Fight Back Against Gout

Overview

Gout is a type of arthritis that causes sudden, very painful attacks in a joint. It usually starts in the big toe, but it can affect the ankle, foot, knee, wrist, fingers or elbow. Gout happens when there is too much of a waste product called uric acid in your blood. Uric acid is made when your body breaks down substances called purines, which come from your own cells and from some foods and drinks. When uric acid builds up, it can form tiny sharp crystals inside or around a joint. Your body's defence system sees these crystals as a threat and attacks them. That reaction is what causes the redness, heat, swelling and pain. The good news is that gout can be treated well, and most people can have far fewer attacks with the right care.

Gout is one of the most common types of inflammatory arthritis. It is much more common in men, and it becomes more common as people get older. Rates have risen in many countries over recent decades.

Gout can affect anyone, but it is most often seen in men over 40 and in women after menopause. It is more common in people who are overweight, who have kidney problems, high blood pressure or diabetes, who drink a lot of alcohol, or who have a family member with gout. It is also more common in some ethnic groups, including Pacific Islander and Māori people, and in people taking certain medicines such as some water tablets (diuretics).

Symptoms

Common symptoms

• Sudden, intense joint pain that often begins overnight
• A joint that is red, hot, swollen and very tender to touch
• The big toe is the most common joint, but the ankle, knee, wrist and fingers can also be affected
• Skin over the joint may look shiny, tight or peeling
• Pain that peaks within 12 to 24 hours and eases over days to a couple of weeks
• Attacks that come back from time to time, sometimes in a different joint
• Firm lumps under the skin near joints or on the ear, called tophi, in people who have had gout a long time
• Stiffness or mild aching in a joint between attacks

Symptoms in children

• Gout is rare in children and teenagers
• If a child has a hot, swollen joint, it should always be checked by a doctor, because other causes are much more likely
• When gout does happen in a young person, it is often linked to another health condition, a family history, or a medicine they take

Symptoms in older adults

• Attacks may affect more than one joint at once, such as the knee and wrist
• Symptoms can be less dramatic, so gout may be mistaken for another kind of arthritis or an infection
• Water tablets and some other common medicines can raise uric acid levels
• Painful joints can increase the risk of falls, so tell your doctor if walking feels unsafe
• Older adults may need their other medicines and kidney function reviewed alongside gout treatment

Causes

Main causes

• Your kidneys not removing enough uric acid — this is the most common reason
• Your body making more uric acid than usual
• Eating a lot of foods that are high in purines, such as organ meats, shellfish and some oily fish
• Drinking alcohol, especially beer
• Drinking a lot of sugary drinks and drinks sweetened with fruit sugar
• Some medicines, including certain water tablets, low-dose aspirin and some blood pressure medicines
• Kidney disease, which makes it harder to clear uric acid
• Dehydration, injury, surgery or a sudden illness, which can trigger an attack
• Losing weight very quickly or fasting for long periods

Risk factors

• Being male
• Getting older
• A family history of gout
• Being overweight or having obesity
• High blood pressure, diabetes, high cholesterol or kidney disease
• Drinking alcohol regularly
• A diet high in purine-rich foods or sugary drinks
• Taking certain prescribed medicines — never stop a medicine without asking your doctor first
• Having had an injury or surgery to a joint

When to see a doctor

See a doctor urgently if:

• You have a hot, swollen, very painful joint for the first time
• You have a fever, shivering or feel generally unwell with a painful joint
• An attack is not improving after several days or is getting worse
• You have severe pain in your back or side, or blood in your urine
• You think a new medicine is causing side effects

Book a routine appointment if:

• You have had two or more attacks and want to talk about preventing more
• You notice firm lumps under the skin near your joints
• Your joints feel stiff or achy between attacks
• You have a family history of gout or kidney stones
• You want advice on diet, alcohol or weight, and how it affects gout

Diagnosis

A doctor will usually ask about your symptoms, look at and gently feel the affected joint, and check your medical history and medicines. They may take a blood test to measure your uric acid level. The clearest test is to take a small sample of fluid from the sore joint with a thin needle and look at it under a microscope. This shows whether uric acid crystals are present and also rules out an infection, which looks similar but needs different treatment.

Tests that may be done

• A blood test for uric acid level
• A sample of joint fluid checked for crystals and for infection
• Blood tests to check kidney function and general health
• X-rays, ultrasound or other scans in some cases, to look at joint damage
• Urine tests if kidney stones are suspected

What to expect at your appointment

Your uric acid level can be normal during an attack, so one normal result does not rule gout out. Sometimes the diagnosis is made from your symptoms and a repeat test is done later. If a joint infection is possible, you may be sent for a fluid sample the same day. Getting the diagnosis right matters, because the treatment for gout and the treatment for a joint infection are very different.

Treatment

Treatment has two goals. The first is to settle the pain and swelling of an attack. The second, and more important long-term goal, is to lower the uric acid level in your blood so that crystals stop forming and attacks stop happening. Your doctor will make a plan based on your age, kidney function, other health conditions and other medicines you take.

Self-care at home

• Rest the joint and raise it on a pillow where possible
• Hold a cold pack wrapped in a cloth against the joint for up to 15 to 20 minutes at a time, with a break between uses
• Keep the joint uncovered rather than tucked under heavy bedding
• Drink plenty of water each day unless your doctor has told you to limit fluids
• Avoid alcohol while you are having an attack
• Keep a simple diary of attacks, foods, drinks and medicines so you can spot patterns
• Ask your pharmacist before taking any over-the-counter pain or cold remedy, especially if you have kidney problems or take other medicines

Medical treatments

For an attack, doctors usually prescribe medicines to reduce inflammation and pain. These may be tablets, or sometimes an injection given by a healthcare professional. For long-term control, there are medicines that lower the amount of uric acid your body makes or help your kidneys clear it. These are usually taken every day, even when you feel fine, and they work slowly over weeks to months. When you first start a uric acid-lowering medicine, attacks can briefly become more frequent, so your doctor may also give you a low dose of an anti-inflammatory medicine for a few months as cover. Never start, stop or change any of these medicines on your own — your doctor needs to adjust them to your kidney function and other medicines. Your pharmacist can explain how to take them and what to watch for.

When is surgery considered?

Surgery is rarely needed for gout. It may be considered if large tophi are pressing on nerves, causing pain or limiting movement, or if a joint has been badly damaged. Kidney stones caused by uric acid sometimes need a procedure to remove them. Most people never need an operation.

Living with this condition

Most of the time, living with gout means keeping your uric acid level down and knowing what to do when an attack starts. Take your long-term medicine as prescribed, keep a cold pack and a plan at home, and tell your doctor early if an attack begins. Many people find that attacks become less frequent and less severe once treatment settles in.

Lifestyle tips

• Reach and stay at a healthy weight, losing weight gradually rather than through crash diets
• Cut back on alcohol, especially beer
• Swap sugary drinks for water
• Stay active with regular walking, swimming or cycling
• Drink enough water through the day
• Get your blood pressure, kidney function and cholesterol checked regularly
• Tell every doctor and pharmacist you see that you have gout

Diet and exercise

Diet alone rarely cures gout, but it can make a real difference alongside treatment. A Mediterranean-style way of eating — plenty of vegetables, fruit, wholegrains, beans and nuts, with fish, olive oil and low-fat dairy — is a good general guide. Some people find that low-fat dairy foods seem to help. Cutting back on organ meats, shellfish, sugary drinks and alcohol is worth doing. Avoid very strict or very fast weight-loss plans, because they can trigger an attack. Gentle movement keeps joints healthy; during a flare, rest the sore joint and return to normal activity as the pain eases.

Mental health and emotional wellbeing

Ongoing pain, sleep loss and repeated attacks can wear you down, and it is common to feel frustrated, low or anxious about future attacks. Gout is not a moral failing and it is not simply caused by overeating or drinking. If worry or low mood is affecting your sleep, work or relationships, please tell your doctor. Talking therapies are available and can help. If you ever feel overwhelmed or unsafe, contact your local emergency number or a local crisis support service right away.

Prevention

You cannot always prevent gout, but you can greatly reduce how often it happens. The most effective step is to lower your uric acid level with treatment if your doctor recommends it. Lifestyle changes — staying at a healthy weight, limiting alcohol and sugary drinks, staying hydrated and eating well — support that. Avoiding dehydration, injuries and sudden crash diets helps too.

Vaccines

There is no vaccine that prevents gout. It is still worth keeping up to date with recommended vaccines for your age and health, because infections and illness can trigger flares.

Screening programmes

There is no national screening programme for gout. A uric acid blood test is usually done only if you have symptoms or a strong family history. If you take a long-term medicine to lower uric acid, your doctor will check your level and kidney function with regular blood tests to make sure the dose is right for you.

Complications

If left untreated

• Attacks that become more frequent, last longer and affect more joints
• Tophi — firm lumps of uric acid under the skin that can damage the joint over time
• Permanent joint damage and loss of movement
• Kidney stones
• Long-term kidney damage
• Sleep problems, time off work and low mood linked to repeated pain
• Gout is also linked with a higher chance of heart and blood vessel problems, so checking blood pressure and cholesterol matters

Long-term outlook

The outlook for gout is genuinely good. With the right treatment and a few lifestyle changes, most people have far fewer attacks, and many go for long stretches with none at all. Tophi can shrink and joints can settle once uric acid levels stay low. The key is to get a clear diagnosis, keep up with your long-term plan, and go back to your doctor if attacks continue — there is usually something more that can be adjusted.

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