In short
Gout is a type of arthritis caused by crystals of urate forming in a joint. An attack brings sudden, severe pain, swelling and redness, most often in the big toe, and lasts one to two weeks. Genes and kidney function matter far more than diet. Attacks are treated with ice, rest and medicines that calm inflammation. People with repeated attacks can prevent them with a daily medicine that lowers urate.
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What is gout?
Gout is a common form of arthritis that causes sudden attacks of painful inflammation in a joint. It happens when a waste product called urate, or uric acid, builds up in the blood and forms needle-like crystals inside the joint.1
It is the most common inflammatory arthritis worldwide.2 In Australian surveys, between 4.5 and 6.8 per cent of adults say they have been diagnosed with gout.3 It is more common in men and in older people, and it is rare in women before menopause.1
Gout symptoms
An attack usually comes on quickly, often overnight:1
- Sudden, severe pain and swelling in one joint
- Warm, red skin over the joint
- A joint so tender that even the weight of a bedsheet hurts
- Difficulty moving the joint
The big toe is the joint most often affected, but gout can strike the feet, ankles, knees, wrists and elbows. An attack usually lasts one to two weeks.1
Between attacks you may feel completely normal. The crystals are still there, though. Although it comes and goes, gout is a long-term condition.4
Sore joints slowing you down?
Talk it through with an Australian doctor online. No referral needed.
What causes gout?
Urate comes from the normal breakdown of your own cells and from food and drink. It builds up when the kidneys don’t clear it fast enough or, less often, when the body makes too much. The crystals form slowly, over months or years. An attack happens when the immune system reacts to them.1
You are more likely to get gout if you:1
- Are male, or over 65
- Have close relatives with gout
- Are overweight
- Have kidney disease, high blood pressure, type 2 diabetes or high cholesterol
- Take certain medicines, including fluid tablets
Is gout caused by diet?
Much less than people think. An analysis of more than 16,000 people found that overall diet explained less than half of one per cent of the differences in urate levels between individuals. Inherited genes explained about 24 per cent.5
That matters because gout carries an unfair reputation as something people bring on themselves through rich food and drink. For most people, it is mainly down to how their kidneys handle urate.
Foods and drinks that affect gout
Diet is not the main cause, but some things do nudge the risk up or down. The best data come from a study that followed about 47,000 men for 12 years:
| Raises the risk | Lowers or doesn’t affect the risk |
|---|---|
| Meat: 41 per cent higher risk in the biggest eaters6 | Dairy products: 44 per cent lower risk in those who had the most6 |
| Seafood: 51 per cent higher6 | Vegetables high in purines, such as spinach and mushrooms: no increase6 |
| Beer: about 49 per cent higher for each daily drink. Spirits raised it less7 | Wine in moderation: no increase7 |
| Sugar-sweetened soft drinks: 85 per cent higher with two or more a day. Fruit juice also raised it8 | Diet soft drinks: no increase8 |
Other points:
- Cherries. In a study of 633 people with gout, eating cherries over a two-day period was linked with a 35 per cent lower risk of an attack.9 This was an observational study, so it is suggestive, not proof
- Weight. A review of 10 studies found that losing weight generally lowered urate and reduced attacks in people who were overweight. Do it gradually. Crash diets and fasting can trigger an attack1,10
- Water. Drink enough, especially when you are unwell1
There isn’t much proof that strictly avoiding high-purine foods reduces attacks. It still makes sense to limit anything you have noticed sets yours off.1
How is gout diagnosed?
The surest test is taking a small sample of fluid from the joint with a needle and looking for urate crystals under a microscope. Your doctor may also order a blood test for urate, and sometimes an ultrasound.1 Blood urate can be normal during an attack, so one normal result doesn’t rule gout out.
Treating a gout attack
- Rest the joint and keep it raised
- Apply an ice pack for 10 to 15 minutes at a time1
- See your doctor early. They can prescribe medicines that relieve the pain and bring down the swelling quickly1
Stopping gout from coming back
This is the part most often missed. Gout is one of the few kinds of arthritis that can be controlled completely. A daily medicine that lowers urate, taken long term, dissolves the crystals, and with them go the attacks and the lumps under the skin.4
- American guidelines strongly recommend it for people with frequent attacks, urate lumps called tophi, or joint damage on X-ray. The dose is adjusted until blood urate is below a target of 0.36 mmol/L11
- In a British trial of 517 people, 95 per cent of those whose treatment was managed this way by a nurse reached the target within two years, compared with 30 per cent of those who had usual care12
- Around the world, only a third to a half of people with gout receive this treatment, and fewer than half of those keep taking it2
Attacks can flare for a while when urate-lowering treatment starts. That is expected, and your doctor can give you something to cover it.11
What happens if gout isn’t treated?
Repeated attacks can permanently damage joints. High urate can also cause kidney stones, kidney damage and tophi, which are firm lumps of crystals that form on the elbows, hands, feet and ears.1 Gout is also linked with a higher risk of heart disease and chronic kidney disease.2
When to see a doctor
- A joint that suddenly becomes painful, swollen and red1
- You have had more than one attack. Ask about prevention
- You have gout and develop new symptoms1
A hot, swollen joint with a fever, or feeling generally unwell, needs to be seen urgently. A joint infection can look just like gout.1
See also types of arthritis and joint pain.
Next step: talk to a doctor
Answer a few quick questions and you’ll get an email about your eligibility. A consultation doesn’t guarantee any particular treatment.
References
- healthdirect. Gout.
- Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol. 2020;16(7):380-390.
- Pathmanathan K, Robinson PC, Hill CL, et al. The prevalence of gout and hyperuricaemia in Australia: An updated systematic review. Semin Arthritis Rheum. 2021;51(1):121-128.
- Dalbeth N, Gosling AL, Gaffo A, et al. Gout. Lancet. 2021;397(10287):1843-1855.
- Major TJ, Topless RK, Dalbeth N, et al. Evaluation of the diet wide contribution to serum urate levels: meta-analysis of population based cohorts. BMJ. 2018;363:k3951.
- Choi HK, Atkinson K, Karlson EW, et al. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004;350(11):1093-103.
- Choi HK, Atkinson K, Karlson EW, et al. Alcohol intake and risk of incident gout in men: a prospective study. Lancet. 2004;363(9417):1277-81.
- Choi HK, Curhan G. Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ. 2008;336(7639):309-12.
- Zhang Y, Neogi T, Chen C, et al. Cherry consumption and decreased risk of recurrent gout attacks. Arthritis Rheum. 2012;64(12):4004-11.
- Nielsen SM, Bartels EM, Henriksen M, et al. Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies. Ann Rheum Dis. 2017;76(11):1870-1882.
- FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res (Hoboken). 2020;72(6):744-760.
- Doherty M, Jenkins W, Richardson H, et al. Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet. 2018;392(10156):1403-1412.
This guide is general information, not medical advice. It doesn’t replace a consultation with a doctor who knows your history. In an emergency, call 000.