Gout is a common and complex form of arthritis that causes attacks of intense pain, heat and swelling in your joints. It typically develops in your foot, especially your big toe, but it can affect other joints too. Symptoms may come and go, with periods where symptoms worsen (flare-ups) — there are ways to prevent flare-ups and manage your symptoms.
Gout is one of the most painful forms of arthritis and the most common form of inflammatory arthritis. It is associated with other metabolic problems (ie problems relating to the chemical reactions occurring in your body) and is often a warning sign to assess the healthiness of your lifestyle. It usually affects men in their 40s and attacks last from five to seven days on average before getting better. If you get immediate treatment, gout may not permanently damage your joints.
Gout develops if there is too much uric acid in your blood. Uric acid is a chemical produced by your body, but usually, it's flushed away in your urine. You may have high blood levels of uric acid because your body is making too much uric acid or because your kidneys aren't removing enough of it from your body.
If uric acid builds up in your blood, it causes sharp, needle-shaped urate crystals to form in and around your joints. This causes inflammation, pain and swelling. Crystals build up slowly but if they work loose into the space inside your joint (synovial cavity), they can trigger an acute attack of inflammation.
Treatment for gout includes:
If left untreated, gout can lead to joint damage and chronic arthritis.
Most people only find out they have gout when they have their first acute attack. Gout symptoms may come on quickly, often at night, and cause extreme joint pain and inflammation — inflammation causes heat, redness, swelling and tenderness in a joint. The skin over your joint may be red and shiny or peel.
After the intense pain is over, you may experience lingering joint discomfort for a few days or weeks. Subsequent gout attacks may be longer and affect more joints. Over time, gout may reduce the range of movement of your affected joints.
Gout symptoms most often affect joints in your limbs, such as your:
You should see your GP if you have any of these symptoms.
If your joint pain is getting worse or you also have no appetite, a fever or feel sick, you should see your GP urgently. These could be signs that you have a joint infection and need urgent treatment.
Your GP will assess your symptoms and they may arrange:
Your GP will also ask about your lifestyle, your diet and how much alcohol you drink. If they think you have gout, they may refer you to a rheumatologist (a specialist in arthritis and joints)
These factors may increase your risk of developing gout:
If you have recently had an injury or surgery, you are also at greater risk of developing gout.
Gout is treated by managing lifestyle factors and also by treating acute and chronic gout symptoms.
Treatments to soothe a flare-up may include:
Medications to prevent gout complications
Your doctor may recommend medications to prevent gout complications if:
You will need to wait until your gout attack is over before starting on medications to prevent gout complications. These medications reduce your uric acid levels but can initially trigger a gout attack. This is because when uric acid levels drop due to the medication, urate crystals in your joints may dislodge, which triggers an attack. However, continuing with treatment is the most effective way to reduce future gout attacks.
Your doctor may prescribe a low, regular dose of colchicine alongside either a medication to block uric acid production or a medication to improve uric acid removal — both of these types of medication will reduce your uric acid levels and therefore reduce your risk of a future gout attack.
Medications that block uric acid production
Medications that improve uric acid removal
These drugs are called uricosurics and help your kidney remove uric acid from your body via your urine. Side effects include a rash, kidney stones and stomach pain. Uricosurics include:
Lifestyle changes to prevent gout coming back
Try to avoid:
Make sure you:
The risks of alternative medicines for gout are not clear. You should speak to your GP before starting on any alternative medicines so they can assess whether the risks outweigh any potential benefits.
Studies have been carried out into whether certain foods, including cherries, coffee and vitamin C, can reduce uric acid levels. Before changing your diet, speak to your GP or a dietitian.
If you feel a gout attack coming on, get treatment immediately.
Before you see your GP, consider making a list of your symptoms, medical history, and any medications and supplements you are taking. You may also want to list any questions you want to ask, such as:
Your GP will discuss your symptoms and medical history with you and may ask you questions, such as:
They may also ask you questions about your family history and lifestyle, such as:
Depending on your symptoms, your GP may refer you to a rheumatologist. Questions to consider asking your rheumatologist include:
If you have other health conditions, you may also want to ask how you can effectively manage them together.
What is the main cause of gout?
Gout is caused by high uric acid levels in your blood. Over time, this causes urate crystals to build up in and around your joints. You may have high uric acid levels if your body produces too much uric acid or if your body can’t remove uric acid fast enough. Lifestyle plays a major role in gout; being overweight and excessive drinking both increase your risk. However, there are other risk factors, such as your age, being male, family history and other medical conditions.
What foods cause gout?
High-purine foods can trigger gout, such as meat, offal, seafood and shellfish. Full-fat dairy foods, sugary drinks and snacks, and beer can also cause gout.
What is the fastest way to get rid of gout?
In the long-term, lifestyle changes can significantly reduce your gout attacks ie eating a healthy diet that avoids high-purine foods and regularly exercising. When dealing with a gout attack, you should rest your affected joints and can try applying an ice pack to cool these joints. You can also take over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen; if these aren’t effective, your GP may be able to prescribe you stronger NSAIDs, or steroid tablets or injections
What does gout look like?
Joints affected by gout are often swollen, red and shiny — sometimes the skin may be peeling.
How do you flush uric acid out of your body?
Your kidneys will naturally remove uric acid from your body via your urine. However, in gout, your uric acid levels may be too high for your kidneys to do this fast enough. It is therefore recommended that you reduce your uric acid levels by altering your diet. Avoiding foods that are associated with high uric acid levels can help, such as full-fat dairy products, meat, seafood, shellfish, and sugary drinks and snacks.
What can be mistaken for gout?
Intense pain in a joint may not be gout, especially if you also have a fever, feel sick or are unable to eat. These could be signs that you have a joint infection. You should see your GP urgently or call 111 as joint infections need immediate medical treatment.
What causes gout in feet?
Gout usually affects the feet first but can affect any joint. In all cases, it is caused by high uric acid levels in your blood. This causes urate crystals to build up in your joints, which leads to inflammation, pain, swelling and tenderness.
Is walking good for gout?
Yes, walking is good for gout. It won’t break down the crystals in your joints but can help you maintain a healthy weight and reduce stress levels — being overweight or highly stressed increases your risk of a gout attack.
Is gout a sign of kidney failure?
Gout can be an early sign of kidney disease. This is because your kidneys remove uric acid from your blood. When your kidneys are not functioning properly, uric acid can build up in your body, causing urate crystals to form in and around your joints — this causes gout.
Is gout an emergency?
Gout is not a medical emergency. However, it does need treatment as soon as possible to prevent long-term damage to your joints.
What does gout pain feel like?
Gout pain during a flare-up is intense. It is sudden and severe. Your joints may also feel tender and warm due to inflammation.
How long does a gout flare-up last?
Flare-ups usually last five to seven days before they get better. However, if gout is left untreated, flare-ups can become more common and last longer.
Why did I suddenly get gout?
There are several risk factors for gout including being male, other medical conditions, your age and your family history. Most people do not realise they have gout until they have a gout attack. Gout attacks are sudden and severe and can be triggered by becoming dehydrated, drinking a lot of alcohol or eating a large, fatty meal. Taking certain medications or having a joint injury can also trigger an attack.