Gout
Gout is a type of arthritis in which small crystals form inside and around the joints. It causes sudden flares of severe pain and swelling.
Gout can be very painful, but treatments are available to help relieve the symptoms and prevent further flares.
Symptoms of gout
Any joint can be affected by gout, but it usually affects joints towards the ends of the limbs, like
- toes, especially the big toe
- ankles
- knees
- fingers
Signs and symptoms of gout include:
- severe pain in 1 or more joints
- the joint feeling hot and very tender
- swelling in and around the affected joint
- red, shiny skin over the affected joint
Almost everyone with gout will experience further flares at some point, usually within a year.
When gout symptoms can happen
Flares of gout tend to:
- occur at night, but they can happen at any time
- develop quickly over a few hours
- last between 3 and 10 days
- come back – you may experience flares every few months or years
- become more frequent over time if not treated
After a gout flare the affected joint should start to return to normal. But, the problem can persist if treatment isn’t started early.
It’s difficult to predict how often flares will occur and when exactly they’ll happen.
Repeated gout flares can lead to joint pain and joint deformities.
When to get medical advice
Speak to your GP urgently if you have:
- severe, worsening joint pain and swelling
- a high temperature (fever) of 38C (100.4F) or above
This could mean you have an infection inside the joint (septic arthritis).
If your GP is closed, phone 111.
Speak to your GP practice if you have:
- symptoms of gout for the first time
- gout and your usual treatments don’t start working within a couple of days
Diagnosing gout
Your GP will ask about your symptoms and medical history, and examine the affected area, to help make a diagnosis.
They may also ask you about your diet and whether there’s any history of gout in your family.
Sometimes further tests will be needed to confirm the diagnosis and rule out other possible causes.
A sample of fluid may be taken from the affected joint. The fluid can be checked for the small crystals that cause gout. It can be tested for infection to rule out septic arthritis.
A blood test known as a serum urate test may be used to measure the amount of urate in your blood. A high level of urate is often linked with gout.
Your GP may wait for 2 to 4 weeks after a flare of gout before carrying out this test. The level of urate in your blood is often not raised at the time of a flare. This is because the urate level in your blood can drop when urate crystals form in the joints.
You may also be tested to check your levels of C-reactive protein (CRP) in your body. High CRP levels can be found in patients with acute inflammation. This is frequently found in patients who are suffering from gout flares.
An X-ray is rarely used to diagnose gout because the condition isn’t usually detectable using this method.
But, an X-ray is sometimes used to help rule out similar conditions that affect the joints, like chondrocalcinosis. Chondrocalcinosis is a build-up of calcium crystals in the joints. It can also be used to assess whether there’s been any joint damage due to repeated or persistent flares of gout.
An ultrasound scan of an affected joint is a simple and safe investigation that’s increasingly used to detect crystals in the joints. It can also detect crystals deep in the skin that aren’t obvious during a physical examination.
Causes of gout
Gout is caused by an inflammatory reaction to urate crystals formed in and around the joints. You have urate in your blood but if levels rise too high, then this allows the build of tiny sharp crystals. In a flare of gout a reaction to these crystals results in pain, redness and swelling of the joint.
Things that may increase your chances of getting gout include:
- obesity, high blood pressure and/or diabetes
- having a close relative with gout
- kidney problems
- eating foods that cause a build-up of urate, like red meat, offal and seafood
- drinking too much beer, spirits, fruit juices or sugary drinks
- some medications like diuretics, beta-blockers, niacin and some chemotherapy medicines
Treatment for gout
If you have gout, treatment is available from your GP to:
- relieve symptoms during a flare
- prevent further flares by taking urate lowering medicines like allopurinol
Symptoms can be relieved using ice packs and by taking medications like:
With preventative treatment, like allopurinol, many people are able to reduce their urate levels enough to dissolve the crystals that cause gout. This means they’ll have no more flares. But, lifelong treatment is usually required.
What to do during a flare
Do
- take any medication you’ve been prescribed as early as possible after you notice a flare – this should start to have an effect within 2 or 3 days
- rest and raise the limb
- avoid knocking or damaging the affected joint
- keep the joint cool – remove clothing covering the joint and apply an ice pack, like a bag of frozen peas wrapped in a towel
- ensure you’re well hydrated
When using an ice pack, apply it to your joint for around 20 minutes. Don’t apply ice directly to your skin and don’t apply it for more than 20 minutes at a time because this could damage the skin.
If necessary, you can keep reapplying an ice pack to your skin during a flare. But, you should wait until your skin has returned to a normal temperature first.
Things you can do to help prevent gout flares
Making some practical changes to your daily routine can also help reduce your risk of further flares of gout, including:
- losing weight if you’re overweight
- maintaining a healthy weight
- avoiding foods containing high levels of purine (the chemical involved in the production of urate), like red meat, offal, oily fish, seafood and foods containing yeast extract
- avoiding sugary drinks and snacks
- taking regular exercise – try activities that don’t put too much strain on your joints
- drinking plenty of water – keeping yourself well hydrated will reduce the risk of crystals forming in your joints
- cutting down on alcohol – avoid beer and spirits in particular and don’t binge drink
There’s evidence that taking regular vitamin C supplements can lower your urate levels, but the effect may only be small. Talk to your GP first if you’re thinking about taking vitamin C supplements, as they aren’t suitable or safe for everyone.
Complications of gout
Sometimes gout can lead to further problems, particularly if it’s left untreated.
These can include:
- kidney stones
- small firm lumps of urate crystals under the skin called tophi
- permanent joint damage
Psychological and emotional effects of gout
Gout can also affect your mood, work and home life. The severe pain that gout causes can make it difficult to do everyday tasks and to get around. This can lead to feelings of depression or anxiety.
If gout is affecting your mood or making everyday life difficult, talk to your GP. They’ll be able to offer treatment and support.
There are also organisations that offer information and advice for people who have gout, like Versus Arthritis.
What’s pseudogout?
Pseudogout can look and feel like gout, but it’s caused by a reaction to a different crystal in the joints. It more commonly affects the knees or wrists.
Last updated:
08 May 2024