Gout is a condition that causes swelling and pain in your joints, usually in your arms or legs.
Gout is a type of arthritis, which 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 found in your:
Gout is caused by a build up of uric acid crystals in your affected joints.
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.
You may only ever have gout once in your life and it may go away without any treatment.
The first symptoms of gout in your affected joint include:
You may also have a mild fever.
If you have gout that reoccurs over many years, you may have further symptoms. This can include firm, white lumps developing beneath your skin – these are made of uric acid crystals and are called tophi. Tophi usually take up to 10 years to develop from your first episode of gout. Having tophi can lead to a range of problems, including:
You may want to discuss with your GP treatments to ease discomfort from having tophi. However, taking antibiotics for inflamed or leaking tophi won’t help because tophi aren’t caused by bacteria.
These symptoms may be caused by problems other than gout. If you have any of these symptoms, see your GP for advice.
Having gout won’t always lead to further problems, but you can reduce your risk of having complications by having treatment and making changes to your lifestyle and diet.
The most common complication of gout is progressive joint damage, which leads to long-term pain, deformed joints and eventually, disability. This may be prevented by changes to your diet and by taking medicines that lower your uric acid levels. There is also some evidence that prolonged high levels of uric acid in your body can increase your risk of vascular diseases, which may lead to a heart attack or stroke.
Other complications that you may have are as follows.
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 formed from substances called purines, which are found in every cell in your body and certain foods. Uric acid is formed in your body when the purines in foods you eat are broken down. It’s also formed when old cells in your body are broken down and replaced by new cells. Excess uric acid is passed through your kidneys and out of your body in your urine. However, the level of uric acid in your blood can rise if:
If the level of uric acid 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 may 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, or you may get gout, but not have high levels of uric acid. 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 get gout if you:
Your GP will ask about your symptoms and examine you. He or she will also ask you about your medical history and that of your family. Your GP will usually take a sample of your blood, which will be sent to a laboratory to measure the levels of uric acid. Your blood sample may also be tested to find out whether there may be another reason for your symptoms.
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 uric acid 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 are made of a calcium salt called calcium pyrophosphate. See our frequently asked questions for more information.
You may need to have an X-ray of your joint in order to rule out other conditions and to find out if any damage has occurred, but this isn’t used to diagnose gout.
You will usually have symptoms of gout for up to two weeks and then they will go away, even without treatment. You may only have one episode of gout in your lifetime, but it might return. If you have no treatment to prevent gout, there is an eight in 10 chance of it returning within three years. Your symptoms of gout may also be more frequent and last for longer.
There are a number of steps you can take to reduce the pain and swelling from having gout.
There are medicines your doctor can prescribe to help to ease your pain and swelling from gout.
Your doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, which may relieve pain and inflammation. If you have a heart condition, high blood pressure, kidney or lung disease, or if you're over 65, these medicines may be harmful, so you need to talk to your doctor before taking them. Don’t take aspirin because this medicine can affect your uric acid levels and make your gout last longer.
If NSAIDs aren't suitable for you, your doctor may prescribe a medicine called colchicine instead. Colchicine also reduces inflammation, but in a different way to NSAIDs. You may have side-effects from this medicine including diarrhoea, but this can be reduced by taking lower doses.
Occasionally, your doctor may prescribe steroid tablets if you can't take NSAIDs or colchicine. Alternatively, he or she may recommend a steroid joint injection if you have gout in a large joint (such as your knee).
Identifying things that cause you to have gout symptoms can help you to eliminate these triggers and reduce your chances of having it again. Gout can be prevented from reoccurring so often and so severely by making changes to your diet and taking medicines if needed.
What you choose to eat and drink can 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:
If you’re planning to make changes to your diet, ask your doctor or a dietitian for advice to ensure you still get all the nutrients you need. Eating a well-balanced diet will help you to manage your symptoms. See our frequently asked questions for more information.
Aim to drink less alcohol – especially cutting out beer, stout, port and fortified wines because these can have the greatest effect on causing gout symptoms. Drinking enough water every day will help to dilute your blood and urine, lowering the uric acid levels in your body.
If you need to lose excess weight, doing regular exercise will help you towards your goal. The recommended healthy level of physical activity is 150 minutes (two and a half hours) of moderate exercise over a week in bouts of 10 minutes or more. You can do this by carrying out 30 minutes on at least five days each week.
In addition to changing your diet, you may need medicines to prevent gout. These help control the levels of uric acid in your blood. The aim is to prevent you getting gout again and if you do, make it last for a shorter time and be less severe. These medicines aren't used to treat symptoms of gout and are usually prescribed several weeks after your last gout symptoms have gone.
Your doctor may prescribe you a medicine called allopurinol to take daily. An alternative is febuxostat if there is a reason why you can’t take allopurinol. Both of these medicines prevent gout by stopping the formation of uric acid. Both allopurinol and febuxostat may actually cause more symptoms of gout when you first start taking them. To help prevent this happening, your doctor may prescribe NSAIDs, colchicine or steroid tablets for you to take alongside allopurinol or febuxostat for up to three months. Make sure you drink enough fluids when taking these medicines.
Your doctor may prescribe you other medicines, such as probenecid, to increase the amount of uric acid that is removed from your body in your urine.
Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.
Produced by Louise Abbott, Bupa Health Information Team, May 2012.
For answers to frequently asked questions on this topic, see FAQs.
For sources and links to further information, see Resources.
Read our brochure about musculoskeletal services from Bupa which include treatment by physiotherapists, podiatrists, osteopaths and sports doctors.
You can't put a value on your health. Most of our assessments include a blood test for gout. View our range of health assessments (or call 0845 600 3458 quoting ref. HFS100).
This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the About our Health Information page.
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