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Gout
Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and General Physician
Next review due August 2021
Gout is a type of arthritis. It causes sudden swelling and severe pain in your joints, especially at the base of your big toe. If you have gout, tiny crystals form in and around your joints and under your skin.
About gout
If you have gout, uric acid, a chemical made by your body, forms tiny crystals in your joints. This can trigger pain, redness and swelling in your joints, causing arthritis. The crystals may also form in other tissues (such as ligaments and tendons) and under your skin.
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, it's called polyarticular gout.
Gout affects around one in every 100 people in the UK. It’s more common in older people and affects more men than women. Women are more likely to get gout after the menopause than at a younger age.
Gout can be very painful and may lead to more problems if it isn’t treated. So if you notice any inflammation in your joints, it’s important to see your GP. You can take medicines to ease 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
- warm, red/purple and shiny skin around your joint – this may feel itchy and peel away
The pain gets worse over a few hours and is usually at its worst within 24 hours. You may find it hard to move your joint because the pain is so bad. You may feel unwell and have a raised temperature (fever). Your joint may be so painful that you can’t walk properly or even cover it at night. Attacks usually last for three to 10 days. Your joint will return to normal, without any pain or swelling, between attacks.
At first, gout may affect only one of your joints and an attack may last for just a few days. But later on, gout may affect several of your joints at the same time. Eventually, you may have several attacks of gout in a year.
Pain, swelling and colour changes in and around your joints may be caused by problems other than gout. If you have any of these symptoms, contact 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 and lifestyle (such as whether you eat a lot of foods that are high in protein).
Your GP may decide not to do any tests at first if you have typical gout symptoms without signs of any other form of arthritis. But four to six weeks after your first attack of gout, they may arrange for you to have a blood test. This is to check the level of uric acid in your blood. If you have a blood test straight after an attack of gout, your uric acid levels may seem lower than they really are. So it’s best to wait a few weeks before having your blood tested.
Many people with high blood levels of uric acid have gout or may get the condition in the future. Crystals form in your joints when uric acid levels in your blood are very high. But other people with high uric acid levels never develop gout at all. You can also have normal levels of uric acid and still have gout. So a blood test for uric acid doesn’t prove your joint pain is caused by gout, but it will help your doctor to diagnose your symptoms.
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, it means you have a similar condition called pseudogout. For more information about pseudogout, see our FAQ: What is pseudogout? below.
If you’ve had gout for a long time, your doctor may ask for an X-ray image to see if your joint is damaged. But you won't need one to diagnose gout in the first place.
Treatment of gout
An attack of gout should be treated as soon as your symptoms appear. You may be able to treat mild symptoms with a mixture of self-help measures and over-the-counter medicines. But if your symptoms are bad or the self-help approach isn’t working, your doctor can prescribe stronger medicines to ease your joint pain and swelling.
Once your symptoms have eased, your doctor may prescribe some medicines to prevent further attacks of gout. For more information on this, see our section: Prevention of gout below.
Self-help for gout
During an attack 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 exercise) 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 easily mould to the shape of your joint.
You can take over-the-counter painkillers, such as paracetamol to help ease the pain or ibuprofen to reduce the inflammation. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist for advice.
Medicines for gout
Your doctor may prescribe medicines to ease an attack of gout.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen may ease the pain and swelling 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 you can’t take NSAIDs, 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 find that NSAIDs, colchicines, or steroid tablets work 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 get gout if you have too much uric acid in your body. Everyone has some uric acid. Uric acid is made in your body when substances called purines are broken down into waste products. Purines are found in certain foods and in and around your body’s cells.
If you have too much uric acid, most of the extra 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 makes too much uric acid
- you eat too many foods containing lots of purines
If your uric acid levels are too high, tiny crystals may build up 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 get gout and others don't, but certain factors may make you more likely to have 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 mean you make more urine
- 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
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How healthy are you?Complications of gout
If your gout isn’t treated properly, you may get firm white lumps under your skin called tophi. These can cause pain and swelling. They may make it harder for you to carry on doing your usual daily activities. You may also be prone to infections 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 arthritis, with long-term pain, deformed joints and, eventually, disability.
Other complications of gout include:
- kidney stones (if uric acid crystals collect in your urinary system, such as kidneys)
- 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 have 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 work out if anything in particular triggers an attack. 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 badly 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. They include:
- liver and kidneys
- fish, such as sardines, herring and anchovies
- seafood such as mussels
- oatmeal
- food and drinks that contain yeast extract such as Marmite
Avoid eating a high-protein, low-carbohydrate diet. If you’re planning to make changes to your diet, ask a dietitian 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: Can some foods and drinks make gout worse? below.
Aim to drink less alcohol, especially beer, stout and port wines because these increase the level of uric acid in your blood. Try to drink at least three litres of non-alcoholic fluids each day because this will help to lower your uric acid levels.
Losing any excess weight may help to prevent gout attacks. But crash dieting can make your gout worse, by increasing the amount of uric acid in your blood. Between gout attacks, aim to do some regular exercise. Quitting smoking may also help to prevent gout attacks. Speak to your local pharmacist or your GP about the best ways to give up smoking.
Medicines
If you have more than two attacks of gout in a year, you may need to take medicines to prevent more attacks. These medicines can help to control how much uric acid you have in your blood. They can’t be used to treat symptoms of gout and you shouldn’t start taking them during a gout attack. Your GP will usually prescribe them a week or two after your 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 is causing you bad 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. To help prevent this, your doctor may prescribe NSAIDs, colchicine, or steroid tablets as well as allopurinol or febuxostat. You’ll usually keep taking these with your allopurinol for at least the first three months.
If febuxostat isn't suitable for you, your doctor may suggest you take other medicines, such as sulfinpyrazone and benzbromarone. These increase the amount of uric acid passing into your urine.
Always ask your GP for advice and read the patient information leaflet that comes with your medicine.
Frequently asked questions
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Can some foods or drinks make gout worse?
Certain foods and drinks can make your gout worse. To reduce how often you get symptoms of gout, try not to eat foods containing 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 may be prone to gout.
Foods that are very high in purines include:
- red meat, such as liver and kidneys
- seafood such as mussels
- oily fish, such as sardines, herring and anchovies
- food and drinks that contain yeast extract such as Marmite
- mushrooms and asparagus
- oatmeal
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 also affect your gout symptoms. Some sugary drinks can increase 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 to ease your gout symptoms. But you may also need to take medicines to treat your symptoms and prevent gout from coming back again.
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What is pseudogout?
Pseudogout is a different medical condition that affects your joints and is often mistaken for gout. If you have pseudogout, you have a build-up of crystals of calcium pyrophosphate in and around your joints. These crystals can often be seen on an X-ray image. Pseudogout is also known as calcium pyrophosphate deposition disease (CPPD). It is more common in older people, and men and women are affected equally.
Gout can affect any joint, but pseudogout mainly affects 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 (for example, steroids). But there aren’t any specific medicines to prevent more pseudogout attacks.
If you think you may have gout or pseudogout, contact your GP for advice.
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Can allopurinol cause serious side-effects?
Allopurinol doesn’t usually cause any serious side-effects, so you should be able to take it for a long time. But it can cause a bad rash in some people. If you notice any rash or other possible side-effects, stop taking the allopurinol and speak to a pharmacist or your doctor. If the rash is only mild, you may be able to try allopurinol again once it’s gone. But if the rash comes back, you won’t be able to take any more allopurinol at all.
Your doctor will prescribe a low dose of allopurinol to start with and then build up your dose gradually. When you first start taking it, you may notice your gout symptoms get worse rather than better. This is usually normal, but speak to your doctor if you’re worried.
Your doctor may prescribe medicines to try to stop your gout symptoms from flaring up. These medicines may include a non-steroidal anti-inflammatory drug (NSAID) or colchicine. You’ll usually keep taking these with your allopurinol for at least the first three months.
It's important to keep taking allopurinol, even if you have an attack of gout. If your symptoms do flare up, you’ll be prescribed other medicines to treat them.
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Other helpful websites
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- Gout. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised February 2018
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- First aid in general practice. PatientPlus. patient.info/patientplus, last checked February 2017
- Ankle injuries. PatientPlus. patient.info/patientplus, last checked February 2016
- Gout treatment summary. NICE British National Formulary. bnf.nice.org.uk, reviewed June 2018
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- Musculoskeletal system. Oxford Handbook of Geriatric Medicine (online). Oxford Medicine Online. oxfordmedicine.com, published February 2018
- Psoriasis. Medscape. emedicine.medscape.com, updated March 2018
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- Rheumatology, dermatology and bone health. Oxford Handbook of Nutrition and Dietetics (online). Oxford Medicine Online. oxfordmedicine.com, published January 2012 and updated December 2015
- Calcium pyrophosphate arthritis. The MSD Manuals. www.msdmanuals.com, last full review/revision April 2018
- Allopurinol. NICE British National Formulary. bnf.nice.org.uk, updated June 2018
- Personal communication, Dr Sundeept Bhalara, Consultant Rheumatologist and General Physician, July 2018.
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Author information
Reviewed by Michelle Harrison, Specialist Health Editor, Bupa Health Content Team, August 2018
Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and General Physician
Next review due August 2021
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