Gout
MBChB (New Zealand), PGDipObstMedGyn, FRACP (New Zealand), FAMS (Rheumatology)
Gout is a form of inflammatory arthritis that occurs when uric acid builds up in the blood. As uric acid levels rise, the excess uric acid begins to crystallise and form needle-like crystals in the joints. These crystals irritate the surrounding tissues and trigger a strong immune response, causing swelling, warmth, redness and severe pain. Gout can affect almost any joint in the body but most commonly involves the big toe, occurring in over 90% of cases. Other commonly affected joints include the foot, ankle, knee, finger, elbow and wrist. Several factors can increase the risk of developing gout:
Purine-rich foods increase uric acid levels in the blood. Red meat, organ meats, shellfish, alcohol and beverages sweetened with high fructose corn syrup can trigger gout flares.
The kidneys play an important role in removing uric acid from the blood. Chronic kidney disease, and medications such as diuretics can interfere with uric acid excretion. When the kidneys cannot eliminate uric acid efficiently, blood uric acid levels rise, increasing the risk of gout.
This may result from genetic factors, metabolic conditions, obesity or medical conditions such as certain blood disorders.
Gout affects men more often than women and can occur at any age. In women, it typically occurs after menopause.
Gout is a progressive condition that develops through four stages.
Asymptomatic hyperuricemia refers to elevated uric acid levels in the blood without any symptoms of gout.
Uric acid crystals deposited in the joints trigger intense inflammation leading to severe pain, redness, swelling and warmth. Gout flares often come on suddenly and may last for several days if not treated promptly.
After a gout flare resolves, patients may experience a symptom-free period before another flare occurs; which may be months or even years later. During this time, the uric acid levels often remain elevated, allowing crystals to continue accumulating in the joints. Without appropriate management, recurrent flares are likely; and these symptom-free intervals may become progressively shorter over time.
When gout remains untreated over many years, deposits of urate crystal, known as tophi, may develop as firm nodules beneath the skin. These tophi can restrict joint movement, cause persistent discomfort, and lead to progressive joint damage. Early and appropriate treatment is essential to preserve joint function and maintain mobility.
A gout flare often begins suddenly, frequently during the night. The affected joint will be warm, red, swollen and extremely painful. While symptoms typically improve within a week, residual discomfort may persist for a longer period. Gout most commonly affects the lower limbs, including the big toe, foot and ankle but it can involve almost any joint in the body.
Typical symptoms include:
Intense joint pain that peaks within the first few hours- Swelling and redness of the affected joint
- Warmth and marked sensitivity, even to light touch
- Reduced range of motion in the affected joint
Gout can sometimes resemble other joint conditions, such as rheumatoid arthritis or psoriatic arthritis, making an accurate diagnosis essential. Evaluation begins with a thorough medical history and physical examination to assess symptoms and identify signs of joint inflammation. Laboratory and imaging investigations may then be used to determine the underlying cause.
A small sample of fluid is taken from the affected joint and examined for uric acid crystals. This is the most definitive way to diagnose gout.
Blood tests measure uric acid levels and assess kidney function. While elevated uric acid levels can support a diagnosis of gout, they are not sufficient on its own to confirm the diagnosis.
Ultrasound, X-rays, or dual-energy CT scans can help detect urate crystal deposits and assess changes in the joint.
How Do Rheumatologists Treat Gout?
Effective gout treatment focuses on three key goals: relieving the pain and inflammation of acute attacks, lowering uric acid levels to prevent future flares and protecting the joints, kidneys and metabolic health over the long term. Specialist rheumatology care addresses all three with precise and evidence-based therapy.
NSAIDs help reduce pain and swelling during an acute gout attack. They are often used at the onset of a flare to provide rapid symptom relief.
Colchicine is commonly used to treat an acute flare or as short-term flare prevention when initiating urate-lowering therapy. It works by reducing the inflammatory response to uric acid crystals and is most effective when taken early in a flare.
Corticosteroids may be prescribed when NSAIDs are unsuitable or when a flare is more severe. They work quickly to reduce inflammation and relieve discomfort, and can be administered orally or as a joint injection.
Urate lowering therapies are long-term medications that reduce uric acid levels in the blood, dissolve urate crystals in the joints and help prevent future gout flares. Some medications work by decreasing uric acid production, while others enhance its elimination through the kidneys. In addition, these treatments help protect joints from long-term damage.
While medications form the cornerstone of gout management, lifestyle habits play a vital supporting role. Staying active, following a balanced diet low in fats and added sugars, and maintaining a healthy weight can help stabilise uric acid levels and reduce the risk of future flares. These measures work alongside medical treatment to support long-term gout control and protect joint health.
Our Rheumatologist
Dr Poh Yih Jia
Senior Consultant Rheumatologist
Dr Poh Yih Jia is a senior consultant rheumatologist with over 20 years of medical experience in New Zealand and Singapore. She has particular expertise in diagnosing and managing gout, inflammatory arthritis and connective tissue diseases.
Her dedication to patient-centred care has earned her multiple accolades, including the Singapore Health Quality Service Award and Service with a Heart Award. She remains dedicated to advancing rheumatology through clinical practice, education and research, ensuring every patient receives the most current, evidence-based care for gout and other rheumatic diseases.
FAQs on Gout
Gout is a type of inflammatory arthritis caused by elevated levels of uric acid in the blood. When uric acid builds up, it can form crystals in the joints, leading to intense pain, swelling and redness. Factors such as genetics, impaired kidney function, diet, certain medications and metabolic conditions can all increase the risk of developing gout.
Yes. Although gout is often perceived as a condition affecting older adults, it can occur much earlier. It is most common in men between 30 and 50 years old, many of whom are active, working adults who may experience their first flare without warning.
Gout flares usually occur suddenly, often at night and typically cause intense pain, warmth, swelling and redness in the affected joint. Gout most commonly affects the big toe, but it can also involve the foot, ankle, knee, hand or other joints.
A rheumatologist provides an accurate diagnosis, manages painful flare-ups and develops a long-term plan to ensure uric acid levels are controlled. Management may include medications, joint injections, imaging and monitoring for complications. The goal is to prevent future flares, reduce the risk of long-term joint damage and support overall metabolic and kidney health.
Gout attacks can be prevented when uric acid levels are well controlled. Regular check-ups allow for ongoing monitoring of uric acid levels and adjustment of medications. Consistent adherence to prescribed treatment is essential to reduce the risk of flare-ups. In addition, healthy lifestyle habits such as staying hydrated, maintaining a healthy weight and limiting alcohol, sugary foods and sweetened beverages can help lower the risk of future attacks.