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Gout

Gout is a condition that causes swelling and severe pain in your joints, often the joint of your big toe.

Gout is a condition where a chemical produced by your body, called uric acid, forms crystals in your joints. The crystals can also appear in your tendons and ligaments, as well as beneath your skin.

Gout is a type of arthritis and causes inflammation in your joints. It most commonly affects your big toe but can affect any of your joints, including those in your:

  • feet and ankles
  • knees
  • hands, fingers and wrists
  • elbows

Gout affects around one in every 100 people in the UK. It's more common in men and older people.

Gout usually affects just one joint in your body but can sometimes affect several of your joints. This is called polyarticular gout and happens more often in older people, particularly women.

You may get gout just once in your life and it can go away without any treatment. However, most people get it more than once. An attack of gout usually lasts five to 15 days.

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Details

  • Symptoms Symptoms of gout

    The first symptoms of gout in your affected joint include:

    • sudden, severe pain
    • swelling and tenderness around the area
    • red and shiny skin around the area, which may peel later on

    You may also have a fever.

    These symptoms may be caused by problems other than gout. If you have any of them, see your GP for advice.

    Tophi

    Another symptom of gout is firm, white lumps that develop beneath your skin. These are made of uric acid crystals and are called tophi.

    Tophi may be your only symptom of gout but they usually develop much later, maybe up to 10 years after your first symptoms. Tophi can cause discomfort if they become inflamed. They can also break down and a white, paste-like substance can leak out.

    Bupa Health Assessment: Gout

    If you are concerned about gout, Bupa can help you get a diagnosis.

  • Diagnosis Diagnosis of gout

    Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

    Your GP may take a sample of your blood, which he or she will send to a laboratory to measure the levels of uric acid. Your blood sample may also be tested for any other conditions that might be causing your symptoms. Your GP may wait a few weeks before taking a blood sample after you have an attack of gout. Otherwise, your uric acid levels may seem lower than they really are. This can happen if the uric acid has recently been laid down as crystals in your joints.

    Many people with gout have high levels of uric acid in their blood. However, you can also have normal levels of uric acid but still have gout.

    Your GP may refer you to a rheumatologist (a doctor who specialises in conditions that affect the joints) for further tests.

    Your doctor may remove some fluid from your swollen joint with a needle. This is then looked at under a microscope. If uric acid crystals can be seen, you have gout. If crystals of the mineral calcium are seen, you have a similar condition called pseudogout. For more information about pseudogout, see our frequently asked questions.

    If you have had gout for a long time, you may need to have an X-ray to check if your joint is damaged. However, you won't need to have an X-ray to diagnose gout.

  • Treatment Treatment of gout

    Self-help

    There are a number of steps you can take to reduce the pain and swelling from gout.

    • Raise and rest your joint. Don’t do any vigorous physical activity or knock your joint.
    • Keep your joint cool and don't cover it. If you place ice on the affected joint, it may help. Use an ice pack or ice wrapped in a towel and apply it for 20 minutes at a time. Don’t apply ice directly to your skin as it can damage it.

    You can take over-the-counter painkillers, such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    Medicines

    Your GP can prescribe you medicines to help ease pain and swelling when you have gout.

    Your GP may prescribe you non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen, which may relieve pain and inflammation. Take these as soon as your symptoms begin and for another 48 hours after they have gone. You may also be prescribed a medicine called a proton pump inhibitor to take at the same time as an NSAID. This will help reduce any side-effects of NSAIDs on your stomach.

    If NSAIDs aren't suitable for you, your GP may prescribe a medicine called colchicine instead.

    If you can't take NSAIDs or colchicine, you may be prescribed steroid tablets. Alternatively, you may be offered a steroid injection in your joint if you have gout in a large joint (such as your knee).

    Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

  • Worried about gout?

    Get a picture of your current health and potential future health risks with a Bupa health assessment. Find out more today.

  • Causes Causes of gout

    You can develop gout if you have too much uric acid in your body. Uric acid is a chemical that everyone has in their blood. It's a waste product that forms from substances called purines. These are found in every cell in your body, and in certain foods, such as seafood and liver. Uric acid is formed when your body breaks down purines in foods. It's also formed when your body breaks down old cells and replaces them.

    Excess uric acid is passed through your kidneys and out of your body in urine. However, the level of uric acid in your blood can rise if:

    • your kidneys don't remove uric acid quickly enough
    • your body produces too much uric acid or you eat too many purine-rich foods

    If the level of uric acid in your body is too high, it can form tiny crystals that collect in your tissues. This is particularly likely in and around your joints and it’s this that can cause your swelling and pain. These crystals tend to form at a cooler body temperature, which is why gout is more common in your fingers and toes.

    You may have high levels of uric acid, but not get gout. It's not known why some people develop gout and others don't. However, there are certain factors that can increase your likelihood of getting gout. For example, you're more likely to get gout if you:

    • are a man aged 30 to 60, or a woman who has been through the menopause
    • eat a diet that contains high levels of purines
    • drink too much alcohol, especially beer
    • don’t drink enough fluids and often become dehydrated
    • take certain medicines, such as diuretics (water tablets), which increase the flow of urine from your body
    • have a family history of gout
    • have kidney disease and don't pass out enough uric acid in your urine
    • are overweight
    • have diabetes
    • have high blood pressure
    • have severe psoriasis (itchy, dry and flaky skin), which can sometimes cause your body to produce too much uric acid
  • Complications Complications of gout

    The most common complication of gout is progressive damage to your affected joint. This can lead to long-term pain, deformed joints and, eventually, disability.

    Other complications include the following.

    • Kidney stones (if uric acid crystals collect in your urinary system). This happens to around two in 10 people who have gout.
    • Damage to your kidneys (if uric acid crystals collect in them).
    • Cardiovascular disease (such as heart attack and stroke) appears to be associated with gout. High levels of uric acid have been associated with a higher risk of death from cardiovascular disease too.

    Gout won’t always lead to complications but you can reduce your risk of them with treatment, and by making changes to your lifestyle and diet.

  • Prevention Prevention of gout

    It can help to identify anything that causes you to have gout symptoms, such as drinking beer, for example. You can then take steps to cut down on these triggers and reduce your chances of having gout again. You can also prevent gout from coming back so often and so severely by making changes to your diet and taking medicines.

    Diet and lifestyle

    What you choose to eat and drink may have an impact on gout. There are some foods that are very high in purines, which can increase the amount of uric acid in your blood. It’s best not to eat much of these foods very often. These include:

    • liver and kidneys
    • fish, such as sardines and anchovies
    • seafood
    • oatmeal

    If you’re planning to make changes to your diet, ask your doctor for advice to ensure you still get all the nutrients you need. See our frequently asked questions for more information.

    Aim to drink less alcohol, particularly beer, stout and port wines, because these raise the level of uric acid in your blood. Make sure you drink enough non-alcoholic fluids as this will help to lower the uric acid level in your body.

    Losing any excess weight will also help to prevent gout.

    Medicines

    If you have more than two attacks of gout in a year or have tophi, you may need to take medicines to prevent it. These can help to control the levels of uric acid in your blood. The aim is to prevent you getting gout again and if you do, reduce how long it lasts and make it less severe. These medicines aren't used to treat symptoms of gout. Your GP will usually prescribe them a week or two after your last gout symptoms have gone.

    If you need to take medicines, you will be prescribed a medicine called allopurinol that you take daily. An alternative is febuxostat if allopurinol isn't suitable for you, for example if you have severe side-effects. Both of these medicines prevent gout by stopping the formation of uric acid. Both allopurinol and febuxostat may actually cause an attack of gout when you first start taking them. To help prevent this happening, you may be advised to take NSAIDs, colchicine or steroid tablets alongside allopurinol or febuxostat. Take these for at least three months.

    If febuxostat isn't suitable for you, other medicines include probenecid, sulfinpyrazone and benzbromarone. These increase the amount of uric acid that your body removes in your urine.

    Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

  • FAQs FAQs

    I've been diagnosed with gout. Are there any foods I shouldn’t eat?

    Answer

    To reduce the symptoms of gout and how often you get it, try not to eat foods that contain very high levels of purines. Purines are substances that are broken down into uric acid and can make gout worse. Foods that contain high levels of purines include certain meats and seafood.

    Explanation

    Gout is caused by a build-up of uric acid, a waste product formed from purines. These are found in every cell in your body and in certain foods. Your diet plays an important role in causing gout. If you make some changes, it may reduce your risk of gout coming back.

    Foods that are very high in purines include:

    • meat, such as liver and kidneys
    • game, such as pheasant and rabbit
    • seafood, such as mussels and scallops
    • oily fish, such as sardines and anchovies
    • food and drinks that contain yeast, such as Marmite
    • mushrooms
    • oatmeal

    There is no need to cut out all of these foods completely because they still contain other essential nutrients and protein. Rather, reduce how much of them you eat as it may help with gout. Instead, you could eat more of sources of protein that are low in purines, such as dairy products and certain vegetables.

    What you drink can also affect your symptoms of gout. For example, some sugary drinks can raise the amount of uric acid in your blood and make gout worse. Cutting down on how much alcohol you drink, especially beer, stout and port wine, can improve your symptoms too. If you drink excessive amounts of alcohol, it can trigger symptoms of gout, even if you’re already taking medicines to prevent it.

    If you eat a low-purine, healthy, balanced diet, it will help you to manage your gout symptoms. However, depending on your condition, you may also need to take medicines to help treat your symptoms and prevent gout from coming back again.

    I've been diagnosed with pseudogout. What's the difference between that and 'real' gout?

    Answer

    Pseudogout is caused by a build-up of different crystals to the ones that cause 'real' gout. Pseudogout is also known as calcium pyrophosphate crystal arthritis.

    Explanation

    You can develop gout if you have too much uric acid in your body. Uric acid is a chemical that everybody has in their blood. If the level of uric acid in your body is too high, it can form tiny crystals that collect in your tissues. These can collect in and around your joints in particular. This is what may cause your swelling and pain.

    When you have pseudogout, the crystals that form aren't uric acid crystals, as they are with 'real' gout. They are made of a calcium salt called calcium pyrophosphate. These crystals can often be seen on an X-ray of your affected joint.

    Pseudogout is most common in people over 60, and men and women are affected equally. Pseudogout can affect any joint, but often it will be your knee, wrist or hip. Pseudogout tends to start with severe pain, stiffness and swelling, and then settles on its own and usually gets better within 10 days. Sometimes, if you have another illness, it can set off pseudogout, but often there is no apparent reason for it starting.

    Like gout, pseudogout can return, or become a chronic condition. A chronic illness is one that lasts a long time, sometimes for the rest of the affected person’s life.

    You can treat pseudogout with similar medicines to those used for gout. However, if you have chronic pseudogout, there are fewer treatment options to prevent it or reduce the frequency of it happening. You may need to take NSAIDs or steroids over a long period of time. This is because there is no treatment to lower the levels of the crystals that cause pseudogout.

    If you think you may have gout or pseudogout, see your GP for advice.

    I have had gout a few times and I am now taking allopurinol. Can I expect any serious side-effects?

    Answer

    In general, serious side-effects from allopurinol are rare and this medicine is suitable for long-term use. However, as with any medicine, look out for anything unusual and speak to a pharmacist if you're worried.

    Explanation

    Allopurinol is a medicine that prevents gout by stopping the formation of uric acid.

    Your GP or rheumatologist (a doctor who specialises in conditions that affect the joints) will prescribe you a low dose of allopurinol to start with. This will help to identify any side-effects of the medicine, such as a rash, before they become serious. He or she will then build your dose up gradually.

    You may get symptoms of gout during the first few months after you first start taking allopurinol. You may be prescribed medicines to try to prevent this. These may include a non-steroidal anti-inflammatory drug (NSAID), or a medicine called colchicine to take alongside allopurinol. Start these medicines as soon as possible and continue taking them for at least three months. It's also important to keep taking allopurinol even during acute attacks of gout.

  • Resources Resources

    Further information

    Sources

    • Gout. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, published 17 May 2011
    • Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res 2012; 64(10):1431–46. doi:10.1002/acr.21772
    • Gout and pseudogout. Medscape. www.emedicine.medscape.com, published 25 November 2013
    • Gout. PatientPlus. www.patient.co.uk/patientplus.asp, published 18 October 2013
    • Gout. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published August 2012
    • Questions and answers about gout. National Institute of Arthritis and Musculoskeletal and Skin Disorders. www.niams.nih.gov, published April 2012
    • Crystal arthropathy – suspected. Map of Medicine. www.mapofmedicine.com, published 23 November 2012
    • Hyperuricemia. Medscape. www.emedicine.medscape.com, published 16 November 2012
    • Zhang W, Doherty M, Bardin T. EULAR evidence based recommendations for gout. Part II: management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2006; 65(10):1312–24. doi:10.1136/ard.2006.055269
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 12 February 2014
    • Febuxostat for the management of hyperuricaemia in people with gout. National Institute for Health and Care Excellence (NICE), August 2011. www.nice.org.uk
    • Choi HK, Willett W, Curhan G. Fructose-rich beverages and the risk of gout in women. JAMA 2010; 304(20):2270–78. doi:10.1001/jama.2010.1638
    • Calcium pyrophosphate deposition disease. Medscape. www.emedicine.medscape.com, published 19 April 2012
    • Calcium pyrophosphate deposition – including pseudogout. PatientPlus. www.patient.co.uk/patientplus.asp, published 5 November 2012
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    Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, March 2014.

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