Gout

Symptoms

The main symptoms of gout are:

• sudden severe pain in a joint – usually your big toe, but it can be in other joints in your feet, ankles, hands, wrists, elbows or knees
• hot, swollen, red skin over the affected joint – redness may be harder to see on black or brown skin.

Causes

Gout is caused by having too much uric acid in your blood. This can lead to crystals forming around your joints, which causes pain.

It sometimes runs in families.

It's more common in men, especially as they get older.

Risk Factors

You might have a higher chance of getting gout if you:

• are overweight
• drink alcohol
• have been through the menopause
• take medicines such as diuretics (water tablets), or medicines for high blood pressure (such as ACE inhibitors)
• have high cholesterol, high blood pressure, kidney problems, osteoarthritis or diabetes
• have had surgery or an injury

Diagnosis

What happens at your appointment:

The GP may ask about your diet and if you drink alcohol if you have symptoms of gout.

They may also do a test to measure how much uric acid is in your blood. Uric acid is a chemical that can lead to crystals forming around your joints which cause pain.

If the test is still unclear, a GP may refer you to see a specialist (rheumatologist) and arrange further tests.

This could include taking a sample of fluid from inside the affected joint, using a thin needle. If this test cannot be done or the diagnosis is still unclear, then a scan will be arranged.

Treatment Options

Attacks of gout are usually treated with a non-steroidal anti-inflammatory (NSAID), like ibuprofen.

If the pain and swelling does not improve you may be given steroids as tablets or an injection.

Treatment to prevent gout coming back

Gout can come back every few months or it may be years. It can come back more often if it's not treated.

If you have frequent attacks or high levels of uric acid in your blood, you may need to take uric acid-lowering medicine.

If you’re having a gout attack, there are things you can do to relieve the pain:

• take any medicine you've been prescribed as soon as possible – it should start to work within 2 days
• rest and raise the limb
• keep the joint cool – apply an ice pack, or a bag of frozen peas, wrapped in a towel for up to 20 minutes at a time
• Do not put pressure on the joint – this can make the pain feel worse
• drink lots of water (unless a GP tells you not to)
• try to keep bedclothes off the affected joint at night

• Don’t put pressure on the joint – this can make the pain feel worse
  

Prevention Tips

Making healthy lifestyle choices may mean you can stop or reduce further gout attacks:

• try to lose weight if you are overweight, but avoid crash diets
• eat a healthy diet – your doctor may give you a list of foods to include or limit
• have some alcohol-free days each week – try not to drink more than 14 units of alcohol a week
• drink plenty of fluids to avoid getting dehydrated
• exercise regularly – but avoid intense exercise or putting lots of pressure on joints
• try to quit smoking
• ask a GP about vitamin C supplements
• Do not have lots of sugary drinks and snacks

• Do not eat lots of fatty foods
  

When To See A Doctor

See a GP if: 

• you have symptoms of gout for the first time
• you have gout and your usual treatments are not helping

An attack of gout usually lasts 1 to 2 weeks if left untreated. If you do not get treatment, future attacks may last even longer. Leaving gout untreated may cause lasting damage to joints.      

See a doctor urgently if you have a sudden pain and swelling in a joint and:

• the pain is getting worse
• you also have a very high temperature (you feel hot and shivery)
• you also feel sick or cannot eat

These symptoms could mean you have an infection inside your joint and need urgent medical help.