What is gout?

Gout is a type of arthritis that causes sudden and severe pain in your joints, often in your big toe. The skin over the affected joint can often be swollen, hot, and red. Gout is caused by a build-up of a natural substance called uric acid. Things that can increase your chances of getting gout include being overweight, drinking alcohol, and diabetes. You can make lifestyle choices and get medication to relieve the symptoms of gout.

What are the symptoms of gout?

The most common symptom of gout is a sudden attack of joint pain. This typically occurs in the base of the joint of your big toe, but it can also happen elsewhere. Gout can also occur in more than one joint at the same time. Gout typically has a very fast onset, where symptoms develop in just a few hours. It can be extremely painful. 

As well as your big toe, you can also get gout in your:

• midfoot (the area underneath your shoelaces)
• ankles
• knees
• fingers
• wrists
• hands
• elbows

Are there other symptoms of gout?

Other symptoms of gout can include:

• affected joints feeling hot and tender
• affected joints becoming extremely sensitive
• swelling in and around the affected joints

red shiny skin over the affected joints, and peeling, itchy, and flaky skin as the swelling reduces.

Not everyone experiences all of these symptoms. Gout symptoms normally last for 5 to 7 days before improving.

What happens if gout does not go away?

If gout becomes chronic, tiny white lumps called tophi can appear under your skin. These lumps are caused by the forming of urate crystals because of a high level of uric acid. This usually occurs on your ears, elbows, or fingers and can be painful. Kidney stones can also occur if your uric acid levels are too high.

What causes gout?

Gout is caused by a build-up of uric acid in the joints. This is normally caused by lifestyle habits or certain health conditions, and events related to them can trigger an attack. For instance, high levels of fat in your body can cause an increase in uric acid that results in gout.

There is some evidence to suggest that gout runs in families. It is more common in men, and the risk increases with age.

Common factors that can increase the risk of gout include:

• being overweight, drinking alcohol, 
• being post-menopausal, 
• taking water tablets or high blood pressure medicine, 
• high cholesterol, 
• high blood pressure, 
• osteoarthritis, 
• diabetes,
• surgery or injury to a joint. 

There is also some evidence that links heart disease and kidney disease to a higher risk of gout.

What can trigger an attack of gout?

A gout attack occurs when uric acid levels are too high and uric acid builds up on a joint. Common triggers for an attack include:

• being dehydrated
• injuring a joint
• having an illness with a high temperature
• drinking too much alcohol
• eating a very large meal of fatty food
• taking certain medicines

How is gout diagnosed?

Gout can be diagnosed by a doctor by looking at your symptoms and looking at the affected joint. There are also several different types of tests which can be used to help diagnose gout.

If a doctor decides to do a test to find out if you have gout, there are several options. These include:

• a test on the fluid in your joints. This typically involves the doctor taking some fluid out of your joint using a needle. They can look at the fluid under a microscope afterwards to see if there are urate crystals in it.
• x-rays can be useful to check whether the inflammation of the joint is caused by something else.
• a blood test to measure the levels of uric acid in your blood. However, this is not always reliable. Some people have gout symptoms, but their level of uric acid is not unusual. It is also possible to have high uric acid without getting gout.
• ultrasound scanning can be a useful test to check for urate crystals in joints. It uses sound waves to detect them.
• a test that combines lots of x-rays from different angles to help find out if there are any urate crystals in your joints. It is called dual-energy computerised tomography (DECT).

How is gout treated?

Gout can be treated using two main types of medication. The first type is used to reduce the pain and inflammation caused by attacks of gout. The second type is used to prevent more serious issues with gout, such as chronic gout, and it does this by lowering your level of uric acid.

What type of medication do I need for gout?

The type of medication that works best for you will depend how severe and frequent your symptoms are, and whether you have any other health issues.

Medication used to treat attacks of gout and prevent gout in future include:

• NSAIDs (Non-steroidal anti-inflammatory drugs). This includes over-the-counter medicines like ibuprofen and naproxen sodium. There are also more powerful versions of NSAIDs like indomethacin and celecoxib.
• Colchicine. This is an anti-inflammatory drug that is effective in reducing pain caused by gout.
• Corticosteroids. These can be used if the pain and swelling does not improve. Corticosteroids reduce gout pain and inflammation and can come in the format of a pill or an injection into the affected joint.

What happens if I keep getting gout?

If you have attacks of gout several times each year, or less frequent but very painful attacks, medication can help reduce the risk of more problems. Under some circumstances, medications can be used to reduce the amount of uric acid in your body. For example, if x-rays show that gout has caused damage to your joints, you have tophi (lumps caused by urate crystals), kidney stones or chronic kidney disease.

These medications include:

• medications to block production of uric acid in your body, such as allopurinol, and febuxostat.
• medications that help your kidneys break down and remove uric acid from your body, such as probenecid.

Can gout be cured?

There is no cure for gout, however symptoms can be managed effectively by controlling diet and taking appropriate medication.

How to prevent gout

You can manage gout symptoms and help to prevent them occurring by taking gout medication and making dietary and lifestyle choices. Medication can help to stop your level of uric acid getting too high, whilst avoiding certain foods which cause your body to create more uric acid can also be effective in preventing gout. Lifestyle choices, such as exercise, can also help to prevent gout.

Using medication

Some medication is anti-inflammatory and can reduce or prevent the pain caused by gout by reducing inflammation of the affected joint. Other medications to reduce the production of uric acid in your body, or to help assist your kidneys in the removal of uric acid from your body. Because a high level of uric acid increases the risk of an attack of gout, reducing the level of uric acid in your body using these medications can help to prevent it.

Changing your diet

You can reduce the risk of gout by making changes to your diet. Your body naturally produces uric acid when breaking down purines, a substance which is found in your body. Some foods also contain purines, and so consuming them can increase your level of uric acid. These include:

• red meat
• organ meat or offal (such as liver and kidney)
• seafood (including anchovies, sardines, mussels, scallops, trout, and tuna)

Drinks can also promote higher levels of uric acid, including:

• drinks sweetened with fruit sugar (fructose)
• alcohol, especially beer

Avoiding consumption of these food and drink items can help to prevent high levels of uric acid. This can result in a reduced risk of gout.

Lifestyle choices

Making choices about your lifestyle can help to prevent future attacks of gout. The following actions can help to reduce the chances of another attack of gout:

• gentle or moderate regular exercise that avoids putting lots of pressure on joints
• achieving a healthy weight (avoid using ‘crash diets’)
• eating a healthy and balanced diet
• staying hydrated
• asking your GP about vitamin C supplements
• having alcohol-free days every week
• avoiding consuming more than 14 units of alcohol per week spread over at least 3 days
• stopping smoking

Sources

Global epidemiology of gout: prevalence, incidence and risk factors Nature [accessed 8th February 2022]

Gout CDC [accessed 8th February 2022]

Gout NHS [accessed 8th February 2022]

Gout NHS Scotland [accessed 8th February 2022]

Gout NICE [accessed 14th February 2022]