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Gout
Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and General Physician
Next review due November 2023
Gout is a type of arthritis. It causes sudden swelling and severe pain in your joints, especially at the base of your big toe. It’s caused by tiny crystals forming in and around your joints.
Symptoms of an attack of gout can be eased with medicines and some self-help measures. You can reduce the chance of getting further attacks with some changes to your lifestyle, including your diet. Some people benefit from long-term medicines to prevent attacks.
About gout
If you have gout, tiny crystals of uric acid (a chemical made by your body) form in your joints. This can trigger arthritis so you get pain, redness and swelling in your joints. The crystals may also form in other tissues (such as ligaments and tendons) and under your skin.
Your big toe joint is by far the most likely to be affected first, but gout can cause any of your joints to become inflamed. After the big toe, gout most usually affects joints in:
- the middle of your feet (instep)
- your ankles
- your knees
- your fingers and wrists
- your elbows
Gout affects more than one in every 50 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 contact your GP.
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. Your joint may be so painful that you can’t walk properly or even bear to cover it at night. You may also feel unwell and have a raised temperature (fever).
Attacks usually last for three to 14 days but may be longer if untreated. 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, it’s important to 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 (including your diet and alcohol intake).
Blood test for uric acid level
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. The reason they’ll wait is because this test is known to be more reliable a few weeks after an attack has ended. 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.
Further tests
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 recommend further tests on your affected joints, including the following.
- Joint aspiration. Some fluid is removed from your swollen joint with a needle then examined under a microscope. If there are uric acid crystals, your rheumatologist will diagnose gout. If they see crystals of calcium, it means you have a similar condition called pseudogout. For more information about this, see our FAQ on pseudogout.
- An ultrasound scan to look for signs of crystals within your joints or tissues, to help tell whether it’s gout or not.
- A CT scan, which can also help your doctor to diagnose gout if they’re not sure.
- X-rays. 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 this test isn’t helpful in diagnosing gout in the first place.
Treatment of gout
An attack of gout should be treated as soon as your symptoms appear. Treatment will reduce the inflammation and ease your pain.
Once your symptoms have eased, your doctor may prescribe some medicines to prevent further attacks of gout and avoid lasting damage to your joints. For more information on this, see our section on prevention of gout.
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.
- Take care not to knock your joint.
- Keep your joint cool and don't cover it.
- Consider using something like a bed-cage to keep the weight of your bedclothes off your joint at night.
- Cooling your joint with an ice pack may help. If you use one, apply it for around 15 to 20 minutes, every few hours. Only continue using the ice pack if it actually eases your pain. If you don’t have an ice pack, try using ice cubes or a packet of frozen peas wrapped in a towel. Don’t apply ice directly to your joint because ice can damage your skin.
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 about taking your medicines, ask your pharmacist.
Medicines for gout
Your doctor may prescribe medicines to ease an attack of gout.
- Non-steroidal anti-inflammatory drugs (NSAIDs) may ease the pain and swelling in your joint. Take these as soon as your symptoms appear and for another two days 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 helps to protect your stomach lining from any side-effects of NSAIDs.
- Colchicine. As an alternative to NSAIDs, your doctor may prescribe a medicine called colchicine to ease your symptoms.
- Corticosteroids (steroids). If you can't take NSAIDs or colchicine, you may be offered steroid tablets.
Which medicine your doctor recommends will depend on your health, other medicines you’re taking and your personal preference. 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 read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist or GP for advice.
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. For examples of foods that are high in purines, see our section on prevention.
If you have too much uric acid, most of the extra passes through your kidneys and out of your body in your pee. The level of uric acid in your blood can rise if:
- your kidneys don't remove uric acid quickly enough (the most common reason)
- 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 inflammation, with 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 (for example, lots of meat and seafood)
- drink too much alcohol, especially beer
- take certain medicines such as diuretics (water tablets)
- have a family history of gout
- have kidney disease
- 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 develop in various places, but are often on your fingers, hands, feet, elbows or Achilles tendon. Tophi don’t usually hurt, but can sometimes suddenly become inflamed, with 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. This can lead to arthritis, with long-term pain, deformed joints and, eventually, disability.
If uric acid crystals build up in your urinary system, they can cause:
- kidney stones
- damage to your kidneys
There is also a link between having gout and developing cardiovascular disease (having a heart attack or 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’ve had an attack of gout, there are things you can do and medicines you can take to help stop you getting another one.
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:
- offal – for example, liver and kidneys
- oily fish – for example, sardines, herring and anchovies
- seafood – for example, prawns and mussels
- food and drinks that contain yeast extract – for example, Marmite and Bovril
Other foods such as meat, poultry, mushrooms, beans and wholegrain cereals are fairly high in purines. Dairy products, eggs, non-wholegrain cereals and pastas, and most fruit and vegetables are low in purines. If you’re planning to make changes to your diet, it may be helpful to ask a dietitian for advice. You need to make sure you will still get all the nutrients you need.
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. And try to avoid getting dehydrated.
Losing any excess weight may help to prevent gout attacks but avoid crash diets or fasting (long periods without eating). And avoid eating a high-protein, low-carbohydrate diet.
Between gout attacks, aim to do some regular exercise.
Medicines
Medicines can help prevent gout attacks coming back by reducing the level of uric acid in your blood. Your doctor may recommend you take a uric acid-lowering medicine if:
- you have two or more attacks of gout in a year
- you have tophi (for more information, see our section on complications)
- gout has caused long-term arthritis in your joints
- your kidneys aren’t working well
- you’re taking diuretic medicines
Your doctor will usually prescribe a medicine called allopurinol. But if you can’t take allopurinol, you may be prescribed febuxostat instead. For more information about the possible side-effects of allopurinol, see our FAQs.
You usually start these medicines a week or two after your gout symptoms have gone. You’ll need to take them for the rest of your life to control your gout. They may cause an attack of gout when you first start taking them. To help prevent this, your doctor may prescribe colchicine or non-steroidal anti-inflammatory drugs (NSAIDs) as well for up to six months.
Always read the patient information leaflet that comes with your medicine carefully. If you have any queries about taking your medicines, ask your pharmacist.
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What is pseudogout?
Pseudogout affects your joints and can give the same symptoms as gout, but it’s a different medical condition. Pseudogout is also known as calcium pyrophosphate disease (CPPD).
If you have pseudogout, you have a build-up of crystals of a substance called calcium pyrophosphate in and around your joints. Like gout, it’s more common in older people but, unlike gout, it affects men and women equally.
Gout can affect any joint, but pseudogout mainly affects larger joints such as your knee, wrist or shoulder. With pseudogout, you don’t have any tophi (firm white lumps) under your skin, and the condition isn’t linked to getting kidney stones.
Like gout, pseudogout can return or affect you for the rest of your life. Attacks of pseudogout can be treated with similar medicines to those used for gout attacks. But there aren’t any specific medicines to prevent you getting more pseudogout attacks.
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What are the side-effects of allopurinol?
The medicine allopurinol doesn’t usually cause any serious side-effects, 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 get a flare-up of your gout symptoms. Your doctor may prescribe medicines such as a non-steroidal anti-inflammatory drug (NSAID) or colchicine to try to stop this happening.
It's important to keep taking allopurinol, even if you have an attack of gout. In time, taking regular allopurinol should mean you have fewer, less severe attacks.
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Other helpful websites
- Versus Arthritis
0800 5200 520
www.versusarthritis.org
Discover other helpful health information websites.
- Versus Arthritis
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Sources
- Gout. BMJ Best practice. bestpractice.bmj.com, last reviewed October 2020
- Gout and pseudogout. Medscape. emedicine.medscape.com, updated June 2020
- Gout. Patient. patient.info/doctor, last edited January 2017
- Gout. MSD Manuals. msdmanuals.com, last full review/revision October 2020
- Calcium pyrophosphate arthritis. MSD Manuals. msdmanuals.com, last full review/revision October 2020
- Gout. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised February 2018
- Gout. NICE British National Formulary. bnf.nice.org.uk, accessed November 2020
- Therapy-related issues: musculoskeletal. Oxford handbook of Clinical Pharmacy. Oxford Medicine Online. oxfordmedicine.com, published online April 2017
- Musculoskeletal problems. Oxford Handbook of General Practice. Oxford Medicine Online. oxfordmedicine.com, published online June 2020
- Musculoskeletal system. Oxford Handbook of Geriatric Medicine. Oxford Medicine Online. oxfordmedicine.com, published online February 2018
- Gout. Versus arthritis. versusarthritis.org, accessed November 2020
- Personal communication, Dr Sundeept Bhalara, Consultant Rheumatologist and General Physician, November 2020
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Author information
Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, November 2020
Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and General Physician
Next review due November 2023
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