Gout

What Causes Gout?

Historically, gout was known as ‘the disease of kings’ because of its association with a rich diet and heavy alcohol consumption. As a result, many people believe gout is caused by diet, however, this is a common misconception.

The biggest risk factor for gout is hyperuricemia, which is an excess of urate (also called uric acid) in the bloodstream. Urate is a waste material produced during the breakdown of substances called purines, which are abundant in meat, fish, and other types of seafood. Usually, most urate is removed from the body by the kidneys, which release it in urine.

In people with gout, the kidneys may not remove enough urate from the body. If urate levels get too high, tiny urate crystals can start to form in body tissues. When these crystals form in the joints, they can trigger the symptoms of gout.

High urate levels - and, therefore, gout - have a combination of genetic and environmental causes. Researchers have identified over a dozen genetic variants that influence how the body handles urate, so people with certain genes have a higher risk of gout. Changes in hormone levels brought about by menopause in women can also contribute to high urate levels. In rarer cases, gout may develop as a result of the body producing too much urate.

However, high urate levels are unlikely to be the only cause of gout, as only 1 in 3 people with hyperuricemia develop gout. Other factors, like the amount of fluid in joints, can play a role. If the joints don’t contain enough fluid, this may increase the risk of urate crystals accumulating in the joints.

Symptoms of Gout

The most common symptom of gout is sudden, severe pain in one of the big toes. Gout pain typically flares up at night and may be powerful enough to wake you up. Although gout usually affects the toes, it can also occur in the ankles, hands, wrists, elbows, knees, or other joints in the feet. Joints affected by gout may also be red, swollen, stiff, and warm to the touch.

Gout symptoms come and go. Symptomatic episodes (called gout attacks or flares) alternate with periods of remission, in which the patient usually has no symptoms. The frequency of gout attacks can vary significantly, some people experience symptoms every few months, while others can go years between flare-ups.

Complications of Gout

Untreated gout can lead to the formation of tophi, which are hard lumps caused by a build-up of urate crystals under the skin. Tophi usually form on the ears, fingers or elbows, are often painful, and may interfere with everyday activities. Other potential complications of gout include:

• Joint damage
• Kidney stones
• Chronic arthritis
• Reduced quality of life (e.g., due to absence from work and reduced participation in social activities)

Gout is also associated with an increased risk of other serious health conditions, including:

• High blood pressure
• Heart disease and heart failure
• Chronic kidney disease
• Diabetes
• Obesity

Risk Factors for Gout

Some people are at greater risk of high urate levels and gout than others. You are more likely to develop gout if you:

• Are overweight or obese
• Are male
• Have a family history of hyperuricemia and/or gout
• Have a genetic condition associated with high urate levels
• Eat a lot of high-purine foods (like meat, fish, and seafood)
• Drink a lot of alcohol or sugary drinks
• Are menopausal
• Are middle-aged or older
• Use certain medications (such as diuretics, aspirin, and ciclosporin)

Treatment for Gout

Gout can’t be cured, but gout medications and lifestyle changes can help ease symptoms, prevent attacks, and reduce your risk of joint damage and other complications.

Gout flares are usually treated with over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen. These can help ease the pain and swelling caused by gout. Gout attacks may also be alleviated by:

• Resting and elevating the affected limb
• Using ice packs to keep the affected joint cool
• Drinking plenty of water

If these measures don’t work, a doctor may prescribe corticosteroids, which are anti-inflammatory drugs that can be taken orally or injected into the joints. Medications that lower blood urate levels can also help prevent future gout attacks.

Many people with gout find that lifestyle and dietary changes improve the frequency and severity of their symptoms. Some studies suggest that gout attacks are more common among people who have recently eaten a lot of meat, fish, or seafood, so avoiding these foods may help. Limiting your alcohol intake, quitting smoking, and maintaining a healthy weight can also help prevent or reduce gout flares.

Sources

NCBI - Gout Overview

NICE - Gout Prevalence

NCBI - Gout Detailed Information

NCBI - Gout Pathophysiology

NCBI - Gout Epidemiology

MedlinePlus - Gout Causes

NIAMS - Gout Health Topics

NICE - Gout Complications

NICE - Gout Causes and Risk Factors

NIAMS - Gout Diagnosis and Treatment

Prescription Doctor - Ibuprofen for Gout

NHS - Gout Information

Authored By

Mohamed Imran Lakhi

MPharm - Lead Pharmacist

Imran Lakhi is the superintendent pharmacist and founder at Prescription Doctor. He has been at the core of our team.

Published on: 07/11/2023

Reviewed By

Dr Giuseppe Aragona

Doctor

This content has been checked for quality and accuracy by Dr. Giuseppe utilises his extensive experience in general practice to ensure the accuracy and safety of the website's content.

Reviewed on: 07/11/2023