Gout

The only way to diagnose gout with certainty is by your doctor finding urate crystals in fluid taken from your joint. Uric acid levels can be measured by blood tests, however these are not always accurate. Uric acid levels may be normal or even lowered during an attack of gout. Blood tests are most useful in ruling out other causes for your symptoms, such as joint infections or other forms of arthritis. X-rays are often normal in the early stages so are not very useful in diagnosing gout.

Without treatment, a gout attack usually lasts about one week. Another attack may not happen for months or even years. If gout is not managed well, the time between attacks may get shorter, the attacks more severe and the joints can be permanently damaged. Sometimes gout can progress into a chronic (long term) condition, causing:

• constant mild pain and inflammation of the affected joints
• tophi – solid lumps of urate crystals, especially on the toes, ears, fingers, hands, forearms, knees and elbows
• kidney stones

Taking action during a gout attack can significantly reduce discomfort and prevent complications.

• See Your Doctor: They may recommend medicines like:
  • Non-steroidal anti-inflammatory drugs (NSAIDs).
  • Corticosteroid tablets or injections.
  • Colchicine.
    Always consult your doctor or pharmacist before starting medication.
• Protect the Joint: Avoid placing pressure on the affected joint. If it’s your big toe, limit walking and use a bed cradle to keep sheets off the joint.
• Manage Pain: Explore tips from resources like the “Dealing with Pain” information sheet.

The good news is that gout can be prevented. The goal of treatment is to lower uric acid levels to a level that prevents gout attacks. Your uric acid level can be checked with a blood test. For most people with gout, the target uric acid level (serum urate) you are aiming to achieve with treatment is:

Less than 0.36 millimoles per litre (<0.36mmol/L)

For some people with more severe gout, the target uric acid level will be less than 0.30 millimoles per litre (<0.30mmol/L). Talk to your doctor about treatments that can help you reach your target uric acid level, including:

• Medicines: There are medicines that can lower uric acid levels in your blood. These medicines need to be taken every day, whether you are having an attack or not.
• Alcohol: Cut down the amount of alcohol you drink and avoid drinking a lot of alcohol at one time (binge drinking). Talk to your doctor or the Australian Government guidelines on recommended alcohol intake.
• Weight loss: If you are overweight, lose weight gradually. Make sure you have a healthy diet as ‘crash’ or ‘starvation diets’ can actually increase uric acid levels. See a dietitian for advice.
• Purine-rich foods: See the Gout & Diet sheet for more information.

Untreated gout can cause permanent damage to the joints. Know your target uric acid level and learn ways to prevent gout attacks.

Pseudogout is often mistaken as gout as it causes similar symptoms. However it is the result of a different type of crystal, called calcium pyrophosphate crystals, forming in the joint. These crystals tend to form in the cartilage, the smooth coating lining the ends of the bones. Pseudogout is diagnosed by finding calcium pyrophosphate crystals in the fluid of an affected joint. It is a separate condition from gout and may require different treatment.