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 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, joints can be permanently damaged (Arthritis Australia 2019).

Who gets gout?

Self-reported data from the Australian Bureau of Statistics 2017–18 National Health Survey shows that an estimated 4.5% of Australians have gout. Gout is more common in males than females—almost 8 in 10 (79%) people with gout are males (ABS 2019).

Note that the AIHW has changed the way it classifies gout from NHS data. Previously, as with most other chronic conditions, a person was classified as having gout if they reported that their gout was both current and long term. Using this method, the prevalence of gout was 0.8%. However, evidence suggests that once a person has gout they always have gout, even if they are not currently experiencing symptoms (Bursil et al. 2019). The prevalence data presented above (4.5% of Australians) counts any person who reported ever having gout.

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.

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 (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).