Your big toe is most likely to be affected first, but gout can cause other joints to become inflamed too. These include joints in:
- the middle of your feet
- your heels and ankles
- your knees
- your hands (the smaller joints)
- your fingers and wrists
- your elbows
If gout affects several of your joints together, this is called polyarticular gout.
Gout can be very painful and may lead to further problems if it isn’t treated. If you notice any inflammation in your joints, it’s important to see your doctor. You can take medicines to ease the symptoms of gout and even stop attacks in the first place.
Symptoms of gout
The first time you have an attack of gout, you may notice:
- sudden pain in your joint - especially at night
- swelling and tenderness around the affected part of your joint
- red and shiny skin around your joint - this may feel itchy and peel away
The pain is usually at its worst within 24 hours. Your joint may be so painful that you can’t cover it with a bedding sheet during the night. Each attack lasts for three to 10 days. Your joint will return to normal, without any pain or swelling, between attacks.
When you first develop gout, only one of your joints is usually affected at any one time. But eventually gout may affect several of your joints, and each attack may last for up to three weeks if you don’t treat it.
These symptoms may be caused by problems other than gout. If you have any of them, ask your GP for advice.
Diagnosis of gout
Your GP will ask about your symptoms and examine you. They may also ask you about your medical history.
Your GP will arrange for you to have a blood test. The levels of uric acid in your blood will be tested. Your blood sample may also be tested for any other conditions that may be causing your symptoms. Your GP may wait four to six 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 is because your uric acid will have recently been laid down as crystals in your joints.
Many people with gout have high levels of uric acid in their blood. But you can have normal levels of uric acid and still have gout.
If your GP isn’t sure that you have gout, they may refer you to a rheumatologist for further tests. A rheumatologist is a doctor who specialises in conditions that affect your joints.
Your rheumatologist may remove some fluid from your swollen joint with a needle. They’ll then look closely at this fluid under a microscope. If they can see uric acid crystals, they’ll diagnose you with gout. If they can see crystals of calcium instead, you have a similar condition called pseudogout. For more information about pseudogout, see our FAQ: What is pseudogout?
If you have had gout for a long time, you may need to have an X-ray to see if your joint is damaged. But you won't need to have an X-ray to diagnose gout in the first place.
Treatment of gout
There are several things you can do to reduce your pain and swelling.
- 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.
- It may help if you place ice on your joint. 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 burn it. If you don’t have an ice pack, try using a packet of frozen peas wrapped in a towel. This will mould easily to the shape of your joint.
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.
Your doctor may also prescribe medicines to ease an attack of gout.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen, may relieve the pain and inflammation in your joint. Take these as soon as your symptoms appear and for another 48 hours after your symptoms have gone. Your doctor may also prescribe a medicine called a proton pump inhibitor to take at the same time as an NSAID. This will help to protect your stomach from any side-effects of NSAIDs, such as irritation of your stomach lining.
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. Most people respond to NSAIDs, colchicines, or steroid tablets within two to three days.
Your doctor may offer you a steroid injection directly into 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.
Causes of gout
You can develop gout if you have too much uric acid in your body. Everyone has some uric acid. Uric acid is one of your body’s waste products and is formed when your body breaks down substances called purines. Purines are found in certain foods and in and around your body’s cells.
If you have too much uric acid, most of the excess passes through your kidneys and out of your body in your urine. 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
- you eat too many foods containing lots of purine
If your uric acid levels are too high, tiny crystals may collect in your tissues, especially in and around your joints. This can cause pain and swelling. These crystals tend to form in parts of your body that have a cooler temperature. This is why gout is more common in your fingers and toes.
You may have high levels of uric acid, but not have gout. It's not clear why some people develop gout and others don't, but certain factors may increase your likelihood of having the condition. You’re more likely to get gout if you:
- are a man aged 30 to 60
- are 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 enough uric acid out of your body 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 of gout
If your gout isn’t treated properly, you may get firm white lumps under your skin called tophi. These can become inflamed and can affect your daily activities, including how you prepare food and get dressed. It can also increase your risk of developing an infection in the skin around the tophi.
If you’ve had gout for a long time, your affected joint may become damaged. Your joint may be painful and feel stiff when you try to move it. This can lead to long-term pain, deformed joints and, eventually, disability.
Other complications of gout include the following.
- Kidney stones (if uric acid crystals collect in your urinary system).
- Damage to your kidneys (if uric acid crystals collect in your kidneys).
- Cardiovascular disease (such as a heart attack and stroke).
You’re less likely to develop complications if your gout is treated as soon as it’s diagnosed. This will usually involve making changes to your lifestyle and diet, and taking any medicines that your doctor prescribes.
Prevention of gout
If you have gout, keeping a diary of your symptoms may help you identify any particular triggers. You can then take steps to cut down on these triggers and reduce your chances of having an attack of gout again. You may stop your gout from coming back so often and so severely by making changes to your diet and taking medicines.
Diet and lifestyle
Your gout may be affected by what you eat and drink. Some foods are very high in purines, which can increase how much uric acid you have in your blood. Try to limit how much of these foods you eat. These include:
- liver and kidneys
- fish, such as sardines, herring and anchovies
- seafood such as mussels
- yeast extract, eg Marmite
If you’re planning to make changes to your diet, ask a dietician for advice to make sure you still get all the nutrients you need. For more information on what not to eat and drink if you have gout, see our FAQ: Foods and drinks to avoid.
Aim to drink less alcohol particularly beer, stout, and port wines because these raise the level of uric acid in your blood. Try to drink at least three litres of non-alcoholic fluids each day, as this will help to lower your uric acid levels.
Losing any excess weight and taking regular exercise may also help to prevent gout attacks.
If you have more than two attacks of gout in a year, you may need to take medicines to prevent it. These can help to control how much uric acid you have in your blood and stop you having more attacks. These medicines can’t be used to treat symptoms of gout and shouldn’t be started while you’re having a gout attack. Your GP will usually prescribe them a week or two after your last gout symptoms have gone. You’ll need to take these medicines for the rest of your life to control your gout.
Your doctor will usually prescribe a medicine called allopurinol, which you take every day. But if allopurinol isn't suitable for you (for example, if you have severe side-effects) you may be prescribed febuxostat instead. Both of these medicines prevent gout by stopping your body producing uric acid. They may cause an attack of gout when you first start taking them. But to help prevent this, your doctor may prescribe NSAIDs, colchicines, or steroid tablets as well as allopurinol or febuxostat.
If febuxostat isn't suitable for you, your doctor may suggest you take other medicines, such as 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.
FAQ: Are there any foods or drinks I should avoid?
Yes, certain foods and drinks can make your gout worse and so are best avoided.
To reduce your symptoms, and how often you get them, try not to eat foods that contain very high levels of purines. Purines are broken down into uric acid in your body. If you have too much uric acid in your blood, you can develop gout.
Foods that are very high in purines include:
- meat, such as liver and kidneys
- seafood, such as mussels and scallops
- oily fish, such as sardines and anchovies
- food and drinks that contain yeast, such as Marmite
- mushrooms, asparagus and beans
There’s no need to cut out all of these foods completely because they still contain other essential nutrients and protein. But you may wish to reduce how much of them you eat.
What you drink can affect your symptoms of gout too. 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, may improve your symptoms.
Eating a low-purine, healthy diet may help you to manage your gout symptoms. But you may also need to take medicines to treat your symptoms and prevent gout from coming back again.
FAQ: What’s the difference between pseudogout and 'real' gout?
If you have ‘real’ gout, you have too much uric acid in your body. Uric acid forms tiny crystals in your tissues, especially around your joints, which can cause pain and swelling. If you have pseudogout, you have a build-up of different crystals made of calcium pyrophosphate. These crystals can often be seen on an X-ray of your affected joint. Pseudogout is also known as calcium pyrophosphate deposition disease (CPPD). It becomes more common as people get older, and men and women are affected equally.
Gout can affect any joint, but pseudogout mainly affects your larger joints, such as your knee, wrist or hip. With pseudogout, you don’t have any tophi (firm white lumps) under your skin.
Like gout, pseudogout can return or affect you for the rest of your life. You can treat pseudogout with similar medicines to those used for gout, such as steroids. But there are fewer treatment options to prevent pseudogout, as no specific medicines can lower your levels of calcium pyrophosphate crystals.
If you think you may have gout or pseudogout, contact your GP for advice.
FAQ: Can I expect any serious side-effects from taking allopurinol?
In general, serious side-effects from allopurinol are rare, so you can take this medicine for long periods of time. But, as with any medicine, you should look out for anything unusual and speak to a pharmacist if you're worried.
Allopurinol is a medicine that prevents gout by stopping the formation of uric acid.
Your doctor will prescribe you a low dose of allopurinol to start with. This will help to identify any side-effects, such as a rash, before they become serious. Your doctor will then build your dose up gradually.
You may notice symptoms of gout during the first few months after you start taking allopurinol. Your doctor may prescribe medicines to try to prevent this. These may include a non-steroidal anti-inflammatory drug (NSAID), or a medicine called colchicine, to take alongside your allopurinol. You’ll usually continue taking them for at least three months. It's also important to keep taking allopurinol, even during acute attacks of gout. If your symptoms do flare up, you’ll be prescribed other medicines to treat them.
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- Rheumatology. Oxford Handbook of Clinical Medicine (online). 9th ed. Oxford Medicine Online. www.oxfordmedicine.com, published online January 2014
- Gout. PatientPlus. www.patient.info/patientplus, reviewed October 2013
- Gout and pseudogout. Medscape. www.emedicine.medscape.com, reviewed September 2015
- Gout. Joint Formulary Committee. British National Formulary (online). London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed February 2015
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- Dr Sundeept Bhalara, Consultant Rheumatologist and General Physician, April 2016
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Peer reviewed by Dr Sundeept Bhalara, Consultant Rheumatologist and General Physician.
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