All About Gout

Overview

Gout is a type of arthritis that causes sudden, severe attacks of pain, swelling, redness and tenderness in a joint, most often the big toe. It happens when there is too much uric acid in the body, and it forms sharp crystals inside a joint.

Yes — gout is one of the most common forms of inflammatory arthritis. In the UK, it affects around 1 in 40 adults, and the number of cases has been rising.

Gout mostly affects men over the age of 40. Women are more likely to develop it after the menopause. You are also more likely to get gout if you have high blood pressure, diabetes, kidney disease or obesity.

Symptoms

Common symptoms

• Sudden, severe pain in a joint, often the big toe
• Swelling, warmth and redness around the joint
• The joint is extremely tender, even to a light touch or a bedsheet
• Pain that often starts at night and is worst during the first 12 to 24 hours
• Difficulty walking or moving the affected joint

Causes

Main causes

• Too much uric acid in the blood
• The body produces too much uric acid or the kidneys do not remove enough
• Sharp uric acid crystals form inside a joint, causing inflammation and pain

Risk factors

• Being male
• Getting older
• Obesity or gaining weight quickly
• Eating a diet high in purines, such as red meat and shellfish
• Drinking alcohol, especially beer, or sugary drinks
• Taking diuretics (water tablets) or aspirin in some cases
• Having kidney disease, high blood pressure, diabetes or high cholesterol
• Family history of gout

When to see a doctor

See a doctor urgently if:

• Severe pain that is not controlled with rest and over-the-counter pain relief (after speaking with a pharmacist)
• A hot, painful swollen joint together with a fever or feeling very unwell — this could be a sign of infection in the joint
• The pain is so bad that you cannot bear weight on the leg or use the arm

Book a routine appointment if:

• If this is your first attack of joint pain and swelling
• If you have repeated gout attacks and have not been reviewed recently
• If you want to talk about medicines that can lower uric acid and prevent future attacks

Diagnosis

A doctor can usually tell if you have gout by listening to your symptoms and examining the joint. They may also order tests to confirm the diagnosis and rule out other problems.

Tests that may be done

• Joint fluid test — a small sample of fluid is taken from the joint and checked under a microscope for uric acid crystals
• Blood test to measure uric acid level (though this can be normal during an attack)
• Ultrasound or a special CT scan to look for crystals in the joint
• X-ray to check for joint damage if gout has been going on for a while

What to expect at your appointment

At your appointment, the doctor will ask about your symptoms, your diet, and any medicines you take. They may gently feel the joint. Some tests may take a few days to come back. You will usually be offered advice on pain relief and lifestyle changes while you wait.

Treatment

Treatment for gout has two goals: stop the current attack quickly and prevent future attacks. Most attacks can be managed with rest, ice and medicines. Long-term treatment lowers uric acid in the blood so that crystals do not form.

Self-care at home

• Rest the joint and keep it raised on a pillow
• Apply an ice pack wrapped in a cloth for 15–20 minutes at a time
• Drink plenty of water to help your kidneys flush out uric acid
• Avoid alcohol and sugary drinks during an attack
• Use a walking stick or avoid putting weight on the affected joint

Medical treatments

Doctors use several types of medicines to treat gout. For an acute attack, they may prescribe anti-inflammatory medicines or a steroid. For long-term prevention, they can prescribe medicines that lower uric acid in the blood. These are usually started after the attack has settled and must be taken every day, not just during pain. It is important to discuss your options with your doctor or pharmacist.

When is surgery considered?

Surgery is rarely needed for gout. It may be considered in very advanced cases where large deposits of uric acid crystals, called tophi, cause nerve compression, severe joint damage or open sores.

Living with this condition

Gout is a long-term condition, but most people can manage it very well. Between attacks, many people have no symptoms. The aim is to keep uric acid at a healthy level so that attacks do not happen.

Lifestyle tips

• Drink plenty of water every day
• Limit alcohol, especially beer and spirits
• Avoid sugary drinks and foods sweetened with fructose
• Maintain a healthy weight, but avoid crash diets
• Plan low-impact exercise like walking, cycling or swimming
• Talk to your doctor about your medicines and any other health conditions

Diet and exercise

A balanced diet with plenty of vegetables, whole grains and low-fat dairy can help. Limit red meat, shellfish and organ meats such as liver or kidney. Regular exercise helps control weight and blood pressure, which can lower your risk of gout attacks. If you have heart or kidney problems, check with your doctor before starting a new exercise plan.

Mental health and emotional wellbeing

Living with a painful condition like gout can cause stress, anxiety and low mood. Sleep may be disturbed during attacks, and it can be frustrating to stop daily activities. It is important to tell your doctor how it is affecting you. Talking to a friend, family member or a mental health professional can also help.

Prevention

You can reduce your risk of gout attacks by staying hydrated, limiting alcohol, eating a balanced diet and keeping to a healthy weight. Not all cases can be prevented, especially if you have a strong family history or kidney problems, but the same changes can make attacks less frequent.

Complications

If left untreated

• Recurrent gout attacks that become more severe and last longer
• Tophi — lumpy deposits of uric acid crystals under the skin, which can be painful and lead to deformity
• Joint damage and permanent arthritis
• Kidney stones or kidney damage from high uric acid levels

Long-term outlook

Gout is one of the most treatable forms of arthritis. With the right combination of lifestyle changes and, if needed, long-term medicines, most people can stop attacks completely and avoid joint damage. The outlook is very good when you stay on the plan you and your doctor agree on.

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