Gout Causes and What Causes Gout

Gout causes sudden attacks of severe pain, heat and swelling in a joint, most often the big toe. Underneath it all is too much uric acid in the blood: when levels stay high for a long time, needle-shaped crystals form in and around the joints, and the body's reaction to them brings on an attack. Common gout causes include your genes, kidneys that clear too little of it, extra weight, alcohol, sugary drinks and some medicines.

Key takeaways

• Gout happens when crystals form in a joint, causing sudden pain and redness, often in the big toe.
• The body makes most of its own uric acid; food, alcohol and sugary drinks add to it.
• An attack settles within one to two weeks, and treatment started early shortens it.
• Daily medicine from a doctor can keep levels low and help stop attacks coming back.
• A hot, red joint with a fever needs urgent care, because it can be an infection.

What Gout Is: Uric Acid Crystals in a Joint

Gout is a form of arthritis caused by uric acid crystals building up in a joint. Uric acid, also called urate, is a waste product made when the body breaks down purines, natural substances found in your own cells and in many foods. Normally the kidneys clear it in urine. When too much is made or too little is cleared, it builds up in the blood and can settle as crystals.

Diet plays a smaller part in gout causes than many people think: the body makes about two thirds of its own urate, and food and drink add the rest.

In Australia, a healthy diet for gout looks much like any heart-healthy diet.

Common Symptoms of Gout Attacks

The main symptoms of gout are sudden, severe pain in one joint, with redness, heat and swelling, often starting at night. The joint at the base of the big toe is the most common place, but the ankle, foot, knee, wrist, fingers and elbow can be affected too. The affected joint can be so tender that even a bedsheet hurts, and some people feel feverish and unwell.

Gout attacks usually peak within a day and settle over one to two weeks, even without treatment. Between attacks the joint often feels normal. If urate levels stay high, though, attacks tend to come back more often, last longer and spread to more joints. Over years, crystals can form lumps called tophi under the skin, damage joints and cause kidney stones.

Gout is common, and more so with age: it mostly affects men from their 30s on and women after menopause. Gout causes symptoms that can look like other problems, such as a joint infection, so a first attack is worth checking with a doctor. Some medications can also set off an attack, and your doctor can review them.

How High Uric Acid Leads to Crystals

High uric acid leads to crystals because blood can hold only so much of it dissolved. Above about 0.40 mmol/L it can come out of solution and form needle-shaped urate crystals, especially in cooler joints such as the toes. High levels of uric acid can be present for years without any symptoms. An attack starts when crystals shed into the joint space and the immune system reacts to them, causing inflammation that leaves the joint red, hot and swollen. That reaction is why gout causes such sudden, severe pain.

Types of Arthritis

There are more than 100 types of arthritis, and gout is one of the inflammatory kinds. Osteoarthritis, the most common, is wear of a joint's cartilage. Rheumatoid arthritis usually affects several small joints on both sides of the body at once. Gout usually starts in one joint at a time, with sudden, severe pain. Pseudogout, caused by a different crystal, can give similar symptoms, so testing fluid from the affected joint helps tell them apart.

How a Gout Attack Is Treated

A gout attack is treated by calming the joint as early as possible, with rest first and medicine if needed. Rest and raise the affected joint, keep the bedclothes off it, and hold an ice pack wrapped in a cloth on it for up to 20 minutes at a time. Drink water and avoid alcohol until it settles.

Medicines work best when started within the first day. A doctor may suggest an anti-inflammatory medicine, another medicine that calms gout, or a short course of steroid tablets or a joint injection; some of these are only available on prescription in Australia. The choice depends on your other conditions: some tablets don't suit people with kidney problems, heart disease or stomach ulcers, and steroids can raise blood sugar in people with diabetes. Pain and swelling usually ease within a few days of starting treatment. If you develop gout that keeps coming back, long-term treatment is the next step.

Testing Uric Acid Levels and Treatment Targets

Doctors diagnose gout from your symptoms, an examination of the joint and tests. The surest test is drawing a little fluid from the joint with a needle and looking for urate crystals under a microscope, which also rules out infection and tells gout apart from another type of arthritis. A blood test measures uric acid levels, but the result can be normal during an attack, so it's often repeated a few weeks later.

Once long-term treatment starts, the target is to keep uric acid below 0.36 mmol/L, or lower if you have tophi. A blood test every few weeks shows when the target is reached, then once or twice a year. Staying on target slowly dissolves the crystals and helps prevent complications such as joint damage, tophi and kidney stones. Your GP can arrange these tests with a pathology request.

Long Term Treatment to Prevent Gout

Long-term treatment to prevent gout starts with habits that lower urate, and adds a daily medicine when attacks keep coming. Drink plenty of water, limit alcohol and sugary drinks, keep serves of offal, red meat and shellfish small, and lose weight slowly if you need to, because crash diets can trigger attacks. Keeping high blood pressure, cholesterol and blood sugar under control helps too.

Medicines to help prevent gout lower the level so that urate crystals slowly dissolve. A doctor usually suggests one if you have two or more attacks a year, tophi, joint damage or kidney stones, and these urate-lowering medicines are only available on prescription in Australia. They're started at a low dose and increased until your blood test reaches its target, then taken every day, often for life, even between attacks.

Attacks can be more frequent in the first few months, so a doctor may add a low dose of a medicine that settles gout for that time. Stopping the daily medicine lets the level rise again, and the attacks return.

Who Is More Likely to Get Gout

Gout is more likely in men, in older adults and in women after menopause, when urate levels rise. It runs in families, and it's more common in people of Māori or Pacific Islander background. Other health conditions raise the risk too, including kidney disease, high blood pressure, diabetes, obesity, high cholesterol and heart disease. So do some medicines, such as certain fluid tablets, and drinking alcohol or sugary drinks often. Many people with gout have one or more of these conditions, so a GP looks for them. Years of high levels can leave urate crystals that cause swelling even between attacks.

When to See a Doctor About Joint Pain

See a doctor about a first attack of sudden, severe pain in a joint, so the cause can be confirmed. Go back if attacks keep returning, you notice lumps under the skin, or your treatment isn't keeping urate levels on target. If you have high blood pressure or kidney problems, ask your GP how gout treatment fits with your other medicines.

Go to an emergency department, or call 000 if you're very unwell, for a hot, red joint with a fever or chills. A joint infection can look like gout, with the same inflammation and swelling, and it needs urgent treatment.

Summary

Gout causes sudden, painful attacks when uric acid builds up as crystals in a joint, and the right tests and treatment can bring levels down. If you're concerned about gout causes or your attacks, a Medio GP can talk it through by phone, request a uric acid blood test and discuss long-term treatment with you.

Frequently asked questions

What is the main reason for gout?

The main reason for gout is too much uric acid in the blood for a long time. What causes gout to flare is urate crystals forming in a joint and the body reacting to them. High levels usually come from the kidneys clearing too little, because of genes, kidney problems or some medicines; food and alcohol add to it.

What are the 10 foods that trigger gout?

The foods and drinks most linked with gout attacks are high in purines or fructose: offal such as liver and kidney, red meat, game meats, shellfish such as prawns and mussels, sardines and anchovies, meat-based gravies and stock, beer, spirits, sugary soft drinks and fruit juice. Smaller serves and fewer drinks help.

Can a doctor help with gout causes?

Yes. A GP can look at what is pushing your urate up, such as your kidneys, weight, alcohol, other conditions and the medicines you take, and arrange a blood test. They can explain who is at risk for gout, treat an attack, and start long-term medicine if it's right for you. A Medio GP can do this by phone for adults 18 and over, and will tell you if the joint needs to be examined in person.

How to make gout go away?

An attack goes away by itself within one to two weeks, and sooner with treatment. Things you can do to help a gout attack include resting and raising the joint, using an ice pack, drinking water, avoiding alcohol and starting the medicine your doctor recommends early. To stop it coming back, you control gout long term by keeping urate below target with daily medicine and healthy habits.

Can stress bring on gout attack?

Physical stress can. An illness, an operation, an injury, dehydration or a crash diet can all set off an attack. Emotional stress is often mentioned by people with gout, but its effect is less clear. Things that increase risk of gout flares more reliably are alcohol, sugary drinks, large purine-rich meals, and starting or stopping urate-lowering medicine.

Can drinking lots of water help with gout?

Yes, staying well hydrated helps. Water helps the kidneys clear uric acid in urine and lowers the chance of kidney stones, and dehydration can trigger an attack. Water alone won't bring high levels down enough to stop attacks, though, so it works alongside diet changes and, where needed, medicine.