Gout is the most common form of inflammatory arthritis, caused by a build-up of uric acid crystals in the joints. When uric acid levels in the blood remain elevated, crystals deposit in joints and surrounding tissues, triggering sudden and intensely painful flares. The big toe is most commonly affected, though gout can also affect the ankle, knee, wrist, and fingers.
Without treatment, flares can become more frequent and longer-lasting, and chronic gout can develop, causing permanent joint damage. With appropriate management, most people can significantly reduce or prevent future attacks.
How common is Gout?
Gout affects an estimated 4.8% of Australian adults — approximately 1.5 million people. It is three to four times more common in men than women, with women's risk increasing after menopause. People with kidney disease, cardiovascular disease, diabetes, or obesity are at significantly higher risk.
Gout typically presents as sudden, severe attacks of joint pain. Symptoms of an acute gout flare include:
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- Intense joint pain – often described as one of the most painful experiences people report; the big toe is the most common site
- Rapid onset of swelling, redness, and warmth around the affected joint
- Extreme tenderness – even the weight of a bedsheet on the affected joint can be unbearable
- Attacks often beginning at night, waking the person from sleep
- Symptoms usually peaking within 12 to 24 hours and resolving within one to two weeks, even without treatment
Between flares, many people are completely symptom-free.
With repeated untreated flares or persistently high uric acid levels, gout can progress to:
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- More frequent and prolonged attacks
- Tophi – chalky-white lumps under the skin caused by urate crystal deposits, often appearing around the fingers, wrists, elbows, knees, or Achilles tendon
- Joint damage and reduced mobility
- Kidney stones (uric acid stones)
Gout is caused by sustained hyperuricaemia – elevated levels of uric acid in the blood.
This occurs when the body either produces too much uric acid, or the kidneys excrete too little of it.
Risk factors include:
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- Diet – foods high in purines increase uric acid production; particularly red meat, organ meats (e.g. liver, kidneys), shellfish, and anchovies. Alcohol – especially beer – and high-fructose drinks (such as soft drinks and fruit juices) are also significant contributors
- Obesity and metabolic syndrome – excess weight increases uric acid production and reduces kidney excretion
- Chronic kidney disease – impairs the kidneys' ability to excrete uric acid
- Certain medications – diuretics (particularly thiazides), cyclosporin, and low-dose aspirin can raise uric acid levels
- Genetics – gout runs in families; some people have a hereditary predisposition to hyperuricaemia
- Other medical conditions – hypertension, diabetes, and cardiovascular disease are associated with higher uric acid levels
An acute gout attack can be triggered by sudden changes in uric acid levels, dehydration, injury, surgery, illness, or heavy alcohol consumption.
A diagnosis of gout is often made based on the clinical picture – sudden onset of severe pain, redness, and swelling in a single joint, particularly the big toe.
However, confirmation may involve:
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- Joint aspiration (arthrocentesis) – withdrawal of fluid from the affected joint for examination under a microscope. Identifying urate crystals in the joint fluid is the most definitive test for gout
- Serum uric acid – a blood test to measure uric acid levels. Note that uric acid levels can temporarily drop during an acute flare, so a normal result does not rule out gout
- Blood tests – to assess kidney function, inflammatory markers, and rule out other causes of joint pain such as infection or pseudogout
- Imaging – ultrasound or dual-energy CT (DECT) can detect urate crystal deposits and is increasingly used in diagnosis; X-ray may show changes in chronic gout
Treatment for gout has two distinct phases: managing acute flares and long-term prevention through urate-lowering therapy.
Acute flare treatment
The goal is rapid reduction of inflammation and pain.
Options include:
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- Colchicine – a first-line treatment for acute gout. Most effective when started within 24 hours of symptom onset; taken at low dose to reduce side effects.
- Non-steroidal anti-inflammatory drugs (NSAIDs) – such as indomethacin, naproxen, or ibuprofen, used to relieve pain and inflammation during a flare
- Corticosteroids – such as prednisolone, used when NSAIDs and colchicine are not suitable (for example in people with kidney disease)
- Resting the affected joint and applying ice can also help during a flare
Long-term urate-lowering therapy (ULT)
ULT is recommended for people who have frequent flares, tophi, joint damage, or ongoing hyperuricaemia. It is started between flares, not during an acute attack.
The goal is to lower uric acid levels to below 0.36 mmol/L (or below 0.30 mmol/L in those with tophi), causing crystals to dissolve and preventing new ones from forming.
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- Allopurinol – the first-line urate-lowering medication. A xanthine oxidase inhibitor that reduces uric acid production. Dose is titrated gradually to reach the uric acid target
- Febuxostat (Adenuric) – an alternative to allopurinol, used when allopurinol is not tolerated or effective
- Low-dose colchicine is often co-prescribed for several months when starting ULT to prevent flares triggered by falling uric acid levels
Lifestyle
Dietary and lifestyle changes can support medical treatment: reducing purine-rich foods and alcohol, staying well hydrated, achieving and maintaining a healthy weight, and reviewing any medications that raise uric acid levels.
The following specialty medications may be available at Ace, a specialty pharmacy for Gout.
Note: Corticosteroids (prednisolone) and NSAIDs are used in acute gout treatment but are not specialty medications.
With Ace, you’ll benefit from:
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- Expert Support — Our dedicated team of health concierges is always available to answer your questions, provide guidance, and help you navigate your condition with confidence.
- Specialty Medication — We offer a wide range of specialty medications and support services, designed specifically for those living with chronic illnesses. Whether you’re looking for help managing a specific condition, or simply need access to the medications you need, we’ve got you covered.
- A Wide Range of Conditions — From diabetes to heart disease, and everything in between, we help manage a variety of special condition
Take control of your health and well-being, and start your journey to better health with Ace today.
Gout & Arthritis Support
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- Arthritis Australia – Gout – information, resources, and support for Australians with gout
- Musculoskeletal Health Australia – Gout
- Arthritis NSW
- Arthritis Victoria
- Arthritis Queensland
- Arthritis SA
- Arthritis WA
Clinical & Research Resources
