Gout is the second most common form of arthritis in New Zealand and more prevalent here than anywhere else in the world. Māori and Pasifika people are particularly affected, mainly due to genetic factors.

Gout causes sudden attacks of severe pain and swelling in the joints, usually starting in the big toe. If left untreated, more attacks may occur and spread to other joints such as knees, elbows, wrists and fingers. Gout can damage joints and kidneys.

What is gout?

Gout attacks happen when there is too much uric acid in your blood. Uric acid is produced when proteins called purines are metabolised from food, and most of it usually passes out of the body in your urine.

Uric acid can build up in your blood if you are overweight, take certain medicines, eat foods containing purines, or have kidney problems. The uric acid turns to sharp, needle-shaped crystals that cause pain and swelling in the joints and can damage cartilage. Crystals under the skin cause lumps called ‘tophi’, while crystals in the kidneys can lead to kidney stones.

People often think that gout arthritis is caused by overeating and drinking too much alcohol but this is only part of the whole story. The main reason for high uric acid levels in your blood is because your body cannot get rid of it properly. This could be because of your genes, weight or existing kidney problems.

Who gets gout?

Some of the factors that contribute to gout arthritis are:

Family history: Some Māori and Pasifika people have genes that make it harder for their bodies to get rid of uric acid. Gout arthritis runs in families, although not all family members will get it, and some people develop gout arthritis with no family history of the disease.

Excess weight: Being overweight or obese slows down the removal of uric acid by your kidneys.

Age: Teenagers have been known to have gout attacks, but it most often affects men over the age of 40 and women after menopause.

Food and drink: You increase your risk if you drink a lot of sugary drinks or alcohol, or eat too much food such as liver, meat or seafood.

Medications: Water or fluid pills (diuretics) can reduce the kidney’s ability to flush uric acid from the blood.

Other conditions: High levels of cholesterol and blood sugar, high blood pressure, and kidney disease can all increase the risk of gout arthritis.

(Major et al. Evaluation of the diet wide contribution to serum urate levels: meta-analysis of population based cohorts BMJ 2018; 363:k3951 doi:10.1136/bmj.k3951.) SOURCE: www.health.govt.nz

Warning signs of gout

• Gout attacks usually occur suddenly, often overnight. The joint will be swollen, red and shiny and extremely painful.
• An attack may last for 7 to 10 days.
• Lumps (tophi) may grow on elbows, hands and feet. These can become sore and swollen and cause skin ulcers.
• Damaged joints are painful and stiff.
• If untreated, gout attacks may become more frequent.

How is gout diagnosed?

Uric acid levels can be measured by a simple thumb-prick blood test. It’s good to have your blood tested at least once a year and try to keep your uric acid level below 0.36 millimoles per litre (mmol/L) to prevent gout attacks.

Gout arthritis can also be diagnosed by testing a sample of fluid around the joint for urate crystals. X-rays will show damage to the joints in advanced stages of the disease, but are not useful for diagnosis as they are often normal in the early stages.

How can I manage my gout?

You do not need to put up with the pain of gout attacks. By watching what you eat and drink and taking medications every day, you can control gout arthritis and prevent damage to your joints and kidneys.

Medication for gout

There are two types of medicine for gout – those that bring your uric acid levels down and those that treat gout attacks. Uric acid medicines should be taken every day, even when you do not have a gout attack:

• allopurinol stops your body making too much uric acid and is for those who have more than one gout attack each year, or who have gouty lumps or kidney stones. See your doctor immediately if you get a skin rash while taking this medicine.
• probenecid helps your body get rid of uric acid through your urine. It is very important to drink at least 6 to 8 cups of water every day if you are taking this medicine or it may cause kidney stones.
• Febuxostat is used to prevent gout attacks or flares and is also called Adenuric. It is used when other medicines like allopurinol cannot be taken or haven’t worked well. Febuxostat is not a treatment for a gout flare – it does not relieve short-term pain and swelling, but you must keep taking febuxostat if you get an attack and are already taking it. Febuxostat is available as tablets (80 mg or 120 mg). Febuxostat is a medication that is metablolised by the liver so your doctor will keep an eye on your liver function while you are taking this medication. If you notice signs of an allergic reaction, such as sudden redness of your skin, skin rashes, itching, swelling of your face, lips or mouth, and problems breathing, such as shortness of breath or wheezing.

Gout attack medicines relieve the pain and swelling, but they do not treat gout arthritis itself:

• non-steroidal anti-inflammatory drugs (NSAIDS) such as naproxen, diclofenac (Voltaren) and ibuprofen should only be used for a short time because they can cause side-effects such as stomach problems, skin rash, and kidney and heart problems.
• steroids can be taken as tablets or by injection. They can make diabetes difficult to control, so discuss this with your doctor if you have diabetes.
• colchicine is usually only used if NSAIDS and steroids are not suitable for you. Make sure you take the correct dose and stop taking it immediately if you have stomach pain, diarrhoea, nausea or vomiting.

Protecting joints from gout

Gout attacks are extremely painful – even the pressure of sheets and blankets can be agonising. Sit where people won’t bump into you and put something under the bedcovers to lift them off your sore joints. Try an ice pack and keep the painful joint raised. Do not exercise during a gout attack but rest until your symptoms improve.

Healthy eating for gout

If you are overweight, losing a few kilograms gradually is the most effective treatment for gout arthritis. Avoiding some foods will help lower the level of uric acid in your blood and prevent gout attacks. You may find particular foods trigger a gout attack but this is different for everyone.

• Eat three meals a day – starving or feasting can bring on a gout attack.
• Eat less chicken, meat and seafood – these foods contain high levels of purines.
• Enjoy low-fat dairy foods, fruit and vegetables every day.
• Drink less alcohol – beer is most likely to cause gout attacks as it contains more purines than other forms of alcohol.
• Drink plenty of water (6 to 8 cups a day) and avoid sugary drinks.

Footwear

Gout in the feet can make it hard for you to walk or wear shoes. Sandals, jandals, slippers or old shoes do not support your feet well and can affect your balance. The right footwear will be comfortable and help prevent further joint damage. Shoes should have:

• plenty of room if your foot swells (not too tight)
• a wide toe
• laces or Velcro so you can tighten or loosen the shoe
• a cushioned insole that supports your foot
• a deep heel so your foot sits properly in the shoe
• a small heel – high heels can cause problems for your feet, knees and legs
• a firm sole that is not worn down.

Support

Make sure you and your whānau/family know what to do if you have a gout attack and talk to them about how they can support you to get enough exercise and eat foods that will prevent gout arthritis. Encourage others to get treatment too if they have signs of gout because it might run in your family. Your doctor will help you make a plan to manage your gout well by taking regular blood tests and monitoring your medication. By working together, you can beat gout arthritis and prevent unnecessary suffering for yourself or your family.

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• Gout Arthritis and Purines – Should people with Gout avoid foods high in purines?
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