About gout
Gout is a type of arthritis, which causes inflammation of your joints. It causes pain and
swelling, usually in one joint in your body – commonly your big toe. However, it can affect
any of your joints, including those found in your:
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feet and ankles
knees
hands, fingers and wrists
elbows
Gout is caused by a build up of uric acid crystals in your affected joints.
According to the UK Gout Society, gout affects around one in every 100 people. It's more
common in men, particularly those aged 30 to 60 and in older people.
Symptoms of gout
You may only ever have gout once in your life and it may go away without any treatment.
The first symptoms of gout in your affected joint include:
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severe pain
swelling and warmth around the area
red and shiny skin around the area, which may peel later on
You may also have a mild fever.
If you have gout that reoccurs over many years, you may have further symptoms. This can
include firm, white lumps developing beneath your skin – these are made of uric acid crystals
and are called tophi. Tophi usually take up to 10 years to develop from your first episode of
gout. Having tophi can lead to a range of problems, including:
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the tophi becoming inflamed, which can cause discomfort
tophi breaking down and leaking out a white, paste-like substance
You may want to discuss with your GP treatments to ease discomfort from having tophi.
However, taking antibiotics for inflamed or leaking tophi won’t help because tophi aren’t
caused by bacteria.
These symptoms may be caused by problems other than gout. If you have any of these
symptoms, see your GP for advice.
Complications of gout
Having gout won’t always lead to further problems, but you can reduce your risk of having
complications by having treatment and making changes to your lifestyle and diet.
The most common complication of gout is progressive joint damage, which leads to longterm pain, deformed joints and eventually, disability. This may be prevented by changes to
your diet and by taking medicines that lower your uric acid levels. There is also some
evidence that prolonged high levels of uric acid in your body can increase your risk of
vascular diseases, which may lead to a heart attack or stroke.
Other complications that you may have are as follows.
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Gout affecting several of your joints (called polyarticular gout). This happens more
often in older people with gout.
Getting kidney stones (if uric acid crystals collect in your urinary tract). This happens
to between one and three in 10 people who have gout.
Damage to your kidneys (if uric acid crystals collect in your kidney tissue).
Causes of gout
You can develop gout if you have too much uric acid in your body. Uric acid is a chemical
that everyone has in their blood. It's a waste product formed from substances called purines,
which are found in every cell in your body and certain foods. Uric acid is formed in your
body when the purines in foods you eat are broken down. It’s also formed when old cells in
your body are broken down and replaced by new cells. Excess uric acid is passed through
your kidneys and out of your body in your urine. However, the level of uric acid in your
blood can rise if:
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your kidneys don't pass uric acid quickly enough
your body produces too much uric acid
If the level of uric acid in your body is too high, it can form tiny crystals that collect in your
tissues, particularly in and around your joints. This is what may cause your swelling and pain.
These crystals tend to form at a cooler body temperature, which is why gout is more common
in your fingers and toes.
You may have high levels of uric acid, but not get gout, or you may get gout, but not have
high levels of uric acid. It's not known why some people develop gout and others don't.
However, there are certain factors that can increase your likelihood of getting gout. You're
more likely to get gout if you:
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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, which are found in red meat, seafood
and some other foods
drink too much alcohol, especially beer
don’t drink enough fluids daily and 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 meaning that your kidneys don't pass enough uric acid out in
your urine
are overweight, have diabetes or high blood pressure
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have psoriasis (itchy, dry and flaky skin), which can sometimes cause your body to
produce too much uric acid
are taking certain types of cancer medicines
Diagnosis of gout
Your GP will ask about your symptoms and examine you. He or she will also ask you about
your medical history and that of your family. Your GP will usually take a sample of your
blood, which will be sent to a laboratory to measure the levels of uric acid. Your blood
sample may also be tested to find out whether there may be another reason for your
symptoms.
Your GP may refer you to a rheumatologist (a doctor specialising in conditions that affect the
joints) for further tests.
Your doctor may remove some fluid from your swollen joint with a needle. This usually
causes no more discomfort than a blood test. If uric acid crystals can be seen in the fluid
under a microscope, you have gout. If calcium crystals are seen, you have a similar condition
called pseudogout. The crystals formed when you have pseudogout are made of a calcium
salt called calcium pyrophosphate. See our frequently asked questions for more information.
You may need to have an X-ray of your joint in order to rule out other conditions and to find
out if any damage has occurred, but this isn’t used to diagnose gout.
Treatment of gout
You will usually have symptoms of gout for up to two weeks and then they will go away,
even without treatment. You may only have one episode of gout in your lifetime, but it might
return. If you have no treatment to prevent gout, there is an eight in 10 chance of it returning
within three years. Your symptoms of gout may also be more frequent and last for longer.
Self-help
There are a number of steps you can take to reduce the pain and swelling from having gout.
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Raise and rest your joint. Don’t do any vigorous physical activity. Rarely, your doctor
may give you a splint to wear to stop you moving your joint.
Keep your joint cool and don't cover it. Ice the affected joint using an ice pack or ice
wrapped in a towel for about 20 minutes at a time to reduce swelling and bruising.
Don’t apply ice directly to your skin as it can damage it. If you need to repeat this, let
your joint return to its normal temperature first.
Drink enough water.
Medicines
There are medicines your doctor can prescribe to help to ease your pain and swelling from
gout.
Your doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen and naproxen, which may relieve pain and inflammation. If you have a heart
condition, high blood pressure, kidney or lung disease, or if you're over 65, these medicines
may be harmful, so you need to talk to your doctor before taking them. Don’t take aspirin
because this medicine can affect your uric acid levels and make your gout last longer.
If NSAIDs aren't suitable for you, your doctor may prescribe a medicine called colchicine
instead. Colchicine also reduces inflammation, but in a different way to NSAIDs. You may
have side-effects from this medicine including diarrhoea, but this can be reduced by taking
lower doses.
Occasionally, your doctor may prescribe steroid tablets if you can't take NSAIDs or
colchicine. Alternatively, he or she may recommend a steroid joint injection if you have gout
in a large joint (such as your knee).
Prevention of gout
Identifying things that cause you to have gout symptoms can help you to eliminate these
triggers and reduce your chances of having it again. Gout can be prevented from reoccurring
so often and so severely by making changes to your diet and taking medicines if needed.
Diet
What you choose to eat and drink can have an impact on gout. There are some foods that are
very high in purines, which can increase the amount of uric acid in your blood. It’s best not to
eat much of these foods very often. These include:
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liver and kidneys
oily fish, such as mackerel, sardines and anchovies
shellfish, including mussels, crab and shrimp
certain vegetables, such as asparagus, cauliflower, lentils, mushrooms and spinach
oats and oatmeal
If you’re planning to make changes to your diet, ask your doctor or a dietitian for advice to
ensure you still get all the nutrients you need. Eating a well-balanced diet will help you to
manage your symptoms. See our frequently asked questions for more information.
Aim to drink less alcohol – especially cutting out beer, stout, port and fortified wines because
these can have the greatest effect on causing gout symptoms. Drinking enough water every
day will help to dilute your blood and urine, lowering the uric acid levels in your body.
If you need to lose excess weight, doing regular exercise will help you towards your goal.
The recommended healthy level of physical activity is 150 minutes (two and a half hours) of
moderate exercise over a week in bouts of 10 minutes or more. You can do this by carrying
out 30 minutes on at least five days each week.
Medicines
In addition to changing your diet, you may need medicines to prevent gout. These help
control the levels of uric acid in your blood. The aim is to prevent you getting gout again and
if you do, make it last for a shorter time and be less severe. These medicines aren't used to
treat symptoms of gout and are usually prescribed several weeks after your last gout
symptoms have gone.
Your doctor may prescribe you a medicine called allopurinol to take daily. An alternative is
febuxostat if there is a reason why you can’t take allopurinol. Both of these medicines
prevent gout by stopping the formation of uric acid. Both allopurinol and febuxostat may
actually cause more symptoms of gout when you first start taking them. To help prevent this
happening, your doctor may prescribe NSAIDs, colchicine or steroid tablets for you to take
alongside allopurinol or febuxostat for up to three months. Make sure you drink enough
fluids when taking these medicines.
Your doctor may prescribe you other medicines, such as probenecid, to increase the amount
of uric acid that is removed from your body in your urine.
Always ask your doctor for advice and read the patient information leaflet that comes with
your medicine.