Gout

Published by Bupa's Health Information Team, May 2010.

This factsheet is for people who have gout, or who would like information about it.

Gout is a condition that causes swelling and pain in joints, usually in the arms or legs.

About gout

Gout is an arthritic condition, meaning that it causes inflammation of your joints. It causes pain and swelling, usually in one joint in your body - commonly your big toe. However, it can affect any of your joints, including those in your:

• heels
• insteps (arches of your feet)
• ankles
• knees
• fingers
• wrists
• elbows

According to the UK Gout Society, gout affects around one in every 100 people. It's more common in men, particularly those aged 30 to 60, and in older people.

Symptoms of gout

The symptoms of gout include:

• severe pain in your joint
• swelling and warmth around your joint
• red and shiny skin around your joint
• mild fever
• firm, white lumps beneath your skin - these are urate crystals called tophi

If you have these symptoms, see your GP.

You will usually have gout for a period of up to two weeks (an attack) and then it will go away, even without treatment. With treatment, this can be reduced to less than a week. You may only ever have one attack of gout in your lifetime, but for many people it returns.

Complications of gout

It's uncommon for gout to cause any further problems but you may develop:

• gout affecting several of your joints (called polyarticular gout)
• inflamed tophi, which can cause discomfort
• kidney stones (if urate crystals collect in your urinary tract)
• kidney damage (if urate crystals collect in your kidney tissue)

Causes of gout

You can develop gout if you have too much urate in your body. Urate (also called uric acid) is a chemical that everyone has in their blood. It's a waste product formed from substances called purines, which are found in every cell in your body and certain foods. Excess urate is usually passed through your kidneys and out of your body in your urine. However, the level of urate in your blood can rise if:

• your kidneys don't pass urate quickly enough
• your body produces too much urate

If the level of urate in your body is too high, it can form tiny crystals that collect in your tissues, particularly in and around your joints. This is what causes the swelling and pain. These crystals form at cooler temperatures, which is why gout is common in your fingers and toes.

Not everybody with high levels of urate gets gout and some people get gout but don't have high levels of urate. 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. You're more likely to have gout if you:

• are a man aged 30 to 60
• are a woman who has been through the menopause, although women are much less likely to develop gout than men
• eat a diet that contains high levels of purines, which are commonly found in red meat and seafood - urate is formed in your body when the purines in foods you eat and old cells in your body are broken down
• drink too much alcohol
• 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 meaning that your kidneys don't pass enough urate out in your urine
• are overweight
• have a medical condition such as psoriasis (itchy, dry and flaky skin) which can sometimes cause your body to produce too much urate
• have high blood pressure
• injure a joint
• are taking certain types of cancer medicines

An attack of gout often occurs for no clear reason, but may be triggered by an illness, injury or drinking too much alcohol.

Diagnosis of gout

Your GP will ask about your symptoms and examine you. He or she will usually take a sample of your blood, which will be sent to a laboratory to measure the levels of urate.

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

Your doctor may remove some fluid from your swollen joint with a needle. This usually causes no more discomfort than a blood test. If urate crystals can be seen in the fluid under a microscope, you have gout. If calcium crystals are seen, you have a similar condition called pseudogout. The crystals formed when you have pseudogout aren't urate crystals - they are made of a calcium salt called calcium pyrophosphate.

You may need to have an X-ray taken of your joint in order to rule out other conditions, but this is less common.

Treatment of gout

Self-help

There are a number of steps you can take to reduce the pain and swelling of a gout attack. Left untreated, attacks of gout may become more frequent and last for longer.

• Raise and rest your joint. You shouldn't do any vigorous physical activity. Sometimes your doctor may give you a splint to wear to stop you moving your joint.
• Keep your joint cool and don't cover it. Apply ice wrapped in a towel to your joint for about 20 minutes to help reduce swelling. You shouldn't apply ice directly to your skin as it can damage your skin. If you need to repeat this, let your joint return to its normal temperature first.

Medicines

There are some medicines your doctor can prescribe to help ease the pain and swelling of an attack of gout.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen, may relieve pain and inflammation. If you have a heart condition, high blood pressure, kidney disease, lung disease or if you're over 65, these medicines may be harmful so you should talk to your doctor about taking them.

If NSAIDs aren't suitable for you, your doctor may prescribe a medicine called colchicine as an alternative. Colchicine works by reducing the build-up of urate in your body. It can have side-effects including sickness and diarrhoea.

Occasionally, your doctor may prescribe steroid tablets if you can't take NSAIDs or colchicine. Alternatively, your doctor may recommend a steroid injection if you have gout in a large joint (such as your knee).

If you have repeat attacks of gout, there are medicines you can take to help to prevent it.

Your doctor may prescribe a medicine called allopurinol for you to take daily. This medicine prevents gout by stopping the formation of urate. Allopurinol may actually cause an attack of gout when you first start taking it. This is because the level of urate in your body will rise a bit before it falls. To help prevent this happening, your doctor may prescribe NSAIDs, colchicine or steroid tablets for you to take alongside allopurinol for up to three months. Make sure you drink enough fluids when taking these medicines.

Your doctor may prescribe a medicine such as probenecid or sulfinpyrazone to increase the amount of urate that is removed from your body in your urine. These medicines aren't used to treat an acute attack of gout and are usually prescribed once an attack is over.

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

Prevention of gout

Identifying anything that brings on an attack of gout and not doing these things is very important.

For example, you:

• shouldn't eat foods that are very high in purines, such as liver, kidney and seafood (especially oily fish such as mackerel, sardines and anchovies), and certain vegetables (asparagus, cauliflower, lentils, mushrooms, oatmeal and spinach) - ask your doctor or a dietician for more advice
• shouldn't drink too much alcohol - especially beer, stout, port and fortified wines
• should eat a well-balanced diet and do regular physical activity to lose excess weight
• should drink enough water

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.