Gout

Gout is a type of arthritis. It causes swelling and severe pain in your joints, especially at the base of your big toe. You may be able to ease and prevent attacks of gout with some medicines and self-help measures.

About gout

If you have gout, tiny crystals of uric acid (a chemical made by your body) form in and around your joints. This can trigger arthritis. You may 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 most likely to be affected first. But gout can cause any of your joints to become inflamed. It may also affect:

• 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.

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 of gout.

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

You may have gout even if the uric acid levels in your blood are within the normal range. And you can have high levels of uric acid in your blood, but not have gout. It’s not clear why some people get gout and others don’t. But some things 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

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. It 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 up to 14 days but may last 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, 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 two to four weeks after your first attack of gout, they may arrange for you to have a blood test. This test checks the level of uric acid in your blood. It’s more reliable a few weeks after an attack has ended. A positive 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 to help tell whether or not you have gout. These tests include 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 on pseudogout, see our section on types of gout.
• An ultrasound scan to look for signs of crystals within your joints or tissues.
• A CT scan.

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 more attacks of gout. They’ll also prevent lasting damage to your joints. For more information, 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. Instead of 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, colchicine 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.

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, ears 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, causing 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

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 your doctor prescribes.