Gout: who to see and what helps

Gout · Kitchener, Waterloo & Cambridge

Gout is a type of inflammatory arthritis in which urate crystals form in a joint, most often at the base of the big toe, and set off sudden, severe pain with swelling and redness. It is diagnosed and treated medically, by a physician or nurse practitioner and sometimes a rheumatologist: medicine for the flare and, when flares keep coming, a daily medicine that lowers urate. Changing what you eat has only a small effect on urate. At CARESPACE the first visit is with a Nurse Practitioner; our dietitians support that care and do not replace it.

What gout is

Gout is the most common form of inflammatory arthritis, affecting as many as one million Canadians, about 4% of men and 1% of women. Uric acid (urate) is a normal product of the breakdown of purines, which come from food and from the body’s own cells, and the kidneys clear it. When the level in the blood stays high for months or years, crystals form in joints and soft tissue. A flare is the immune system reacting to those crystals.

Symptoms of gout

• Severe pain in one joint that comes on fast, often overnight
• Redness, heat and swelling over the joint
• The base of the big toe most often; also the midfoot, ankle, knee, hand, wrist or elbow
• An attack that lasts one to two weeks if it is not treated
• Later, in some people: tophi, hard chalk-coloured lumps under the skin of the toes, fingers, elbows or ears

Attacks can return within months or not for years, and they come more often when gout is left untreated.

What causes gout

Urate builds up when the kidneys do not clear it as fast as the body makes it, and genes play a strong part: two people on the same diet can have very different levels. The risk is higher in men, with age and after menopause, with kidney disease, high blood pressure and excess weight, and with some medicines, such as water pills (diuretics). Alcohol, sugary drinks, red meat and some seafood add to it. A flare can be set off by an illness, dehydration, a joint injury, heavy drinking or a very large meal, a crash diet or a missed dose of gout medicine. Because of the genetic part, clinicians are asked to talk about food and drink without blaming the person.

How gout is diagnosed

From the story, an examination and a blood test. In UK guidance, a urate level of 360 micromol per litre or more confirms the diagnosis in someone with typical symptoms. The level can read normal during a flare, so if gout is still strongly suspected the test is repeated at least two weeks after the flare settles. When the picture is unclear, fluid can be drawn from the joint to look for crystals, or the joint can be scanned.

When a hot, swollen joint is urgent

A gout flare and an infection in a joint can look alike. Go to an urgent care clinic or an emergency department the same day if you have sudden joint pain and swelling and any of these: the pain is getting worse; you have a very high temperature, or feel hot, cold or shivery; or you feel sick or cannot eat. These could mean an infection inside the joint, which needs urgent medical help. Do not wait for an appointment with us.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

See a physician or nurse practitioner if this is your first attack, or if you have gout and your usual treatment is not working.

What the evidence says about treating gout

• Two guidelines. The UK’s (NICE, 2022) uses “offer” and “consider”; the American College of Rheumatology’s (2020) grades its recommendations, and those are the “strongly” and “conditionally” below. Strong rests on moderate or high certainty that the benefits outweigh the risks. Conditional means the balance is closer or the evidence is weaker.
• A flare is treated with medicine, started early. The UK instruction is to offer an anti-inflammatory (NSAID), colchicine or a short course of steroid tablets. Ice is an extra: it may help alongside the medicine, and is conditionally recommended.
• Long-term medicine lowers urate. Gout is a lifelong condition that progresses without treatment and benefits from long-term urate-lowering medicine. In the UK that medicine is offered to people with multiple or troublesome flares, tophi, chronic gouty arthritis, chronic kidney disease (stages 3 to 5) or diuretic treatment, and discussed with everyone else who has had a flare. The American guideline strongly recommends it for tophi, joint damage on imaging or two or more flares a year, and conditionally recommends against it after a first flare unless there is kidney disease, a very high urate level or kidney stones.
• Diet: not enough evidence for any specific diet. The UK instruction is to explain that there is not enough evidence that any specific diet prevents flares or lowers urate, and to advise a healthy, balanced diet. The American panel found the effect of diet or individual foods on urate to be small, and conditionally recommends limiting alcohol, purines and high-fructose corn syrup, on low or very low certainty evidence.
• Weight. Excess weight may make flares and symptoms worse. Weight loss is conditionally recommended for people who are overweight, on very low certainty evidence.
• Vitamin C and cherries. Adding vitamin C is conditionally recommended against, and there is no recommendation on cherries or dairy because the evidence was too weak. The NHS, by contrast, tells people to ask their doctor about vitamin C supplements.
• Other medicines matter. Switching the water pill hydrochlorothiazide to another blood pressure medicine is conditionally recommended where feasible, and stopping low-dose aspirin that is taken for a good reason is conditionally recommended against. Those are decisions for your prescriber.

What the medicines involve

These are prescribed by a physician or a nurse practitioner. Allopurinol is the first choice for lowering urate in American guidance; in the UK it is allopurinol or febuxostat. The dose starts low and is raised, with monthly blood tests, until urate is below 360 micromol per litre. Flares are common in the first months, so colchicine may be offered alongside while the target is being reached. The medicine is taken every day, including when you feel well.

How each CARESPACE service treats gout

Nurse Practitioner

Diagnosing, ordering and interpreting tests, prescribing and referring to specialists are all within a Nurse Practitioner’s authority in Ontario, which is the whole medical side of gout: assessing the joint, ordering the urate test, prescribing for a flare, and starting and adjusting urate-lowering medicine against monthly results. A rheumatology referral is worth considering when the diagnosis is uncertain, treatment is not working or cannot be tolerated, or there is more advanced kidney disease or an organ transplant.

See our nurse practitioner team →

Nutrition & Dietitian

No specific diet has been shown to prevent flares, so a Registered Dietitian can work on the things with a conditional recommendation behind them: alcohol, sugary drinks, the purine-rich foods you eat most, and steady weight loss if you carry excess weight. Steady matters, because crash diets and fasting are flare triggers.

See our nutrition team →

Other services people ask about

Physiotherapy, massage and acupuncture. The UK recommendations for gout mention none of them, and during a flare the advice is to rest the limb and keep pressure off the joint. Naturopathic medicine. No guideline we read gives it a role. On the supplements people ask about most, vitamin C is conditionally recommended against and cherry extract has no recommendation; talk to a pharmacist, physician or nurse practitioner before starting either.

Where most people start

With a Nurse Practitioner, or your own physician, because gout is confirmed with a blood test and controlled with prescription medicine. Add a Registered Dietitian if alcohol, sugary drinks or weight are part of your picture.

How your team works together

Gout is mainly a one-prescriber condition. The Nurse Practitioner or physician can handle the flare, the urate target and the blood tests; a dietitian can work on food, drink and weight. The medicine is the part with strong evidence.

Browse by service: nurse practitioners and registered dietitians.

What to expect at your first visit

1. The story of your attacks. Which joint, how fast it came on, how long it lasted and how many you have had.
2. Your other health conditions and medicines, especially blood pressure and kidney problems and water pills.
3. An examination of the joint, and a check for tophi.
4. What happens next. You leave with a plan, which may include a blood test for urate, repeated after the flare if needed, and what to take if another flare starts.

What you can do at home

During a flare:

• Take the medicine you were prescribed as soon as you can; it should start working within two days.
• Rest and raise the limb, keep pressure off the joint, and keep bedclothes off it at night.
• Cool the joint with an ice pack wrapped in a towel for up to 20 minutes at a time. Do not use heat on an inflamed joint.
• Drink plenty of water, unless you have been told to limit fluids.

Between flares:

• Keep taking urate-lowering medicine every day if you are on it.
• Have some alcohol-free days each week, and go easy on sugary drinks.
• If you are overweight, lose weight gradually and avoid crash diets.
• Stay active, but not with intense exercise or heavy pressure on the joints.

Outlook

An untreated attack usually settles in one to two weeks, and later attacks may last longer. Gout itself does not go away: without treatment new crystals keep forming, and repeated attacks over a long period can damage joints and lead to tophi and kidney stones. Urate-lowering medicine is given to clear the crystals, prevent flares, shrink tophi and prevent long-term joint damage, although the crystals already there can take years to disappear.

Gout treatment in Kitchener, Waterloo and Cambridge

Kitchener. Nutritionist & Dietitian in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Nutritionist & Dietitian in Waterloo and Nurse Practitioner in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Nutritionist & Dietitian in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

What foods should I avoid with gout?

No specific diet has enough evidence behind it, so the basic advice is a healthy, balanced diet. Limiting purine-rich foods (red and organ meats and some seafood among them), alcohol and high-fructose corn syrup is conditionally recommended, and the effect of any one food on urate is small.

Can I still drink beer?

The advice is to limit alcohol, not necessarily to stop. Have some alcohol-free days each week; beer is the drink Arthritis Society Canada singles out. In the home of Kitchener-Waterloo Oktoberfest, that is worth knowing before the festhallen open each fall.

Do cherries or vitamin C help gout?

The American College of Rheumatology reviewed both. It conditionally recommends against adding vitamin C, and made no recommendation on cherries because the evidence was of low or very low certainty. The NHS takes a softer line on vitamin C and tells people to ask their doctor. Either way, talk to a pharmacist, physician or nurse practitioner before starting a supplement.

Will I need gout medication for life?

Often, yes. Urate-lowering medicine is usually continued after the target is reached and is typically lifelong; continuing it indefinitely has a conditional recommendation. Not everyone with gout is on it.

Can I see a dietitian about gout in Cambridge?

Yes: Nutritionist & Dietitian in Cambridge. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• National Institute for Health and Care Excellence. Gout: diagnosis and management (NG219). 2022. UK guidance.
• FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care & Research, 2020.
• Arthritis Society Canada. Gout. Medically reviewed October 2022.
• NHS. Gout. Reviewed August 2023; the next review was due in August 2026.
• College of Nurses of Ontario. NP Practice Resources (what Nurse Practitioners are authorized to do). Viewed November 2026.
• Kitchener-Waterloo Oktoberfest. Official site. Viewed November 2026.

Related conditions

Rheumatoid Arthritis
Osteoarthritis
Kidney Health
High Blood Pressure
Foot Pain

Ready to book?

Book online with a nurse practitioner or a registered dietitian, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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