Gout
Sources consulted
This article is original patient-education content.
- NICE—Gout. CKS(2023)
- NHS—Gout(2023)
- ACR—ACR Guideline for the Management of Gout(2020)
Based on international clinical guidelines
Overview
Gout is a type of arthritis that causes sudden, severe pain, swelling, and redness in a joint. It happens when tiny crystals of uric acid form inside the joint.
Key facts
- Gout often strikes the big toe, but can affect other joints like the ankle, knee, or wrist.
- Flare-ups (attacks) can come on quickly, often at night, and last a few days to a week.
- Gout is treatable, and most people can manage their symptoms with lifestyle changes and medical care.
Yes, gout is common. It affects about 1 in 40 adults in the UK and is the most common form of inflammatory arthritis in men.
Gout is more common in men, especially over age 40. Women are more likely to develop it after menopause. You are also more at risk if you have a family history of gout, are overweight, or have certain health conditions like kidney disease.
Symptoms
- If the joint is very hot, red, and painful and you also have a fever or chills — this could be a sign of a serious infection.
- If you have sudden chest pain, shortness of breath, or difficulty moving a joint after an injury.
- ⚠If the pain is so severe that you cannot move or use the joint at all.
- ⚠If you have a known gout flare and your usual over-the-counter pain relief does not help after a day.
- ⚠If you have a gout attack and also have a fever or feel generally unwell.
Common symptoms
- Sudden, intense pain in a joint (often the big toe) that feels like burning or throbbing.
- Swelling, redness, and warmth around the joint.
- The joint is extremely tender, even to the touch or weight of a bedsheet.
Symptoms in children
- Gout is very rare in children, but if it occurs, the symptoms are similar to adults: sudden joint pain, redness, and swelling.
Symptoms in older adults
- In older adults, gout may affect multiple joints at once, such as fingers, wrists, and elbows.
- The pain may be less intense but can last longer and be more frequent.
Causes
Main causes
- Gout is caused by too much uric acid in the blood (hyperuricaemia).
- Uric acid can form into sharp, needle-like crystals that build up in a joint, causing inflammation and pain.
- The body makes uric acid when it breaks down purines — substances found naturally in your body and in certain foods.
Risk factors
- Eating a diet rich in purines: red meat, organ meats (like liver), shellfish, and some fish (like sardines).
- Drinking too much alcohol, especially beer and spirits.
- Drinking sugary drinks (like soda) that contain high-fructose corn syrup.
- Being overweight or obese.
- Having high blood pressure, diabetes, kidney disease, or high cholesterol.
- Taking certain medications, such as diuretics (water pills) or low-dose aspirin.
- Having a family history of gout.
- Recent surgery, injury, or dehydration (which can trigger a flare).
When to see a doctor
See a doctor urgently if:
- If you have a joint that is hot, red, and swollen and you also have a fever — this could mean an infection.
- If the pain is so extreme that you cannot bear any weight or move the joint.
Book a routine appointment if:
- If you have sudden joint pain for the first time, even if it goes away.
- If you have had several gout attacks and want to discuss long-term treatment to prevent future flares.
- If you think you have gout but have not been diagnosed.
Diagnosis
Your doctor will ask about your symptoms, examine the affected joint, and may order tests to confirm the diagnosis.
Tests that may be done
- A blood test to check your uric acid level (though some people with gout have normal levels during a flare).
- A joint fluid test: your doctor uses a needle to draw fluid from the swollen joint and looks under a microscope for uric acid crystals — this is the most reliable way to diagnose gout.
- An ultrasound or X-ray may be used to look for crystal deposits or joint damage.
What to expect at your appointment
The diagnosis is usually straightforward. The joint fluid test can be a little uncomfortable but is quick and gives a clear answer. Your doctor will explain the results and discuss the best treatment plan for you.
Treatment
Treatment for gout has two main goals: stop the pain and inflammation of a current flare, and prevent future flares by lowering uric acid levels. Both are important.
Self-care at home
- Rest the painful joint and keep it raised (elevated) on a cushion or pillow.
- Apply an ice pack wrapped in a towel to the joint for 15–20 minutes at a time, several times a day.
- Drink plenty of water (aim for 8–10 glasses a day) to help flush out uric acid.
- Avoid alcohol and sugary drinks, and cut back on foods high in purines (red meat, shellfish) during a flare.
- Try to lose weight if you are overweight, but do not crash diet — sudden weight loss can actually trigger a flare.
Medical treatments
Your doctor may recommend prescription medicines to reduce pain and swelling during a flare. These include anti-inflammatory drugs (NSAIDs) or other medications that calm the immune system. For long-term prevention, your doctor may prescribe a medicine that lowers uric acid levels in the blood. It is important to take these medicines exactly as prescribed — even if you feel well — because they help prevent future attacks and damage to joints.
When is surgery considered?
Surgery is rarely needed for gout. In very severe cases where large crystal deposits (called tophi) press on nerves or cause joint deformity, a doctor might consider removing them. This is not common.
Living with this condition
Living with gout means being aware of what triggers your flares and taking steps to avoid them. For most people, this means eating a balanced diet, staying hydrated, limiting alcohol, and taking any prescribed medications regularly. If a flare does happen, act quickly with rest, ice, and pain relief as recommended by your doctor.
Lifestyle tips
- Maintain a healthy weight — even losing 5% of your body weight can lower uric acid levels.
- Exercise regularly (like walking, swimming, or cycling) but avoid high-impact activity when a joint is inflamed.
- Drink at least 2 litres of water daily unless your doctor tells you otherwise.
- Limit or avoid beer, spirits, and sugary soft drinks.
- Eat more low-fat dairy, fruits, vegetables, and whole grains.
Diet and exercise
A diet low in purines can help. Choose more plant-based proteins like beans and lentils, and stick with low-fat dairy. Red meat, organ meats, and certain fish (like anchovies, sardines, and mussels) are high in purines, so enjoy them in small amounts only. Gentle exercise like walking and stretching is fine during a flare, but avoid any activity that puts pressure on the painful joint. Between flares, regular exercise can help you keep your weight stable and improve overall health.
Mental health and emotional wellbeing
Gout can be frustrating and painful, and repeated flares may cause anxiety or sadness. It is normal to feel this way. Talk to your doctor or a counsellor if you feel overwhelmed. Staying active, connecting with others who understand, and focusing on what you can control can help your mood.
Prevention
Yes, you can reduce your risk of having gout flares by managing your uric acid levels. This includes eating a balanced diet, staying at a healthy weight, drinking plenty of water, limiting alcohol, and taking any prescribed uric-acid-lowering medicine regularly.
Screening programmes
If you have a family history of gout or have conditions like high blood pressure, diabetes, or kidney disease, your doctor may check your uric acid level as part of a routine blood test. There is no routine screening for the general population.
Complications
If left untreated
- Chronic joint inflammation that can damage the joint and cause deformity.
- Formation of tophi — lumps of uric acid crystals under the skin, often around fingers, toes, elbows, or ears.
- Kidney stones made of uric acid, which can cause pain and affect kidney function.
- More frequent and longer-lasting gout attacks over time.
Long-term outlook
With proper treatment, most people with gout can live full, active lives without long-term joint damage. The key is to work with your doctor to keep uric acid levels in a safe range and to manage flares quickly. Gout is a chronic condition, but it is also one of the most manageable forms of arthritis.
Find support
International organisations
Local organisations
- Arthritis Australia ↗ · Australia
Helplines
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Always verify with your doctor
Health guidelines vary by country and region. The information in this article is based on international clinical guidelines but may not reflect the specific guidelines, medications, or practices in your country. Always discuss your health concerns with your own doctor or healthcare provider, and refer to your local national health guidelines where available.
Important notice This information is for educational purposes only. It does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your specific situation. If you are experiencing a medical emergency, call your local emergency services immediately.