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Gout

Key points

  • Gout is a type of arthritis, which causes inflammation of your joints.
  • Gout can affect any of your joints but is most common in the big toe.
  • What you eat and drink can have an impact on gout.
  • You may be prescribed medicines to help to ease pain and swelling from gout.
 

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

About gout

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.

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.

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.

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

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 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.

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.


Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, March 2014.

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  • 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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