Gout causes attacks of pain and swelling, usually in the big toe. Gout is a kind of arthritis. It is most common in men, especially Māori and Pacific men.
If you get a painful gout attack
Talk to your doctor, nurse, pharmacist or Arthritis NZ educator about gout attack medicine to treat the pain of gout attacks and about taking uric acid medicine every day to bring down your uric acid levels and prevent further attacks.
Why do I get gout?
A lot of people think that gout is caused by food and drink such as seafood, meat and beer.
A New Zealand research study found that what you eat and drink only makes a difference of 10% to your uric acid (also called urate).
(Major et al. Evaluation of the diet wide contribution to serum urate levels: meta-analysis of population based cohorts BMJ 2018; 363:k3951 doi:10.1136/bmj.k3951.)
What causes high uric acid levels?
Gout is caused by too much uric acid in your blood.
It is normal to have uric acid in our blood because our bodies need some uric acid. Most people get rid of any extra uric acid in their urine.
Most Māori and Pacific peoples have genes which stop their kidneys getting rid of extra uric acid in their urine.
Most Māori and Pacific peoples will need to take uric acid medicine to bring their uric acid down.
What happens during a gout attack?
Gout attacks happen when there is too much uric acid in your blood and the acid turns into very sharp crystals in your joints. These crystals can damage your joints, bones and kidneys.
Gout does not go away when the pain of the gout attack goes away. You still have too much uric acid in your blood and crystals in your joints. This means you still have gout.
Māori men and Pacific men get really bad gout much earlier than other groups. So young Māori men and young Pacific men will need to decide to take uric acid medicine when they are in their 20s and 30s.
How does gout affect you?
Gout attacks can damage your joints, bones and kidneys.
Gout attacks stop you from:
- playing with your kids
- playing sport
- going fishing and diving
- going out with family and friends
- going to church and community events.
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.
How can I bring my uric acid levels down?
There are three types of uric acid medicines. Your doctor, nurse or pharmacist will explain which uric acid medicine is right for you and why. They will also talk to you about how to take your uric acid medicine.
You will start on a low dose of uric acid medicine. Every month your dose will be increased until your uric acid level comes down to .36 mmol/L or .30 mmol/L if you have lumps of uric acid crystals under your skin.
You must take your uric acid medicine every day. If you stop taking your uric acid medicine, then your uric acid will increase very quickly. You will get a painful gout attack.
You might get a gout attack when you first start taking uric acid medicine as your body gets rid of the extra uric acid already in your body.
To help you manage any gout attacks, your doctor, nurse or pharmacist will give you a gout attack medicine to take for 3 to 6 months when you first start taking uric acid medicine.
Medicines for gout
1. Uric acid medicines – bring your uric acid down
Take uric acid medicine every day. This will stop you having gout attacks.
Serious side effects of uric acid medicines – stop taking your uric acid medicine if you get a bad skin rash. Tell your doctor, nurse or pharmacist immediately. You will need to change to another uric acid medicine.
2. Gout attack medicines – treat the pain of gout attacks
You will need to take a low dose of a gout attack medicine to prevent gout attacks for 3 to 6 months when you start your uric acid medicine. It takes time for your uric acid to come down.
Your doctor, nurse or pharmacist might also give you another medicine to take for a week in case you get a bad gout attack.
Serious side effects of gout attack medicines – stop taking gout attack medicines if you vomit, get really bad pain in your stomach or blood in your poo. Tell your doctor, nurse or pharmacist immediately. You will need to change to another gout attack medicine.
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 need to get your uric acid levels down to 0.30 to get rid of your tophi.
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
Being overweight increases your uric acid levels.
- Keep active.
- Stay fit.
- Keep playing sport.
- Keep going to the gym.
- Keep your weight down.
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.
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.
Choosing the right shoe
If you get gout in your foot, try not to wear:
- 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:
- are comfortable (not too tight), so there is room if your foot swells up
- have a wide toe to leave room for your sore toe
- have laces or velcro so you can tighten or loosen your shoe
- have a cushioned insole that supports your foot
- have a deep heel so your foot fits into your shoe properly
- have a small heel because high heels can cause problems with your feet, knees and legs
- have a firm sole that is not worn.
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.