Your Questions About Gout: Answered
Clinical rheumatologist Dr Philip Robinson answers some common questions about gout.
Gout is a type of arthritis and it manifests as swollen, tender and red joints. Commonly when it first appears it will affect the big toe of the foot, but in time it will move on to other joints. The onset is often at night. They wake up with swollen, extremely painful wrists, foot or toe which limits movement in the joint. It can affect walking, making a cup of tea or going about their daily activities and it will tend to reach a peak within 24 hours. If it’s left untreated it will probably settle down within seven days approximately, but if you treat it, then it can settle down very quickly.
The cause, is the formation of urate crystals in joints. The urate crystals are not a problem but the fact that the body gets worked up about them being there, is the problem. The body attacks them and tries to destroy them and that immune response to the crystals, is what causes the swelling, pain and the redness. The crystals get there because the level of urate in the blood is too high and that goes over the level at which that chemical crystallises.
How common is it?
Around one in five people will have high levels of urate in their blood, but only about one in twenty people will have gout. There are reasons like obesity which will cause the urate to go up. Obesity is increasing in the whole population so we see that the level of urate in blood or hyperuricemia, is increasing. So there are more people with high levels of urate and that means there are more people with gout in the community.
What I tell my patients when I treat them is that we can get your urate levels down in your blood by using medication an you’re certainly welcome to try changes in diet.
Is there a special diet that can help?
I always talk to patients about the things that can cause a flare up in their gout. For example alcohol binges, seafood binges and sugar sweetened soft drinks are the three things that I talk to my patients about.
Very prescriptive diets aren’t so effective, primarily for the reason that people don’t stick to them, and people eat what they eat because they like doing that or because that’s their culture.
So generally what I say to my patients is, we need to use medication to treat your gout because changing your diet, if it does have any effect, it is not going to have the effect that we need it to have.
Dr Philip Robinson is a clinical rheumatologist at Brisbane Rheumatology and staff specialist at the Royal Brisbane and Women’s Hospital, as well as Senior Lecturer at the University of Queensland.
Philip trained in general medicine and rheumatology in New Zealand and then completed a PhD and post-doctoral fellowship at the University of Queensland. His current research interests are in gout, spondyloarthritis, fibromyalgia and the disease associations of serum rate.