Abstract
Gout is a common inflammatory arthritis associated with high levels of uric acid, affecting individuals worldwide. Understanding public awareness of gout is crucial for disease management and prevention. This study aimed to assess the knowledge and awareness of gout among adults living in Jeddah, Saudi Arabia, and to identify the sources of their information regarding the disease. This cross-sectional study was conducted in Jeddah, Saudi Arabia, from August 2024 to July 2024. The study included 509 participants aged ≥ 18years, recruited through an online questionnaire distributed on social media platforms. The questionnaire assessed demographic characteristics, presence of chronic diseases, prior diagnosis of gout, sources of information, and knowledge about gout. Knowledge scores were categorized into “good” (≥60%) or “poor” (<60%) based on the participants’ responses. Among the 509 respondents, 49.7% were aged 18 to 30 years, 75.4% were female, and 87.8% were Saudi nationals. The majority (70.3%) had a university-level education, and 28.1% were employed. Chronic diseases were reported by 16.9% of the participants, with hypertension being the most common, and 28.3% were obese. A total of 6.3% of participants reported a prior diagnosis of gout. The most common sources of information were the Internet and social media (40.5%), followed by family and friends (35.2%). Regarding knowledge, 79.8% had heard of gout, and 64% correctly identified excessive red meat consumption as a cause. Symptoms such as joint pain (67%) and joint swelling (44%) were the most commonly recognized. Preventive measures such as maintaining a healthy lifestyle and reducing meat intake were reported by 60.7% of participants. The mean knowledge score was 7.78 ± 2.79, with 83.7% classified as having poor knowledge and 16.3% with good knowledge. No significant relationships were found between knowledge level and participants’ demographics, sources of information, or previous diagnosis of gout (P > .05). However, participants without chronic diseases had significantly better knowledge about gout (P < .05). The study revealed a low level of knowledge about gout among adults in Jeddah, with significant gaps in understanding its causes, symptoms, and prevention. Public health interventions are necessary to improve awareness, especially in individuals with chronic diseases.
Keywords: awareness, chronic diseases, Gout, knowledge, prevention, public health, Saudi Arabia
1. Introduction
Gout is one of the most common types of inflammatory arthritis.[1] Gout occurs when uric acid forms crystals in the joints and is often associated with high levels of uric acid in the blood.[2] This condition mostly affects the big toe joint.[3] Urate crystals form when blood uric acid levels go up, which also raises the chance of developing kidney stones.[4] Sometimes, gout can come with tophi, and this can lead to gouty arthritis later on. Two acute gout can lead to really intense pain, swelling, and discomfort in the joints, along with some other symptoms. Intercritical gout is the period when there are no symptoms between gout attacks.[4] The term “Podagra” is a term that refers to a condition where urate crystals affect the first metatarsophalangeal joints, leading to intense pain.[3] It is often used to describe acute gout. Also, there are clear signs of flare-ups that come with severe gout symptoms. This involves significant inflammation that leads to discomfort and pain lasting approximately 5 to 10 days.[4]
The pathophysiology of gout involves a complex interplay of genetic, metabolic, and immune processes that contribute to disease progression. Various genetic and metabolic factors lead to hyperuricemia, which sets the stage for monosodium urate (MSU) crystal formation.[2] The formation of these crystals is influenced by metabolic, physiological, and other individual characteristics.[2] Once MSU crystals deposit in the joints, they trigger an acute inflammatory response through soluble inflammatory factors, cellular elements, and innate immune processes.[2] The immune system then plays a role in resolving this acute inflammation.[4] However, in chronic gout, persistent inflammatory mechanisms, along with the effects of immune cells and MSU crystals on chondrocytes, osteoblasts, and osteoclasts contribute to bone erosion, joint damage, cartilage degradation and the formation of tophi.[2]
Regarding its prevalence, there has been a noticeable rise in its prevalence around the world. For example, in Canada, a rise in the prevalence of gout had been noted notably from 3 percent in 2003 to 3.8 percent in 2012.[5] Likewise, the prevalence of gout has risen by more than 1.5 to 2.0 times in North America and Scandinavia.[6–8] In China, the prevalence of hyperuricemia was reported to be 25.3%, while the prevalence of adult gout was noted to be 0.36%.[9] In Saudi Arabia, a study looked at how common gout is and found that 8.42% of the participants had hyperuricemia.[10]
Several countries, such as the United Kingdom and the United States have created management strategies for gout due to the increasing prevalence of the disease. Traditionally, treatment for gout has not really proven to be effective. In 2014, there was a rise in the number of emergency room visits in the United States due to gout flares, reaching a total of 2.1 million.[11] During 28% of these visits, prescriptions for opioids were given, and among those, 80% were for patients who were already using opioids.[12] To prevent and treat gout flares, there are certain recommended medications.[7] However, a lot of patients do not receive therapy to reduce blood urate levels, and adherence to treatment is often low, which diminishes its effectiveness.[8] The American College of Rheumatology and the European League Against Rheumatism support not only pharmacological interventions but also emphasize the importance of education and nutrition.[9] So, the best way to manage gout might include using different medications, changing what you eat, and possibly taking some dietary supplements.
Even though it has a big impact and is really important, studies indicate that many people in Saudi Arabia do not know enough about gout. A study that looked into physicians’ knowledge of gout revealed that only 32.8% had a solid understanding of the condition.[13] Raising public awareness of diseases is a crucial step in preventing and managing it within the community.
This study aimed to assess the awareness of gout disease among the adult population in Jeddah City, Saudi Arabia.
2. Subjects and methods
2.1. Study design and settings
This cross-sectional study aimed to assess the awareness of gout disease among adults in Jeddah city, Saudi Arabia. The study was conducted from August 2024 to July 2024.
2.2. Inclusion and exclusion criteria
The study included adults aged 18 years and older who were residing in Jeddah city, Saudi Arabia. Individuals younger than 18 years were excluded from the study.
2.3. Data collection procedure
The data collection procedure involved distributing a validated questionnaire, which had been used in a previous study, through social media platforms.[14] The questionnaire included items to assess the participants’ demographics, including chronic diseases, previous diagnosis with gout, sources of information about gout, and knowledge about gout.
According to knowledge questions, every correct answer was given a score of “1,” and every wrong or “I don’t know” answer was given a score of “0” leaving a total score of 11. If a participant’s score was <60% of the total, the overall awareness score was classified as bad, and if the participant’s score was 60% or higher, the overall awareness score was considered good.
2.4. Ethical considerations
This study was approved by the research ethics committee of King Abdulaziz University Jeddah, Saudi Arabia, on March 7, 2024 (Reference No. 61-24). All participants provided informed consent before data collection, ensuring confidentiality and voluntary participation.
2.5. Data analysis
The chi-squared test (χ2) was used to examine relationships between categorical variables, with results presented as numbers and percentages. Quantitative variables were summarized using mean and standard deviation and a P-value of less than .05 was considered statistically significant.
3. Results
Of the studied 509 participants, 49.7% had an age ranging from 18 to 30 years, 75.4% were females, 87.8% had Saudi nationality and 49.1% were married. The majority (70.3%) had a university level of education and 28.1% were employed. Of them, 16.9% had chronic diseases, with hypertension the most common and 28.3% were obese (Table 1).
Table 1.
Distribution of the participants according to their demographic characters, and chronic diseases (No. 509).
| Variable | No. (%) |
|---|---|
| Age (years) | |
| 18–30 | 253 (49.7) |
| 31–40 | 77 (15.1) |
| 41–50 | 72 (14.1) |
| >50 | 107 (21) |
| Gender | |
| Female | 384 (75.4) |
| Male | 125 (24.6) |
| Nationality | |
| Saudi | 447 (87.8) |
| Non-Saudi | 62 (12.2) |
| Marital status | |
| Widow | 9 (1.8) |
| Single | 229 (45) |
| Married | 250 (49.1) |
| Divorced | 21 (4.1) |
| Educational level | |
| Primary | 3 (0.6) |
| Middle | 4 (0.8) |
| Secondary | 114 (22.4) |
| University | 358 (70.3) |
| Other | 30 (5.9) |
| Occupation | |
| Student | 172 (33.8) |
| Unemployed | 194 (38.1) |
| Employed | 143 (28.1) |
| Having any chronic diseases | |
| No | 423 (83.1) |
| DM | 17 (3.3) |
| HTN | 38 (7.5) |
| Both | 31 (6.1) |
| Having obesity | |
| No | 365 (71.7) |
| Yes | 144 (28.3) |
DM = diabetes mellitus, HTN = hypertension.
Of the participants, 32 (6.3%) were previously diagnosed with gout (Fig. 1). As for their sources of information about gout, the most common sources were the Internet and social media (40.5%) and family and friends (35.2%) (Fig. 2).
Figure 1.
Percentage distribution of the prevalence of gout among studied participants.
Figure 2.
Percentage distribution of sources of information about gout.
Table 2 demonstrates that most of the participants (79.8%) had heard about gout. As for correct information about gout causes, 64% reported eating a lot of red meat, and only 2.2% reported heart diseases. As for symptoms and signs related to gout disease, the most commonly reported were joint pain (67%) and swelling around the joint (44%). About 65% (65.8%) reported that gout is accompanied by other diseases, with obesity (45.2%), and level of cholesterol in the blood (40.7%) the most commonly reported. Only 38.3% reported the presence of a relationship between gout disease and increased complications of kidney disease. More than half (57%) reported that gout can be prevented, and most of the participants (60.7%) reported that all the following measures (losing excess weight, drinking plenty of fluids, such as water, doing physical activities, and healthy eating patterns) are methods of prevention. At the same time, 51.9% of them reported that all these measures (stop eating large amounts of meat, change to a healthy lifestyle, and take medications under medical supervision) are methods of treatment.
Table 2.
Participants’ responses to knowledge questions about gout (No. 509).
| Variable | No. (%) |
|---|---|
| Have you heard about gout disease? | |
| No | 103 (20.2) |
| Yes | 406 (79.8) |
| Which of the following is a cause of gout disease? | |
| Heart diseases | 11 (2.2) |
| Eating a lot of red meat | 320 (64) |
| Thyroid disorders | 60 (12) |
| Lack of sleep | 30 (6) |
| Sports/exercise | 15 (3) |
| Autoimmune disorders | 115 (23) |
| Unknown causes | 45 (9) |
| I don’t know | 120 (24) |
| Which of the following is related to gout disease? | |
| Heat | 107 (21) |
| Diarrhea | 12 (2.4) |
| Joints pain | 342 (67.2) |
| Redness | 100 (19.6) |
| Swelling around the joint | 224 (44) |
| Fractures | 28 (5.5) |
| Abdominal pain | 24 (4.7) |
| I don’t know | 119 (23.4) |
| Do you think gout is accompanied by other diseases? | |
| No | 174 (34.2) |
| Yes | 335 (65.8) |
| If yes, which of the following is related to gout disease? | |
| HTN | 144 (28.3) |
| Obesity | 230 (45.2) |
| Level of cholesterol in the blood | 207 (40.7) |
| Heart diseases | 131 (25.7) |
| Diabetes mellitus | 128 (25.1) |
| Kidney diseases | 103 (20.2) |
| Do you think there is a relationship between gout disease and increased complications of kidney disease? | |
| No | 14 (2.8) |
| I don’t know | 300 (58.9) |
| Yes | 195 (38.3) |
| Can gout disease be prevented? | |
| No | 21 (4.1) |
| I don’t know | 198 (38.9) |
| Yes | 290 (57) |
| What are the ways to prevent gout? | |
| Losing excess weight | 8 (1.6) |
| Drink plenty of fluids, such as water | 7 (1.4) |
| Doing physical activities | 10 (2) |
| Healthy eating pattern | 84 (16.5) |
| All the above | 309 (60.7) |
| I don’t know | 91 (17.9) |
| What is the treatment of gout disease? | |
| Stop eating large amounts of meat | 51 (10) |
| Change to a healthy lifestyle | 58 (11.4) |
| Take medications under medical supervision | 26 (5.1) |
| All the following | 264 (51.9) |
| I don’t know | 110 (21.6) |
HTN = hypertension.
The mean knowledge score was 7.78 ± 2.79, and according to the knowledge score classification, 83.7% of the participants had poor knowledge about gout, and 16.3% had good knowledge. According to the relationship between the level of knowledge about gout and participants’ demographics, a nonsignificant relationship was found (P ≥ .05). At the same time, a nonsignificant relationship was found between the level of knowledge about gout and sources of information about gout or previous diagnosis with gout (P ≥ .05). On the other hand, good knowledge about gout was significantly higher among participants who did not have any chronic diseases (P ≤ .05) (Table 3, Figs. 3 and 4).
Table 3.
Relationship between participants’ level of knowledge about gout and their demographic characters, chronic diseases, sources of information, and previous diagnosis with gout (No. 509).
| Variable | Knowledge level | χ 2 | P-value | |
|---|---|---|---|---|
| Poor No. (%) |
Good No. (%) |
|||
| Age (years) | ||||
| 18–30 | 213 (50) | 40 (48.2) | 3.6 | .308 |
| 31–40 | 69 (16.2) | 8 (9.6) | ||
| 41–50 | 59 (13.8) | 13 (15.7) | ||
| >50 | 85 (20) | 22 (26.5) | ||
| Gender | ||||
| Female | 326 (76.5) | 58 (79.9) | 1.65 | .198 |
| Male | 100 (23.5) | 25 (30.1) | ||
| Nationality | ||||
| Saudi | 375 (88) | 72 (86.7) | 0.1 | .744 |
| Non-Saudi | 51 (12) | 11 (13.3) | ||
| Marital status | ||||
| Widow | 8 (1.9) | 1 (1.2) | 2.81 | .422 |
| Single | 193 (45.3) | 36 (43.4) | ||
| Married | 205 (48.1) | 45 (54.2) | ||
| Divorced | 20 (4.7) | 1 (1.2) | ||
| Educational level | ||||
| Primary | 3 (0.7) | 0 (0.0) | 4.29 | .368 |
| Middle | 4 (0.9) | 0 (0.0) | ||
| Secondary | 91 (21.4) | 23 (27.7) | ||
| University | 305 (71.6) | 53 (63.9) | ||
| Other | 23 (5.4) | 7 (8.4) | ||
| Occupation | ||||
| Student | 143 (33.6) | 29 (34.9) | 0.38 | .825 |
| Unemployed | 161 (37.8) | 33 (39.8) | ||
| Employed | 122 (28.6) | 21 (25.3) | ||
| Having any chronic diseases | ||||
| No | 354 (83.1) | 69 (83.1) | 11.1 | .011 * |
| DM | 10 (2.3) | 7 (8.4) | ||
| HTN | 36 (8.5) | 2 (2.4) | ||
| Both | 26 (6.1) | 5 (6) | ||
| Having obesity | ||||
| No | 307 (72.1) | 58 (69.9) | 0.16 | .686 |
| Yes | 119 (27.9) | 25 (30.1) | ||
| Where have you heard about gout disease? | ||||
| Family and friends | 153 (35.9) | 26 (31.3) | 0.64 | .423 |
| Doctors/healthcare | 100 (23.5) | 22 (26.5) | 0.35 | .554 |
| News/magazines | 48 (11.3) | 9 (10.8) | 0.01 | .911 |
| Internet and social media | 171 (40.1) | 35 (42.2) | 0.11 | .731 |
| No one | 86 (20.2) | 14 (16.9) | 0.48 | .486 |
| Do you have gout? | ||||
| No | 402 (94.4) | 75 (90.4) | 1.89 | .169 |
| Yes | 24 (5.6) | 8/(9.6) | ||
DM = diabetes mellitus, HTN = hypertension.
Statistically significant (P ≤ .05).
Figure 3.
Percentage distribution of the participant’s level of knowledge about gout.
Figure 4.
Relationship between participants’ level of knowledge about gout and having chronic diseases (No. 509).
4. Discussion
The current study identifies several significant observations concerning the knowledge and awareness of gout amongst the participants in Jeddah, Saudi Arabia. Of the 509 participants, the majority were female (75.4%) and within the 18 to 30 years age group (49.7%). The awareness of gout was high at 79.8%, and the major sources of information included the internet and social media (40.5%) and family and friends (35.2%). However, the overall knowledge about gout was relatively low, with 83.7% of participants scoring poorly on the knowledge scale, while only 16.3% demonstrated good knowledge. Interestingly, participants without chronic diseases had significantly better knowledge than those with chronic c\onditions (P = .011). Furthermore, 57% of the participants stated that gout is preventable, although only 38.3% identified it with worsening kidney disease complications.
When comparing our findings with other studies, we observed some similarities and differences. For instance, in our study, 79.8% of participants heard about gout disease, the internet, and social media were the participants’ main sources of information (40.5%), followed by family and friends (35.2%), doctor/healthcare providers (24%), newspapers/magazines (11%), and 19.6% did not have any source of information. Our findings are in line with a previous study conducted in Jazan, Saudi Arabia,[15] which discovered that the internet is the most widely used source of information regarding gout disease (22.5%), followed by friends/colleagues (15.4%), doctor/healthcare providers (14.5%), another source (21.1%), and 23% of participants did not have any source.[15]
In our study, we examined several potential causes of gout, including heart disease, excessive consumption of red meat, thyroid disorders, lack of sleep, lack of exercise, autoimmune disorders, and unidentified factors. The majority of participants (64%) identified consuming large amounts of red meat as the primary cause of gout. Meanwhile, 24% did not attribute gout to any of the listed causes. Additionally, 23% of participants believed autoimmune disorders were responsible, 12% cited thyroid disorders, and 9% thought the cause was unknown. Other causes included lack of sleep (6%), lack of exercise (3%), and heart disease (2.2%). These findings are consistent with a prior study conducted in 2021, which found that the majority of participants (78.4%) identified consuming a large amount of meat as the primary cause of gout. Other causes included autoimmune disorders (12.6%), thyroid diseases (8.2%), and heart disease (4.4%).[16] Additionally, some participants attributed gout to unknown causes (7.6%), lack of exercise (5.2%), and lack of sleep (4.4%).[16] In comparison, a 2024 study conducted in Jazan found that 51.3% of participants believed there is no relationship between consuming red meat and developing gout, whereas 23.3% believed there is a relationship.[1]
As for gout awareness, our findings are consistent with other studies conducted in Saudi Arabia. A survey conducted in Taif revealed that the level of knowledge is still very low, particularly among the youth, with only 35 of the participants aged between 18 and 30 years, 59% had adequate knowledge about gout.[17] Likewise, the present investigation revealed that this younger population had limited knowledge of the disease. These results suggest that there may be deficiencies in health literacy among younger populations, owing to the lack of specific health promotion campaigns aimed at youth.
Among symptoms of gout identified by our participants, joint pain was endorsed by 67% and joint swelling by 44%, which is consistent with prior research. For instance, a 2021 study found that 71.4% of participants identified joint pain as a major symptom, followed by swelling (53.4%).[16] However, a study conducted in Taif in 2020 found that redness (40%) was more frequently identified as a symptom compared to joint pain (10.7%).[17] Such changes in awareness of certain symptoms could have implications for the early detection and management of the disease.
Additionally, in our study, it was observed that there is a severe lack of awareness of complications of gout, especially in its effect on kidney disease. Only 3% of participants knew the association between gout and kidney issues, which is similar to the Riyadh study conducted in 2021, where 51% of the participants had no knowledge about the association.[16] Since hyperuricemia may cause kidney stones as well as chronic kidney disease, it is vital to enhance the general population’s awareness of these complications.
Numerous studies have explored the relationship between serum uric acid levels and lipid profiles, but the results have been inconsistent. Nonetheless, a case-control study conducted in 2022 found that patients with gout had a significantly higher prevalence of dyslipidemia compared to a control group without gout.[18] According to our questionnaire, 40.7% of participants identified a relationship between cholesterol levels and gout.
Obesity affects approximately 650 million individuals globally and is associated with many obesity-related disorders.[19] The correlation between weight gain and an elevated risk of gout was clarified by a retrospective cohort research conducted in the United States.[20] The study found that gaining weight after reaching adulthood was linked to a higher risk of developing gout. These results have demonstrated how important it is to maintain a nonobese weight and weight decrease throughout adulthood in order to avoid and treat gout.[20,21] In our study, 45.2 agreed when asked about this point and regarded it as showing low awareness.
Regarding the prevention of gout, 57% of the participants are aware that it is a condition that may be prevented, but over 33%, or 38.9%, were unaware of this. Comparably, in the Al Kaabba research, 35.2% of respondents said that gout was not a disease that could be prevented, whereas the majority of respondents (59.4%) said that it could.[14]
5. Conclusion
This cross-sectional survey study carried out in Jeddah showed poor knowledge about gout in adults. The awareness of gout among the participants seemed low, despite the fact that most participants had heard of the disease. The findings suggest that most participants were not informed of the fundamental aspects of gout, including indications, risk factors, and associations with other disorders, including obesity and renal disease. In essence, the primary sources of information, including the Internet and social media, were insufficient to provide comprehensive knowledge about gout. In addition, knowledge about gout was significantly higher in subjects who did not have chronic diseases, which could potentially suggest that chronic diseases are associated with poorer awareness. These findings emphasize the importance of developing patient-specific educational programs that can increase the level of public awareness and contribute to better gout management.
Author contributions
Conceptualization: Mohannad A. Alzain, Samara Hebaishi, Laila Almohammadi, Shatha Alghamdi, Samaa Hebaishi.
Data curation: Mohannad A. Alzain, Mohammed A. Bazuhair, Muruj S. Alharthi, Wail Abdullah Alamoudi, Bandar Hasan Saleh, Samara Hebaishi, Shatha Alghamdi, Samaa Hebaishi, Laila Almohammadi.
Formal analysis: Mohannad A. Alzain, Mohammed A. Bazuhair, Muruj S. Alharthi, Bandar Hasan Saleh, Samara Hebaishi, Shatha Alghamdi, Samaa Hebaishi, Laila Almohammadi, Najim Z. Alshahrani.
Funding acquisition: Mohannad A. Alzain, Muruj S. Alharthi, Wail Abdullah Alamoudi, Bandar Hasan Saleh, Mohammed A. Bazuhair, Najim Z. Alshahrani.
Investigation: Mohannad A. Alzain, Muruj S. Alharthi, Bandar Hasan Saleh, Samara Hebaishi, Shatha Alghamdi, Samaa Hebaishi, Laila Almohammadi, Najim Z. Alshahrani.
Methodology: Mohannad A. Alzain, Mohammed A. Bazuhair, Wail Abdullah Alamoudi, Shatha Alghamdi, Samara Hebaishi, Samaa Hebaishi, Laila Almohammadi, Najim Z. Alshahrani.
Project administration: Mohannad A. Alzain, Najim Z. Alshahrani.
Resources: Mohannad A. Alzain, Muruj S. Alharthi, Bandar Hasan Saleh, Najim Z. Alshahrani.
Software: Mohannad A. Alzain, Wail Abdullah Alamoudi, Mohammed A. Bazuhair.
Supervision: Mohannad A. Alzain.
Validation: Mohannad A. Alzain, Samara Hebaishi, Laila Almohammadi, Shatha Alghamdi, Samaa Hebaishi, Wail Abdullah Alamoudi.
Visualization: Najim Z. Alshahrani.
Writing – original draft: Mohannad A. Alzain, Samara Hebaishi, Shatha Alghamdi, Laila Almohammadi, Samaa Hebaishi, Najim Z. Alshahrani.
Writing – review & editing: Mohannad A. Alzain, Mohammed A. Bazuhair, Wail Abdullah Alamoudi, Bandar Hasan Saleh, Muruj S. Alharthi, Najim Z. Alshahrani.
Abbreviation:
- MSU
- monosodium urate
The authors have no funding and conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Alzain MA, Bazuhair MA, Alharthi MS, Alamoudi WA, Saleh BH, Hebaishi S, Alghamdi S, Hebaishi S, Almohammadi L, Alshahrani NZ. Public knowledge and awareness of gout among adults in Jeddah, Saudi Arabia: A cross-sectional study. Medicine 2025;104:16(e42192).
Contributor Information
Mohannad A. Alzain, Email: Maaalzain1@kau.edu.sa.
Mohammed A. Bazuhair, Email: obazohair@kau.edu.sa.
Wail Abdullah Alamoudi, Email: waalamoudi@kau.edu.sa.
Bandar Hasan Saleh, Email: bhsaleh@kau.edu.sa.
Samara Hebaishi, Email: shebaishi0001@stu.kau.edu.sa.
Shatha Alghamdi, Email: shathaghamdii@gmail.com.
Samaa Hebaishi, Email: shebaishi0001@stu.kau.edu.sa.
Laila Almohammadi, Email: Lailaalmohammadi1@gmail.com.
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