Historically, gout has been known as “the rich man’s disease”. What is gout, what are the main symptoms and causes, and what treatments are available?

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Gout is the most common type of inflammatory arthritis, affecting between 1 and 2% of the population in the UK. It causes sudden severe episodes of pain in a joint, usually the big toe.

Gout has been named the “the rich man’s disease” or “the disease of kings”, due to its association with a diet high in luxuries like red meat and wine.

What are the symptoms of gout?

Gout symptoms come and go in episodes called attacks or flare-ups. Attacks often occur at night and usually peak after 12 to 24 hours.

Symptoms of a gout attack include:

• Sudden severe joint pain and tenderness, most commonly in the big toe. Gout can also affect other joints such as those in your feet, ankles, hands, wrists, elbows, or knees.

• Heat, swelling, redness or discolouration around the affected joint

• Joint stiffness

What can trigger a gout attack?

A gout attack may come on with no apparent cause, but attacks of gout are often triggered by factors such as:

• Drinking excessive alcohol

• Eating a large, high-fat meal

• Dehydration

• A high temperature

• Sudden illness or infection

• Stress

• Injuring your joint

• Certain medicines

• Exposure to arsenic - even low levels of arsenic in the environment such as in some pesticides, fertilisers, and soil have been shown to trigger gout attacks in women

• Extreme weather changes

What causes gout?

Gout is caused by high levels of uric acid in the blood. Uric acid is produced by the body as it breaks down chemicals known as purines that are found in many foods, including red meat, organ meats and some types of seafood.

Normally, uric acid is filtered out through your kidneys and leaves your body in your urine (pee). However, if you have too much uric acid, or your kidneys don’t remove it fast enough, levels in the blood can get too high - a condition known as hyperuricaemia. This can cause needle-like uric acid crystals to build up and settle around your joints, triggering symptoms of gout.

What are the risk factors for gout?

You may have a higher risk of developing gout if you:

• Have a family history of gout

• Are male and over the age of 30

• Are female and have been through the menopause

• Are overweight

• Drink alcohol

• Take certain medications such as diuretics, aspirin, or some blood pressure tablets

• Have a chronic health condition such as high cholesterol, high blood pressure, kidney disease, osteoarthritis or diabetes

• Have had previous joint surgery or an injury to a joint

When to see a doctor

Make an appointment with your GP if you experience symptoms of gout for the first time, or if you have been diagnosed with gout, but your usual treatment isn’t helping.

Call 111, or ask for an urgent GP appointment if:

• You have severe or worsening pain

• You have a fever (a temperature above 38ºC)

• You have nausea and are unable to eat

How is gout diagnosed?

Gout is diagnosed using a combination of your symptoms, an examination of your affected joint, and sometimes, a blood test. Gout can only be diagnosed during a gout attack.

Your GP will ask you some questions about your symptoms as well as your diet and whether you drink alcohol. They may order a blood test to check the level of uric acid in your blood.

In some cases, your GP may refer you to a specialist for further tests.

Treatments for gout

Treatment for gout involves relieving your symptoms and preventing or reducing further gout attacks. An untreated gout attack can last one to two weeks, and future attacks may last even longer. Untreated gout can also cause long-term damage to your joints.

Relieving symptoms of gout

During an attack, joint pain and swelling are normally treated with a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen. If this doesn’t work, your doctor may prescribe a steroid as a tablet or injection.

Some things you can do yourself to relieve symptoms during a gout attack include:

• Rest your affected joint and elevate the limb to, or above, the level of your heart

• Apply an ice pack wrapped in a towel or cloth to your affected joint for up to 20 minutes at a time

• Drink lots of water

• Keep bedclothes off the affected joint at night

• Avoid putting pressure on the affected joint

• Take any medication you’ve been prescribed, as directed by your doctor

Preventing gout attacks

Preventing or reducing future attacks of gout involves lifestyle changes and, in some cases, medication.

Some things you can do yourself to reduce the risk of future attacks include:

• Lose weight if you are overweight

• Follow a healthy, balanced diet (your doctor may advise you about foods to limit or avoid)

• Stop or limit alcohol

• Drink plenty of fluids to prevent dehydration

• Take regular exercise - gentle, non-weight bearing exercise is best to avoid putting pressure on your joints

• Quit smoking

If you have frequent gout attacks or high levels of uric acid in your blood, your doctor may prescribe medication to lower your uric acid levels.

Complications of gout

If you have recurrent gout attacks over a long period of time, this is known as chronic gout. Chronic gout may affect more joints, and attacks may last longer and become more severe.

Complications of chronic gout include:

• The development of large masses of uric acid crystals in the soft tissues or bones around the joints (tophi)

• Joint damage and arthritis

• Kidney stones

• Heart disease

Gout FAQs

How do I get immediate pain relief during a gout attack?

As soon as you feel symptoms of a gout attack, take the following steps to reduce your symptoms.

1. Take a non-steroidal anti-inflammatory medication such as ibuprofen or naproxen, or an alternative medication if your doctor has prescribed one. Always read the patient information leaflet that comes with any medication carefully and ask your doctor or pharmacist if you have any questions.

2. Elevate your affected limb

3. Apply ice packs or a cold compress to the affected joint

4. Drink plenty of water

5. Avoid foods high in purines that can elevate your uric acid level even further

What foods cause gout?

The causes of gout are complex and may not be the same for everyone, but foods high in purines may raise the uric acid level in your blood and trigger a gout attack. Following a low purine diet, in combination with medication, is normally the best way to prevent gout attacks.

Foods high in purines include:

• Offal such as liver, kidneys, heart, and sweetbreads

• Game meats like rabbit, pheasant, and venison

• Oily fish, including anchovies, herring, sardines, mackerel, whitebait, and trout

• Seafood, especially shellfish, fish roe and caviar

• Meat and yeast extracts like Marmite, Bovril, gravy, and beer

It is also best to avoid:

• Alcohol

• Food and drinks containing high-fructose corn syrup, including soda, some breakfast cereals, sweets, and fast food

What are the first signs of a gout attack?

The first signs of a gout attack may be different for everyone, and you will probably start to recognise the early signs that an attack is starting. You may feel a tingling, burning or throbbing sensation in a joint, commonly your big toe. The area around the joint may feel hot to the touch and appear red and swollen. Pain usually gets worse very quickly and starts to improve after around 12 to 24 hours.