What is gout?

Gout is a form of inflammatory arthritis. It occurs when excess uric acid in the blood leads to deposits of uric acid crystals in one or more joints. These deposits cause inflammation, with the big toe joint being most commonly affected. Gout can also affect other joints in the arms (fingers, wrists, elbows) and legs (toes, ankles, knees).

Signs and symptoms

Gout may be episodic (acute) or chronic. Acute gout is characterised by sudden attacks (flares) of severe pain, swelling, redness, heat, tenderness and stiffness in the affected joints.

These flares can last for days or weeks, and are followed by long periods without any symptoms. If flares occur in the same joint over many years, and the underlying excess of uric acid is not controlled, gout can become chronic.

Who gets gout?

Self-reported data from the Australian Bureau of Statistics 2014–15 National Health Survey show that 191,760 Australians (0.8% of the population) have this condition. Gout is more common in males than females—8 in 10 (81%) people with gout are males.

While the self-reported prevalence of gout may be low, Australian population-based studies show variation for different population groups. A study of a general practice population found the prevalence of gout to be 1.5%, and more than 11% in men aged 85 and over [8]. Another study found the prevalence of gout to be 5.2% (8.2% in males compared to 2.1% in females) in the South Australian population [10].

The prevalence of gout varies worldwide. Prevalence rates in developed countries range from 1.2%–4.1%, while the rates in developing countries are lower and range from 0.3% to 1.7% [6,9].

Risk factors

The underlying cause of gout is excess uric acid in the blood—a metabolic disorder called hyperuricaemia. This disorder is an independent risk factor for cardiovascular disease [1] and metabolic syndrome [3]. Risk factors for hyperuricaemia include obesity, diabetes, hypertension and heart disease, poor kidney function and kidney disease, and a diet high in meat, seafood and alcohol.

Other factors that are associated with an increased risk of gout are sex and age—gout is more common in men than in women, and increases with age—and family history.

Impacts

Gout can be very disabling due to significant pain and functional impairment. Frequent attacks of gout have been found to be associated with reduction in work participation [2,7].

According to the 2011 Australian Burden of Disease Study, gout accounted for 0.8% of the burden due to musculoskeletal conditions. Males experienced more (83%) of the burden than females (17%).

Gout can be managed or even prevented by long-term therapy with medications and life style changes to control hyperuricaemia and reduce levels of uric acid in the body.

References

  1. Capuano V, Marchese F, Capuano R et al. 2016. Hyperuricaemia as an independent risk factor for major cardiovascular events: a 10-year cohort study from Southern Italy. Journal of Cardiovascular Medicine. doi:10.2459/JCM.0000000000000347.
  2. Chandratre P, Roddy E, Clarson L et al. 2013. Health-related quality of life in gout: a systematic review. Rheumatology (Oxford). 52(11):2031–2040.
  3. Grassi D, Ferri L, Desideri G et al. 2014. Chronic hyperuticaemia, uric acid deposit and cardiovascular risk. Current Pharmaceutical Design 19:2432–2438.
  4. Khanna PP, Perez-Ruizz F, Maranian P et al. 2011. Long-term therapy for chronic gout results in clinically important improvements in the health related quality of life: short form-36 is responsive to change in chronic gout. Rheumatology 50:740–745.
  5. Khanna D, Fitzgerald JD, Khanna PP et al. 2012. American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care & Research 64(10):1431–1446.
  6. Kuo CF, Grainge MJ, Zhang W et al. 2015. Global epidemiology of gout, prevalence, incidence and risk factors. Nature Reviews Rheumatology 11:649–62. doi:10.1038/nrrheum.2015.91.
  7. Lindsay K, Gow P, Vanderpyl J et al. 2011. The experience and impact of living with gout: a study of men with chronic gout using a qualitative grounded theory approach. Journal of Clinical Rheumatology 17:1–6.
  8. Robinson PC, Taylor WJ & Dalbeth N 2015. An observational study of gout prevalence and quality of care in a national Australian general practice population. Journal of Rheumatology 42(9):1702–1707.
  9. Smith E, Hoy D, Cross M, et al. 2014 The global burden of gout: estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases 73:1470–1476.
  10. Ting K, Gill TK, Keen H et al. 2016. Prevalence and associations of gout and hyperuricaemia: results from an Australian population-based study. Internal Medicine Journal 46(5):566–573.