric acid, the levels in your blood increase. The uric acid can then turn into tiny, sharp, glass-like crystals which collect in your joints causing gout.
The crystals can also cause lumps under your skin called tophi.
Māori and Pacific peoples are more likely to have the gene that stops their kidneys getting rid of enough uric acid.
Symptoms of gout
Gout causes severe pain, swelling and redness in one or more of your joints. It often affects your big toe but can affect your:
- knee
- foot
- wrist
- ankle
- hand
- elbow joints.
It can come on suddenly and often starts at night.
Diagnosing gout
Your healthcare provider will ask you about your symptoms and examine the affected parts of your body. They can usually diagnose gout by examining your sore joint. They will arrange a blood test to measure your uric acid levels, either at the time of your attack, or later.
If it is not clear whether you have gout or a joint infection, you may need to have a procedure called a joint aspiration. This involves taking fluid out of the affected joint using a needle and syringe. The fluid is sent to a laboratory to be tested.
Treating an attack of gout
Anti-inflammatory medicines are used for an attack of gout. These include non-steroidal anti-inflammatories (NSAIDs) and colchicine. Also, a class of drugs called corticosteroids, most often prednisone.
All anti-inflammatories can have serious side effects, especially if used for more than a few days. This is especially important if you have other health conditions and are on other medicines.
Your healthcare provider will discuss the medicines with you and give you advice on what is most appropriate for you.
Medications to prevent gout attacks
Your healthcare provider will recommend you take medication to lower the uric acid in your blood if you have:
- had more than 2 attacks of gout in a year
- complications of gout
- a strong family history.
This will reduce your chance of getting acute gout and long-term damage.
The goal with this medication is to keep your uric acid levels below 0.36 mmol/L. You will need blood tests to check your levels.
- You usually start the medication at a low dose and increase it slowly to reduce side effects.
- It can take weeks to months to work and you may get gout attacks when you are first taking it. You may need to take an anti-inflammatory medicine with your preventer for the first few months.
- It is important to take your urate-lowering medicine every day, even when you feel well. Continue taking it while you have a gout attack.
Urate-lowering medication is an ongoing, long-term treatment that you have to continue taking for many years.
- Allopurinol is the most commonly used urate-lowering medication.
- If you cannot take allopurinol, your doctor may prescribe another medicine such as probenecid or febuxostat.
Self-care for gout
There are things you can do to manage or improve your health. There are also things you can do to manage an attack and help prevent gout from coming back.
- Take your medication for an attack early and as prescribed by your healthcare provider.
- Rest and put your painful joint up on a pillow.
- Mould ice or frozen peas (wrapped in a tea towel) around your joint.
- Drink plenty of water.
- Do not stop taking your urate lowering medicine during an attack.
Know your uric acid level and aim to keep it low.
- Long-term control of your uric acid levels will help to reduce gout attacks in the future.
- The target uric acid level is 0.36 mmol/L or less. You will need to have blood tests once a month until you reach this level. After this, you can have blood tests every 6 to 12 months.
- To keep your level low, you may need to take a urate lowering medicine long-term even when you are well.
Complete a gout management plan with your healthcare provider. A gout management plan can help you manage gout attacks and track your uric acid level.
Have a heart and diabetes check. People with gout have a higher risk of getting diabetes, high blood pressure, heart disease and kidney problems.
Heart and diabetes check (internal link)
Get support and information through Arthritis New Zealand.
Gout — Arthritis New Zealand (external link)
- Aim to be a healthy weight. If you need to lose weight, lose it gradually, aiming for 1 to 2kg a month. Losing weight too quickly can trigger gout.
- Eat 3 meals a day. Starving or feasting can bring on a gout attack.
- Limit the amount of lean meat, chicken and seafood you eat to 2 small servings a day. A serving is the size and thickness of the palm of your hand.
- Aim to have at least 5 servings of vegetables and 2 servings of fruit a day. A serving is the amount that fits into the palm of your hand. Have low-fat dairy products and wholegrains daily.
- Drink plenty of fluid (8 cups a day). Avoid sugary drinks such as cordials, fruit juice and flavoured milk.
- Limit alcohol, especially beer as this can increase uric acid. If you do choose to drink alcohol, limit it to 1 to 2 standard drinks a day and have at least 2 alcohol-free days every week. A standard drink is a 330 ml bottle of beer, a 100 ml glass of wine or a 30 ml nip of spirits. During a gout attack, it is best to avoid all alcohol.
- You may find you need to limit a particular food that triggers your gout, such as tomatoes.