Gout

Gout causes attacks of pain and swelling, usually in the joint of the big toe. Gout is a kind of arthritis. It is most common in men.

Summary

If you get a gout attack

Talk to your doctor, nurse, pharmacist or Arthritis NZ educator about medicine to treat the gout attack and about taking medicine every day to bring down your uric acid levels and prevent further attacks.

Why do I get gout?

You might think that gout is caused by drinking too much beer and fizzy drinks and eating too much meat and shellfish. In fact, gout is caused by having too much of a chemical called uric acid in your blood.

Your body makes uric acid when you eat food. It is normal and healthy to have some uric acid in your body. Most people get rid of uric acid through their urine.

How does gout affect you?

Gout can be a sign you could get diabetes, heart disease and kidney problems.

Gout can be very painful and can stop you doing all the things you enjoy. Gout can stop you playing sport and spending time with your family or whānau.

Gout can stop you feeling good about yourself and your life.

What causes your gout attacks?

If there is too much uric acid in your blood, the acid turns into crystals in your joints especially your toes, knees, elbows, wrists and fingers.

The crystals are very sharp, like needles, and your joint gets very sore and painful. This is called a gout attack.

Crystals can cause damage to your joints.

The crystals cause lumps which are called tophi (you say toe-fy). If tophi get too big they can make it hard for you to wear shoes, use a knife and fork, write and walk easily.

What causes high uric acid in your body?

80% of high uric acid is caused by your body not getting rid of uric acid properly. This could be because of:

  • your genes
  • your weight
  • kidney problems.

20% of high uric acid is caused by what you eat and drink.

How can you get rid of uric acid in your body?

You can get rid of 80% of uric acid by taking uric acid medicines every day.

You can get rid of 20% of uric acid by:

  • eating less seafood and meat
  • not drinking beer, fizzy drinks and orange juice
  • drinking water
  • being active – walk, swim, go to the gym
  • losing weight if you need to.

How you get rid of uric acid

Most people get rid of uric acid through their urine. Some people get rid of only some of their uric acid, and the rest stays in their blood.

Treatment

How uric acid medicines help you

Some uric acid medicines stop your body making too much uric acid.

Some uric acid medicines help your body get rid of uric acid through your urine.

Medicines for gout

There are 2 types of medicines for gout.

1. Uric acid medicines

Uric acid medicines bring your uric acid levels down. You need to take them every day.

Common uric acid medicines are allopurinol and probenecid. There are other uric acid medicines as well, such as febuxostat and benzbromarone.

You need to take uric acid medicine every day, even if you are having a gout attack. When you start taking uric acid medicines, you might get a gout attack as your body is getting rid of the extra uric acid.  So make sure you also get medicine to prevent the pain from a gout attack.

Side effects

Make sure you ask your doctor, nurse or pharmacist what the side effects of uric acid medicine could be and what you should do if you get side effects. Stop taking uric acid medicine immediately if you get a bad skin rash and tell your doctor, nurse or pharmacist. 

2. Gout attack medicines

Gout attack medicines treat the pain of gout attacks.

There are 3 types of gout attack medicines:

  • Anti-inflammatories such as diclofenac (Voltaren®), ibuprofen (Nurofen®) and naproxen
  • Steroids such as prednisone
  • Colchicine taken short term for pain.

You can also take a lower dose of these gout attack medicines for up to 6 months when you start on uric acid medicines. Taking low doses of gout attack medicines helps to stop pain from gout attacks while your uric acid medicine gets rid of the extra uric acid in your body.

Side effects

Most gout attack medicines should not be taken long term because they can cause side effects such as stomach problems.

Always ask your doctor, nurse or pharmacist how long you should take your gout attack medicine and the side effects of your gout attack medicine. Make sure you know what you should do if you get side effects.

Starting on uric acid medicine

Your doctor, nurse or pharmacist should start you on a low dose and slowly build up to a stronger dose. Remember when you start on uric acid medicine you also need to take a low dose of a gout attack medicine such as colchicine. You will be taking at least two medicines for up to 6 months. Some people might have to take three medicines.

Checking your uric acid level

When you take uric acid medicine your target is to get your uric acid levels down to 0.36. You need to get your uric acid level checked regularly. You might need to take a stronger dose of your uric acid medicine if your levels don’t come down. If you have tophi you might need to get your uric acid levels down to 0.30 to get rid of your tophi.

Prevention

Risk factors for gout

You are Māori or Pacific

Many Māori and Pacific people have genes that make it harder to get rid of uric acid from their bodies.

Your doctor has told you you have high uric acid levels

Uric acid is a chemical that everyone has in their body. Some people have higher uric acid levels than others. High levels of uric acid can turn into gout.

You can reduce your uric acid levels by keeping active, staying fit, keeping your weight down, eating a healthy diet and not drinking beer and sugary drinks.

You have a family history of gout

If people in your family have gout then you have a higher chance of getting gout.

Things you can do to reduce your chances of getting gout by bringing down your uric acid levels

Exercise

Being overweight increases your uric acid levels.
  • Keep active.
  • Stay fit.
  • Keep playing sport.
  • Keep going to the gym.
  • Keep your weight down.

Food

Some foods, such as red meat and seafood, increase your uric acid levels.
  • Keep eating a healthy diet.
  • Eat lots of vegetables and some fruit.
  • Eat low fat yoghurt or cheese such as Edam.
  • Eat only small amounts of red meat or seafood. Eat chicken and white fish.
  • Eat takeaways only once a week.

Drink

Alcohol, sugary soft drinks and fruit juice increase uric acid levels.
  • Keep drinking water, coffee and tea, diet soft drinks and lite blue and green milk.
  • Don’t drink too much beer, RTDs or other alcohol.
  • Don’t drink sugary drinks such as energy drinks, ordinary soft drinks, orange juice and powdered drinks.

Living with

Choosing the right shoe

If you get gout in your foot, try not to wear:

  • sandals
  • jandals
  • slippers
  • old shoes.

These shoes don’t support your feet properly when you are walking or standing. This can affect your balance and make your pain worse.

People with gout in their feet need to wear shoes that:

  1. are comfortable (not too tight), so there is room if your foot swells up
  2. have a wide toe to leave room for your sore toe
  3. have laces or velcro so you can tighten or loosen your shoe
  4. have a cushioned insole that supports your foot
  5. have a deep heel so your foot fits into your shoe properly
  6. have a small heel because high heels can cause problems with your feet, knees and legs
  7. have a firm sole that is not worn.

Diagram pointing out features on a shoe – laces or velcro, a small heel, firm sole, and 'deep heel', referring to the back of the shoe.

You need to buy a good quality shoe but your shoes don’t have to be expensive.

If you are not sure about what shoes to buy, take this list with you and talk to the salesperson in the shop.

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