Gout — NZ Condition Guide | KiwiMeds

What is Gout?

Gout is a form of inflammatory arthritis caused by a build-up of uric acid crystals in the joints. It causes sudden, severe attacks of pain, swelling, redness, and tenderness — most often in the big toe, but it can also affect ankles, knees, wrists, and fingers. New Zealand has one of the highest rates of gout in the world — it affects around 3–4% of the adult population, with Māori and Pacific men having the highest rates of any group globally.

Symptoms

Gout typically presents as sudden, severe joint pain — often starting at night and reaching peak intensity within 12–24 hours. The affected joint is swollen, red, warm, and extremely tender (even the weight of a sheet on the joint can be unbearable). Attacks usually last 5–10 days and then completely resolve. Between attacks, there are no symptoms. Over time, without treatment, attacks become more frequent, affect more joints, and can lead to permanent joint damage and tophi (deposits of uric acid crystals under the skin).

Causes and Risk Factors

Gout is caused by hyperuricaemia — high levels of uric acid in the blood. Uric acid is produced when the body breaks down purines (found in certain foods and formed naturally). When uric acid levels are too high, crystals form in joints. Risk factors include being male (gout is more common in men), age, being Māori or Pacific (genetic factors affect how the kidneys handle uric acid), obesity, high purine diet (red meat, shellfish, organ meats), alcohol consumption (especially beer), certain medications (diuretics, low-dose aspirin), and kidney disease.

Diagnosis

Gout is often diagnosed clinically based on the characteristic symptoms. A blood test for uric acid may be done, though levels can be normal during an acute attack. Joint fluid aspiration (taking a sample of fluid from the joint) showing uric acid crystals confirms the diagnosis. Your GP may arrange this or refer you to a rheumatologist for complex cases.

Treatment in New Zealand

Acute gout attacks are treated with anti-inflammatory medicines — NSAIDs (e.g. naproxen, indomethacin), colchicine, or corticosteroids. These are most effective when started as soon as symptoms begin. Long-term gout management involves urate-lowering therapy — allopurinol is the standard first-line treatment, funded by Pharmac. Allopurinol lowers uric acid levels, reducing the frequency and severity of attacks. Febuxostat is an alternative for those who cannot tolerate allopurinol. Dietary changes (reducing red meat, shellfish, alcohol) and staying well hydrated also help.

NZ-Specific Information

New Zealand’s high gout rates are a significant health equity issue — Māori and Pacific peoples are disproportionately affected and often have more severe disease. Allopurinol is funded by Pharmac and is the cornerstone of long-term gout treatment. Many GPs in NZ follow the 3 Ts of gout management: Test (check uric acid), Treat (start allopurinol), and Target (aim for uric acid below 0.36 mmol/L). Arthritis New Zealand provides free information and support.

Frequently Asked Questions

Can gout be cured? Not cured, but with allopurinol and lifestyle changes, many people become attack-free. Should I start allopurinol during an attack? Traditionally, allopurinol is started 2–4 weeks after an acute attack resolves, though recent evidence suggests it can be started during an attack. Follow your doctor’s advice. Can I drink alcohol with gout? Alcohol — especially beer and spirits — raises uric acid levels and should be minimised.

Supplements That May Support Management

⚠️ Important: The supplements listed below have varying levels of clinical evidence. They are not a substitute for prescribed medications and should only be considered as adjunctive support under the guidance of a qualified healthcare professional. Always inform your GP or pharmacist before commencing any supplement, as interactions with prescribed medicines are possible.

• Vitamin C — Vitamin C has a modest uricosuric effect, increasing renal excretion of uric acid. Supplementation at 500–1000 mg/day has demonstrated reductions in serum urate of approximately 0.5 mg/dL in clinical trials, providing modest but meaningful adjunctive benefit.
• Quercetin — Quercetin inhibits xanthine oxidase (the same enzyme targeted by allopurinol), supporting reduced uric acid production. It also has anti-inflammatory properties that may reduce gout flare severity. Doses of 500 mg twice daily have been studied.
• Tart Cherry Extract — Tart cherries contain anthocyanins with both uricosuric and anti-inflammatory properties. Regular consumption (as juice or concentrated supplement) has been associated with reduced gout flare frequency and modestly lower serum urate levels in observational studies.
• Folic Acid — Folic acid may inhibit xanthine oxidase activity, though clinical evidence for meaningful urate reduction remains limited. It is an inexpensive, low-risk addition if dietary folate intake is inadequate.

Relevant Vaccinations

Individuals living with gout may benefit from the following vaccinations. Please discuss your vaccination status with your GP or practice nurse, as eligibility and funding through the New Zealand National Immunisation Schedule may apply.

• Influenza (annual) — Febrile illness including influenza can precipitate gout flares through dehydration and altered uric acid excretion. Annual influenza vaccination is recommended.
• Pneumococcal — Recommended for those with gout-associated chronic kidney disease, which increases susceptibility to pneumococcal infection.

Dietary Guidance

Evidence-based dietary modifications play a meaningful role in the management of gout. The following foods are generally recommended as part of a balanced, condition-appropriate diet. A referral to a registered dietitian may be beneficial for personalised nutritional planning.

• Tart cherry juice or fresh cherries — Among the most evidence-based dietary interventions for gout. Regular consumption (e.g., 237 ml tart cherry juice daily) has demonstrated 35–40% reductions in gout attack risk in prospective studies, via both uricosuric and anti-inflammatory mechanisms.
• Low-fat dairy (skim milk, low-fat yoghurt) — Low-fat dairy products are uniquely uricosuric and orotic acid-containing, promoting renal urate excretion. Regular consumption is associated with meaningfully lower serum urate levels and reduced gout risk.
• Abundant water intake (≥2 litres daily) — Adequate hydration is foundational to gout management, increasing renal urate clearance and reducing crystal supersaturation in joint fluid and the urinary tract.
• Vegetables (all types, including purine-containing ones) — Unlike purine-containing meats and seafood, purine-rich vegetables (asparagus, spinach, mushrooms) are NOT associated with increased gout risk and should not be restricted. A vegetable-rich diet supports alkaline urine and urate excretion.
• Limit: red meat, organ meats, shellfish, beer, spirits — These are the most evidence-based dietary triggers for elevated uric acid. Red meat and shellfish are high in purines; alcohol (particularly beer and spirits) both increases urate production and reduces renal excretion. Wine has a less pronounced effect.
• Limit: fructose and sugar-sweetened beverages — Fructose is the only carbohydrate that increases uric acid production (via AMP degradation). Sugar-sweetened soft drinks are strongly associated with gout risk and serum urate levels.

Related Conditions & Medications

Related medications: Allopurinol. Related conditions: Hypertension, Type 2 Diabetes.