Gout
1. Introduction
Gout is a common type of inflammatory arthritis where uric acid builds up in the body and urate crystals are deposited in the joint. This can cause intense pain, swelling, redness and stiffness at the affected joint which could take up to a week to settle down (1,2). If recurring gout attacks go left untreated it can progress to a more chronic form of gout where you can have symptoms between attacks and this can lead to joint damage (2-4). Gout typically affects one joint in isolation, commonly the big toe; but it can also affect the ankles, knees, hands and wrists, and elbows. Men are affected more often than women (1).
Frequently Asked Questions
- Gout is a common type of inflammatory arthritis that causes sudden severe joint pain. Excess uric acid collects and forms crystals within the joint causing irritation and swelling (1).
- Gout is a common inflammatory arthritic condition affecting 7% of men and 3% of women [1-3].
- It is uncommon in women before menopause (1,3).
- Early medical diagnosis and management is key to prevent worsening pain and a full recovery (2,3).
- Gout flare ups usually only last a few days and are easily treated (2).
- It is important to see your GP to discuss lifestyle changes to help prevent future flare ups (2-4).
- People suffering from high blood pressure, high cholesterol or chronic heart failure (1-4).
- Diabetics (1-4).
- Obese people (1-4).
- Heavy drinkers or those with kidney disease (1-4).
- Men are affected more often than women (1).
- Sudden severe pain.
- Hot, red, swollen and stiff joint (1-4).
- Gout commonly affects one joint in isolation.
- Typically, the big toe is a common area to be affected but it can also affect the ankles, knees, hands and wrists, and elbows (2, 3).
- Inability to walk due to pain.
- Manage acute pain and inflammation with NSAIDs e.g. ibuprofen (1, 2).
- Reduce the risk factors associated with the condition by losing weight, reducing alcohol, and keeping fit and active (2-4).
- Reduce the intake of sugar and purines in foods such as red meat, organ or game meats and some seafood (2,3).
- See your GP if you experience regular episodes.
- Acute flare ups usually settle within a few days to a week (2).
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk.
2. Signs and Symptoms
- Sudden severe pain which typically comes on at night (1-4).
- Hot, red, swollen and stiff joint (1-4).
- Unable to put pressure through the joint e.g. difficulty walking (2,3).
- Sensitivity to pressure on the affected joint e.g. pain with a duvet on your toe or tight-fitting shoes (2,3).
3. Causes
Gout is caused by monosodium urate crystals being deposited in or around a joint. Typically, this is associated with poor lifestyle and health factors (1-2). Aside from that there can be a hereditary component to gout, meaning it can run in the family (2,3).
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone developing gout. It does not mean everyone with these risk factors will develop symptoms.
- Family history of gout (1).
- It is more common in men than women (1).
- Being overweight (1-4).
- Having metabolic diseases such as high blood pressure, high cholesterol and diabetes (1-4).
- High alcohol consumption (1-4).
- Kidney disease (1-4).
- Taking diuretics (1, 2).
5. Prevalence
Approximately 1 in 14 men and 1 in 35 women develop gout. It is uncommon in women before menopause (1,3).
6. Assessment & Diagnosis
During your consultation with the physiotherapist, they will take a detailed history of your condition, identifying any risk factors for gout. A physical examination may be required to see if the joint is hot, red, swollen or restricted in movement. Blood tests can be useful in testing uric acid levels, however they are not always accurate as uric acid tends to peak after an attack has ended rather than at its start.
7. Self-Management
The main aim of managing acute gout is reducing pain and disability caused by the inflammation in the joint. This can be done using non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. You can also use ice to help with the inflammation (1).
Longer term management should be done in conjunction with your GP. They may put you on preventative medication which lowers uric acid levels in the body (1-3).
8. Rehabilitation
Rehabilitation for gout is usually different for each person depending on which area of the body is affected and the risk factors they have. All exercise programmes should include general exercise to help with weight management and reduce the risk of high blood pressure, high cholesterol and diabetes. Specific rehabilitation programmes should aim to maintain joint range of motion, particularly in those affected by repeated gout attacks. These tailored rehabilitation programmes can be designed by your physiotherapist during your consultation.
9. Gout
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
This programme provides an example of some safe and effective exercises for someone who is recovering from an acute episode of gout.
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- 1
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- 910
10. Return to Sport / Normal life
There is no reason why a person cannot return to full function and sporting activities once acute flare ups have subsided. Maintaining a healthy lifestyle is vital in reducing the risk of flare ups and sport/activity should be encouraged.
11. Other Treatment Options
Should NSAIDs prove ineffective then your GP may prescribe stronger medication such as steroids as well as uric acid reducing medication (1-3). You may also be referred to rheumatology to help manage recurring flare ups.
References
- Neogi, T., 2011. Gout. New England Journal of Medicine, 364(5), pp.443-452.
- Roddy, E. and Doherty, M., 2010. Gout. Epidemiology of gout. Arthritis research & therapy, 12(6), p.223.
- Roddy, E. and Choi, H.K., 2014. Epidemiology of gout. Rheumatic Disease Clinics, 40(2), pp.155-175.
- Choi, H.K., Mount, D.B. and Reginato, A.M., 2005. Pathogenesis of gout. Annals of internal medicine, 143(7), pp.499-516.
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