Gout is where a joint becomes inflamed due to the build up of crystals (uric acid) in or around the joint. This causes inflammation, pain and swelling.

The lumps of urate crystals are called tophi. Tophi tends to appear more frequently in the ears, toes, hands and elbows. 30% of people who are left untreated from GOUT, develop tophi within the first 5 years of their first attack. These crystal deposits can destroy joints (like taking a bite out of a bone).

Being able to manage your training load and your expectations will be important in mitigating injury risk. Any sharp rises in training load can lead to an earlier onset of fatigue, which in turn increases your injury risk (such as overuse injuries, muscles strains, and even bone stress injuries)

GOUT can be associated with metabolic syndromes (obesity, high blood pressure, high blood sugar levels, high blood lipids)

What are the symptoms of GOUT?
An attack of GOUT usually comes on very quickly, often overnight. The joint becomes very red, swollen and extremely painful. GOUT normally affects one joint at a time, often the joint of the big toe. Other joints, such as hands, wrists, knees, ankles and elbows can also be affected by GOUT.

What causes GOUT?
GOUT is usually caused by our kidneys not flushing uric acid out quickly enough.

What is Urate?
Urate is uric acid (aka crystal deposits in GOUT). Urate is a normal waste product of the body and can build up over time unless changes are made to our diet and medications. Urate comes from the breakdown of cells. So the more cells that are broken down, the more urate that is made. Our kidney’s help us to remove urate. So if our kidney filtering process is inadequate (such as in people with recurrent GOUT), we could have potential build up of urate leading to crystal deposits.

Risk factors for developing GOUT

  • Diet (red meats, fructose & seafood can increase levels of uric acid)
  • Alcohol
  • Genetics
  • Kidney impairment
  • Medications (diuretics)
  • Metabolic syndrome (obesity, high blood pressure, diabetes)
  • Psoriasis

Diagnosis of GOUT
The only way of diagnosing GOUT with certainty is by extracting fluid from your joint and finding urate crystals. Urate levels can also be measured by blood tests, however these are not always accurate. Blood tests are more utilised for ruling out other inflammatory conditions (such as rheumatoid arthritis). X-rays are often normal in the early stages of GOUT and aren’t useful. A thorough subjective and physical examination is usually suffice in diagnosing GOUT.

What do I do during a GOUT attack?

  • Seek immediate treatment from a Doctor
  • Medication recommendations (e.g – NSAIDs, uric acid reducers)
  • May recommend corticosteroid injection?
  • Education around diet and alcohol consumption

Why physio is important?

  • Physio’s can be the first line of contact – meaning we are often in a position to pick GOUT up and refer on in the first place. It’s important that physio’s are able to identify a GOUT attack so that long term complications as stated above can be avoided
  • It’s very common to develop secondary complications from GOUT (e.g – abnormal gait/walking patterns, joint stiffness, reduced strength). Physio’s help with recovering from GOUT once the inflammation and pain has settled and help to improve functional outcomes
  • May recommend corticosteroid injection?
  • Implementation of exercise programs

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