Gout

Gout is a common type of inflammatory arthritis. It develops when there is too much uric acid in the blood, a waste product made when the body breaks down substances called purines. When uric acid levels are high, it can form tiny, needle-shaped crystals in and around a joint, which trigger sudden inflammation.

The result is a gout attack, or flare: a period of intense joint pain and swelling that often eases over days to a couple of weeks. Gout most commonly affects the big toe but can also affect other joints such as the ankles, knees, fingers and wrists.

A gout attack usually comes on suddenly, often during the night. The affected joint becomes very painful, swollen, hot and red, and even the light weight of a bedsheet can feel unbearable. The pain is often most severe in the first 24 hours and then gradually settles, with the skin over the joint sometimes peeling as it heals.

Between attacks there may be no symptoms at all. Over time, if gout is not managed, attacks can become more frequent and affect more joints, and hard lumps of crystals called tophi can form under the skin around joints.

Gout is caused by high uric acid levels, which can result from the body making too much uric acid or not removing enough through the kidneys. Risk is higher in men, after the menopause in women, with increasing age and where there is a family history of gout.

Things that can raise uric acid or trigger an attack include being overweight, drinking alcohol (especially beer and spirits), sugary drinks, eating a lot of purine-rich foods such as red meat and shellfish, dehydration and certain medicines such as some diuretics. Conditions like high blood pressure, diabetes, kidney disease and metabolic syndrome are also linked to gout.

Gout is often diagnosed from the typical pattern of a sudden, very painful, red and swollen joint, together with an examination and your medical history. A blood test can measure the level of uric acid, although levels can sometimes be normal during an attack, so the result is interpreted alongside your symptoms.

To confirm the diagnosis, fluid may be drawn from the affected joint with a needle and examined under a microscope for uric acid crystals. Imaging such as ultrasound or X-rays is sometimes used, particularly to assess longstanding gout or to look for joint damage and tophi.

Treatment has two aims: easing an attack and preventing future ones. During an attack, anti-inflammatory medicines are used to reduce pain and swelling, and resting and raising the joint and applying an ice pack can help. It is best to start treatment as soon as an attack begins.

To prevent further attacks, medicines that lower uric acid in the blood may be advised, especially for people who have frequent attacks, tophi or joint damage. These are taken long term and work gradually, so they are usually continued steadily rather than stopped between flares. Managing weight, diet, alcohol and related conditions also helps lower the risk.

The chance of attacks can be reduced by keeping to a healthy weight, drinking plenty of fluids, limiting alcohol and sugary drinks, and cutting down on foods high in purines such as red meat and shellfish. Treating linked conditions like high blood pressure and reviewing medicines that raise uric acid can also help.

With the right treatment, most people are able to control gout well and have fewer or no attacks. If gout is left untreated, repeated attacks can damage joints and lead to lasting problems, so ongoing management and, where advised, long-term uric-acid-lowering treatment are important.