Chronic musculoskeletal conditions

What is gout?

Gout is a form of inflammatory arthritis that develops when an excess of uric acid in the blood leads to deposits of uric acid crystals in one or more joints, causing inflammation.

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.

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 (Capuano et al. 2016) and metabolic syndrome (Grassi et al. 2014). 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 (Capuano et al. 2016; Grassi et al. 2014).

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

How common is gout?

Self-reported data from the Australian Bureau of Statistics 2017–18 National Health Survey shows that an estimated 0.8% of Australians have gout, which they described as ‘current and long term’. Gout is more common in males than females – almost 9 in 10 (87%) people with gout are males (ABS 2019).

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%, with gout increasing with age to 11% in men and 4.6% in women aged 85 and over (Robinson et al. 2015).

Impact of gout

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 (Chandratre et al. 2013; Lindsay et al. 2011).

According to the 2015 Australian Burden of Disease Study, gout accounted for 0.9% of the burden due to musculoskeletal conditions. Males experienced more (82%) of the burden than females (18%) (AIHW 2019a). In 2015–16, gout cost the Australian health system an estimated $176.5 million, representing 1.4% of disease expenditure on Musculoskeletal conditions and 0.2% of total disease expenditure (AIHW 2019b).

Treatment and management of gout

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.

Gout can be controlled with early and ongoing treatment, including:

• establishing a definitive diagnosis
• providing rapid pain relief for flares
• preventing flares and complications (Graf et al. 2015; Khanna et al. 2012; Richette et al. 2016).

Flares and complications can be managed by reducing risk factors for hyperuricaemia (dehydration, obesity and alcohol intake), taking urate-lowering medications to keep uric acid levels low, and managing comorbid conditions, such as high blood pressure, chronic kidney disease, diabetes and heart disease (Khanna et al. 2012).

The use of non-steroidal anti-inflammatory drugs (NSAIDs), low-dose colchicine and oral/intra-muscular/intra-articular glucocorticoids has also been found to be effective in managing acute gout (Graf et al. 2015; Richette et al. 2016).

Data from the AIHW National Hospital Morbidity Database (NHMD) show that, in 2020–21:

• 8,100 hospitalisations had a principal diagnosis of gout (32 per 100,000 population).
• 80% of all hospitalisations for gout were for males (6,500 hospitalisations), compared with 20% for females (1,600 hospitalisations).
• The hospitalisation rates increased with age and were highest for people aged 85 and over (245 per 100,000 population) (Figure 1).

• The average length of overnight stays also increased with age and was longest for people aged 85+ at 6.7 days (Figure 1).

Figure 1: Rate of hospitalisation for gout, by sex and age, 2020–21

The hospitalisation rate for Australians with a principal diagnosis of gout increased between 2010–11 and 2020–21 from 22 hospitalisations per 100,000 population to 32 per 100,000 population. There was a slightly larger increase for males (43%, from 36 to 51 per 100,000 population) compared with females (35%, from 9.2 to 12 per 100,000 population) (Figure 2).

The hospitalisation rate for gout among males dropped markedly in 2019–20. This may have been due to widespread public health mandates because of the COVID-19 pandemic. In 2020–21, the hospitalisation rate returned to near or slightly above the pre-pandemic rate. Interestingly, the hospitalisation rate among women had been on a gentle decline since 2016–17 and this trend was not noticeably impacted in 2019–20.

Approximately three-quarters of all hospitalisations with a principal diagnosis of gout are overnight stays. The average length of stay for these hospitalisations has trended downwards from 5.9 in 2010–11 to 4.9 in 2020–21.

Figure 2: Hospitalisation for gout, by sex, 2010–11 to 2020–21