Gout education for your team

Clinical Knowledge Guide for Healthcare Providers | Health New Zealand – Te Whatu Ora

Updated June 2026  |  Aotearoa New Zealand  |  For use by primary care teams

During this continuous quality improvement (CQI) project, it was also identified that there needed to be a clinical update for GPs/nurses on gout. Best practice treatment and management for gout had changed over recent years and there needed to be a greater understanding of the impact of genetics on gout, especially in younger Māori and Pacific males.

Whanganui GOUT STOP programme evaluation report 2020

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"We realised we know a lot about diabetes because we are dealing with it all the time – what it is, how to treat it, medications, tests, how to talk with patients about it, so much. But we don't have the same knowledge about gout."

— Nurse leader, ProCare Gout Collaborative Practice

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Talking about gout in a new way means being up to date with the latest guidance, particularly how genetics affect urate/uric acid levels, so this knowledge can be shared with whānau Māori and Pacific peoples with gout, and the wider community.

8 Key Areas of Clinical Knowledge

1. Causes of Gout

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Key message: Gout is not the person's fault. Gout is not about self-control or excessive consumption of high purine foods.

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Gout is caused by high levels of urate/uric acid in the body (hyperuricaemia).
Only 10% of elevated urate is attributable to diet and alcohol consumption.
90% of elevated urate is due to genetic factors - particularly among whānau Māori and Pacific peoples - which cause the kidneys to under-excrete urate.
Higher body weight also impairs renal urate excretion, but many weight-loss eating plans (high protein, seafood, green leafy vegetables) may worsen gout.
Advice about increasing activity and losing weight should be deferred until the person has achieved their urate treatment target and is no longer experiencing painful acute attacks.

2. Acute Gout Attacks

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Serum urate commonly falls during an acute attack. Do not use a normal urate level to exclude gout.

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Up to 40% of patients will have a serum urate ≤0.36 mmol/L at presentation with an acute attack.
Prior to an attack, supersaturated urate crystallises in a joint, triggering an intense innate inflammatory response producing a hot, red, swollen, exquisitely painful joint.
After the pain resolves, monosodium urate (MSU) crystals remain in the joint and periarticular tissues, continuing to cause structural damage.
With each recurrent attack, the crystal burden grows. Tophi (visible subcutaneous deposits) may develop and cause progressive joint and bone destruction.
When a patient presents with a first attack, ask about previous unexplained joint pain or injuries slow to settle - prior unrecognised episodes are common.
Gout is a marker for other long-term conditions: **type 2 diabetes, cardiovascular disease, hypertension, and chronic kidney disease (CKD)**.

3. Whānau Māori and Pacific Peoples with Gout

Gout as an Equality and Equity Issue

These equity and equality issues mean that whānau Māori and Pacific peoples with untreated gout are much more likely to experience impacts to continued employment, ability to engage with families, participate in community activities and play sport and be active as well as mental and emotional wellbeing issues caused by self-blame and stigma (equity).

Issue	Impact on Māori and Pacific Peoples	Type
Prevalence	2–3 times more likely to develop gout than other ethnic groups	Equality
Age at onset	Commonly presents in late teens and early 20s, significantly earlier than other populations	Equality
Hospitalisation	5–10 times more likely to be admitted with severe gout than any other ethnic group	Equality
ULT access	Substantially less likely to be prescribed long-term urate-lowering therapy (ULT)	Equity
NSAID prescribing	Far more likely to receive short-term NSAID prescriptions only, without ULT	Equity

Community Beliefs and Stigma

Longstanding, strongly held beliefs in Māori and Pacific communities include:

Gout is caused by excessive food and alcohol consumption (especially seafood and beer).
Gout is temporary and resolves when pain settles.
Pain medicines are the primary treatment.
Having gout reflects a personal failure of self-control.

These beliefs are reinforced when primary care teams focus solely on pain relief and dietary advice without addressing underlying causes or the benefits of long-term ULT. People with gout commonly experience stigma, self-blame, and social judgment from employers, communities, and health services.

4. Impacts of Gout on Patients and Their Whānau

Because Māori and Pacific peoples develop gout at younger ages and live with it for longer, the burden on individuals, families, and communities is profound.

Employment: Acute attacks quickly deplete sick leave; employers may attribute absences to poor self-management rather than a chronic condition.
Physical activity and weight management: Recurrent pain limits mobility, compounding difficulties with maintaining a healthy weight.
Family and community participation: Inability to engage fully with children, whānau, sport, church, and cultural activities.
Mental and emotional wellbeing: Self-blame, stigma, and inaccurate medical messaging contribute to psychological distress and reduced help-seeking.
Reinforcement of community misconceptions when gout is inadequately treated and explained.

5. Pain Relief During Acute Gout Attacks

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⚠ Clinical Alert: Ongoing NSAID prescribing carries serious risks. All acute prescriptions should be accompanied by ULT education and planning.

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First-line options for acute gout include NSAIDs, colchicine, or corticosteroids (oral or intra-articular), guided by comorbidities, renal function, and patient preference.
Ongoing NSAID use carries risk of GI bleeding, kidney damage, and cardiovascular events – particularly in patients with CKD, cardiovascular disease, or older age.
Low-dose colchicine is preferred in many patients. Read more about dosing and precautions in renal impairment and refer to your local HealthPathways guidance.
Advise patients of the risks of purchasing NSAIDs over the counter and sharing prescription medicines with family members.
Every prescription for acute pain relief is an opportunity to discuss long-term ULT and prevent future attacks.

6. Treatment Goals

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