Gout: causes, symptoms and treatment

Published February 2024 | 5 min read
Expert contributors Dr David Liew, rheumatologist and medical director at Arthritis Australia; Dr Maxine Szramka, rheumatologist
Words by Angela Tufvesson

Gout is a painful and debilitating form of arthritis. Learn about the symptoms of gout, what it feels like and how to manage the condition.

First recorded more than 4,500 years ago, gout is one of the oldest known joint diseases. Because of its links with rich foods and excessive alcohol consumption, gout has been dubbed the ‘disease of kings’ and has long been joked about in popular culture.

The trouble is that lighthearted banter can downplay the seriousness of gout. It’s an extremely painful condition that is affecting a growing number of Australians.

"The pain is comparable to childbirth and kidney stones – it's some of the worst pain you can experience," explains rheumatologist and clinical pharmacologist Dr David Liew, medical director of Arthritis Australia.

Fortunately, gout treatments can be very effective, and lifestyle changes may also help to reduce the frequency of flare-ups and the severity of the condition.

What is gout?

Gout is a form of inflammatory arthritis that’s caused by a build-up of a substance called uric acid in your bloodstream. Your body makes uric acid when it breaks down purines – chemical compounds found in the body’s cells and a wide range of foods, such as red meat and shellfish. When there's too much uric acid, needle-shaped urate crystals will start to form inside your joints, causing pain and swelling.

Dr Maxine Szramka, a Gold Coast-based rheumatologist, says the big toe of the foot is most commonly affected, along with the hands, wrists, knees and ankles.

How is gout diagnosed?

Your doctor may take a sample of fluid from the painful joint to check for urate crystals. A blood test can also check for high levels of uric acid.

Even though gout and osteoarthritis often occur together – possibly because each increases your chance of developing the other – the root causes are different. Osteoarthritis is caused by wear and tear on the cartilage in the joints and not by uric acid.

"Gout likes to target joints where there's existing damage and where there might be osteoarthritis, which makes it confusing," says Dr Liew. "But the way we treat gout is very different to the way we treat osteoarthritis."

If you do have osteoarthritis, the Osteoarthritis Healthy Weight for Life program supports eligible HCF members^* who want to reduce the pain in their joints, improve their mobility or prepare for hip or knee surgery.

What does gout feel like?

For Frank Smith, 83, gout caused "probably the worst pain I have ever had, including bone breaks". He says he woke one morning to extreme pain in the joint at the base of his left big toe.

"I have the normal aches and pains of an older person with osteoarthritis, but this was something new," says Frank. "I could only walk with difficulty. The pain gradually faded over 48 hours, but the swelling and redness lasted several weeks."

Frank's experience is typical. The symptoms of gout usually occur suddenly – often at night – and can last for one to two weeks. They include:

• intense joint pain
• joint swelling
• red and shiny skin
• joint is hot to touch
• restricted movement of the joint.

"A very typical presentation is waking up with a big, red, fat, hot, swollen toe that's super sensitive and appears out of the blue," explains Dr Szramka. "Even the feeling of a bed sheet on your toe can be incredibly uncomfortable."

Gout can be episodic, with attacks or 'flares' becoming more common if it’s left untreated. "While people might have one or two episodes, often it's the kind of thing that gets more and more frequent, and becomes more and more of a problem," says Dr Liew.

What causes gout?

The incidence of gout is increasing worldwide. One study found Australia has the second-highest prevalence globally, behind New Zealand, and that the number of cases increased by 20% over the past two decades.

The Australian Institute of Health and Welfare reports that 0.8% of Australians have gout, although other studies put the figure as high as 5.2%. Dr Liew believes there’s still a "stigma" associated with gout, so it's not often identified, which may explain the variance in reporting.

He also says that the rates of gout are increasing in line with our expanding waistlines. You're more likely to develop gout if you have high levels of uric acid in your body, which can happen if you're overweight.

Gout is more common in men and in people over 65. It's also associated with metabolic syndrome. "It often goes along with high blood pressure, type 2 diabetes and high cholesterol," explains Dr Liew.

Gout can run in families, and it tends to be more common among some ethnic populations. "Among people of Polynesian background, for example, gout is exceptionally common and the burden of gout in these communities is substantial," says Dr Liew.

While it's by no means the only risk factor, a diet high in purine-rich foods and drinks such as red meat, shellfish and alcohol – especially beer – may also increase your risk of gout. "A lot of my patients know that if they're drinking too much, their gout can flare up," says Dr Szramka.

Effective gout treatments

If left untreated, gout can lead to worsening pain, joint damage and "substantial disability", says Dr Liew. "Through the inflammatory processes that it triggers, uncontrolled gout can also increase the risk of heart attack and stroke," he adds.

Thankfully, there’s a lot you can do to treat and manage gout. Lifestyle changes like losing weight and limiting alcohol intake can help with gout management by lowering uric acid levels.

As for the most effective diet for gout, there's no scientific evidence that particular foods directly cause gout, but some studies have shown that people who have gout are more likely to eat foods rich in purines. Arthritis Australia recommends a healthy, balanced diet, alongside medicines to help reduce uric acid levels.

For most people, medication can help to get the pain and inflammation of gout under control. "Being able to take those medicines quickly can stop the gout flare from getting worse and really reduce pain, swelling and suffering," says Dr Liew. Frank says he now takes a daily allopurinol pill [which reduces uric acid] and has not had a serious recurrence – only minor flare-ups.

Ongoing gout treatments focus on reducing levels of uric acid in the body. "Prevention is the most important thing with gout," says Dr Szramka. "If someone is getting two or more attacks a year, we'd look at putting them on a gout preventer to lower the uric acid and prevent them from getting acute episodes of gout."

Speak to your GP

If you think you might be experiencing any symptoms of gout, it's important you chat with a GP as soon as possible. Our partnership with GP2U, an online video GP service, makes it easier and more convenient for eligible members to access telehealth services. All HCF members with health cover can access a standard GP consultation (up to 10 minutes) for a fee of $50.

Register on GP2U

Support with nutrition

Losing weight and keeping it off over a long period of time can be challenging. That's why we give eligible HCF members access to the evidence-based CSIRO Total Wellbeing Diet^{^}. Join over 500,000 Aussies who have lost weight, kept it off and improved their health and wellbeing.