Gout is an inflammatory arthritis caused by excess uric acid forming crystals inside joints. It commonly affects the big toe, ankle, knee and foot. Attacks are sudden and intensely painful. With modern treat-to-target management, gout is both preventable and highly treatable.
Why Is Gout Increasing?
Key contributors include increased red meat intake, sugary drinks (fructose), alcohol (especially beer), rising BMI and obesity, and sedentary lifestyle. Higher body weight increases uric acid production and reduces kidney excretion. Genetics also play an important role — if close relatives have gout, high uric acid or kidney stones, individual risk is significantly higher.
Gout and Heart Risk
Gout is linked with hypertension, diabetes, high cholesterol, coronary artery disease and increased cardiovascular mortality. It is not only a joint condition — it reflects broader metabolic risk. Certain medications can also increase uric acid levels, including diuretics used in heart failure and thiazide diuretics for blood pressure management.
Modern Treat-to-Target Management
Effective gout control requires regular serum urate monitoring, dose adjustment of urate-lowering therapy, achieving a target urate below 360 µmol/L (lower in severe disease), and ongoing structured review. Maintaining target urate prevents flares, dissolves crystals over time, protects joints and reduces long-term complications.
Why Specialist Review Matters
A rheumatology assessment can confirm diagnosis (joint aspiration when needed to exclude infection), assess kidney function, review cardiovascular risk, identify tophi or joint damage, and optimise medication safely. Accurate diagnosis is important as other conditions such as pseudogout, infection and inflammatory arthritis can present similarly.
If Left Untreated
Poorly controlled gout can lead to recurrent severe attacks, permanent joint damage, tophi (uric acid deposits under the skin), kidney stones and increased cardiovascular risk. With proper management, most patients achieve minimal or no flares, improved urate levels and protected joints.
Frequently Asked Questions
What causes a gout attack?
A gout attack occurs when uric acid crystals deposit in a joint, triggering sudden intense inflammation. Triggers include high-purine foods, alcohol, dehydration and certain medications.
Is gout just a diet problem?
Diet plays a role, but genetics and kidney function are equally important. Most patients need urate-lowering medication alongside dietary changes.
What is the target uric acid level in gout?
The target serum urate is below 360 µmol/L, or below 300 µmol/L in patients with severe or tophaceous gout.
Can gout affect the kidneys?
Yes. Chronic elevated uric acid can lead to kidney stones and, over time, affect kidney function. Kidney assessment is part of gout management.
Is allopurinol safe long term?
Yes, allopurinol is widely used, safe and effective when monitored appropriately. It is the most common first-line urate-lowering therapy.
