Gout is a common and complex form of arthritis that can affect anyone – though it’s more common in men than women. It happens when small, sharp crystals form inside and around the joints causing swelling, redness, and pain.
If you’re suffering from gout, or think you might be, then you’re certainly not alone. According to the UK Gout Society, around one in 14 men and one in 35 women are affected by gout, and cases are on the rise.
With this in mind, the NHS has emphasised the importance of taking measures to prevent gout – and of seeking treatment immediately to avoid lasting damage to joints.
Below, we’ll take a closer look at what causes gout, what the symptoms are, and how to manage it and stop further flares.
What is gout and is it serious?
Gout is a very painful form of inflammatory arthritis that can come and go, and becomes more common with age (particularly in men over 40). Some people have flares every few years, which last days or weeks, while others may have flares more frequently.
Many people think that gout isn’t a big deal, but repeat flares can cause large bumps to form in the joints and surrounding tissues. These bumps are called tophi and can erode bone and cartilage – causing permanent joint damage or deformity.
If steps aren’t taken to treat and prevent gout, flares can also become more frequent and longer lasting. People with gout also have a higher risk of developing kidney stones (we’ll look at why below).
What causes gout?
Gout is caused by a build-up of uric acid in the body. Uric acid is a waste product created when the body breaks down substances called purines. Purines are normally produced in the body and are also found in certain foods.
Uric acid is constantly being made but it’s also constantly being filtered out of the body – a process which usually keeps uric acid levels in the blood at a normal level.
But if too much uric acid builds up in the blood (a condition known as hyperuricemia), it can cause gout or kidney stones. In the case of gout, it does this by forming sharp, needle-like crystals around joints.
Why does uric acid build up in the blood?
Uric acid is always present in the blood to some extent – and there’s usually a delicate balance between how much our body makes and how much gets passed out in urine and stools.
However, it’s when our kidneys don’t pass out enough uric acid that it starts to build up in the blood and cause problems.
It’s unlikely that uric acid levels will build up when eating a healthy, balanced diet. Though, it can if your diet is one that contains lots of foods and drinks with a high purine content. This includes red meat, offal, seafood, foods containing yeast extract, sugary drinks, spirits, and beer.
There are also other factors that can make a person more likely to have high levels of uric acid in the blood, and therefore develop gout. These include…
- Genetics – having a close relative with gout
- Kidney problems
- High blood pressure, diabetes, and/or high blood pressure
- High levels of fat and cholesterol in your blood
- Psoriasis (a skin condition that red, crusty patches of skin with silvery scales)
- Osteoarthritis
- Some medicines – such as chemotherapy medications and ‘water’ tablets (diuretics, which help your body get rid of extra salt and urine) used to control high blood pressure
- Age and sex – men over 40 are most affected.
- Men are more likely to develop gout than women because women have lower uric acid levels naturally. Though female levels tend to rise after menopause
- Surgery and trauma – for example, some people with high uric acid levels may have a postsurgical gout flare
What are the symptoms of gout?
The most common symptom of gout is sudden, intense pain – often in the big toe.
The reason for this is that uric acid is sensitive to temperature changes and turns into crystals at cooler temperatures. And since the big toe is furthest from the heart, and therefore the coolest part of the body, it can become an easy target.
However, gout can also occur in other joints in your feet, hands, wrists, elbows, or knees. Sometimes, it may start in the big toe and spread to these other areas over time.
Aside from intense pain, other symptoms of gout include…
- Hot, red, shiny skin over the affected joint
- Swelling in and around the affected joint
- Joints feeling tender to the touch – even a light touch, such as from a bed sheet, can cause pain
- Skin peeling, itching, and flaking as the swelling goes down
Pain during a flare is usually worse during the first 24-48 hours and will then usually start to subside and feel more like lingering discomfort. Most gout flares last five to seven days – though can be eased more quickly with treatment and last up to two weeks without.
There can be weeks, months, or even years in between flares, and some people may only ever have one attack. Gout flares that are less severe can also be mistaken for other forms of arthritis.
How is gout diagnosed?
The NHS advises that those experiencing symptoms of gout should seek medical treatment immediately to prevent permanent damage to joints.
Sometimes doctors may diagnose gout by simply examining the joint, and asking you about your medical history and diet.
However, they may also ask you to have a blood test and/or a joint fluid test. A blood test is used to check levels of uric acid in the blood. Though, it’s important to note that this is most useful two to four weeks after the initial flare has settled. This is because uric acid levels can be lower while someone is experiencing a flare.
A joint fluid test is considered to be the most effective way to diagnose gout. With this, a needle and syringe are used to take a sample of fluid from the affected joint and check for small crystals that cause gout – and possibly also test for infection to rule out septic arthritis.
How is gout treated?
What to do during a gout attack
Gout flares can be very painful – and because they usually come on quickly, can also cause alarm. However, there are some things you can do to help reduce your pain, shorten the length of a flare, and protect the affected joint as best as possible.
The NHS advises that during a gout flare, people should…
- Take prescribed medications as early as possible at the first signs of a flare (we’ll look at these in more detail below). It can take two to three days for these to take effect, so the earlier you take them the better.
- Rest and raise the affected limb
- Try to avoid knocking or damaging the affected joint
- Keep the joint cool using ice packs (peas wrapped in a tea towel will do!)
- Stay hydrated
Note: Though these symptoms can be a sign of a gout flare, the NHS advises calling 111 or making an urgent GP appointment if you have a high temperature, the pain is getting worse, and/or you feel sick and can’t eat – as this may mean that you have an infection inside your joint that needs treating immediately.
NSAIDs
The first way gout flares are usually treated is with non-steroidal anti-inflammatory drugs (NSAIDs) – such as naproxen, diclofenac, and etoricoxib – which reduce pain and inflammation in the joint.
Your doctor may prescribe you an NSAID once they’ve made a gout diagnosis – and if they do, it’s a good idea to keep them with you at all times so you’re prepared at the first sign of any future flares. The NHS recommends that they be taken throughout the flare and for 48 hours afterwards.
NSAIDs can be quite harsh on the stomach so may not be suitable for everyone. Though, if your doctor does prescribe them, they may also prescribe an additional medication called a proton pump inhibitor (PPI), which can reduce the risk of indigestion, stomach ulcers, and bleeding in the stomach.
Alternative medications to NSAIDS
If you’re unable to take NSAIDs, other treatment options that your doctor may prescribe include a medicine called colchicine, which can reduce some of the pain and swelling caused by gout; or corticosteroids, which are sometimes used to treat severe gout if other treatments don’t work.
Can gout be prevented?
There are ways that you can reduce your chances of developing gout or having future flares. Sometimes this can be done by making lifestyle changes alone, while other times your doctor might also advise that you take medication. The latter is more likely if you have frequent flares of gout.
Lifestyle changes that can lower uric acid levels
Lifestyle changes that can help to reduce your risk of developing gout or having future flares, include
- Maintaining a healthy weight by making long-term sustainable changes. It’s best to avoid crash dieting as this can cause the kidneys to retain uric acid. We have plenty of tips on ways you can lose weight safely in the diet and nutrition section of our website.
- Getting regular exercise – though it’s best to go for low-impact options that don’t put too much strain on joints, and to exercise in between flair-ups, rather than during.
- Choosing low-purine foods, such as fruits, nuts, vegetables, and whole grains. You can find out more about what foods to eat on this page from Verywell Health.
- Staying well hydrated – as this can help to prevent crystals from forming in your joints.
- Cutting down on food and drink that contain high levels of purine, such as offal, red meat, seafood, and foods that contain yeast extract, beer, spirits, and sugary drinks. Verywell Health has more information on what foods to avoid.
- Making sure you’re getting enough vitamin C. This is because there’s been evidence to suggest that vitamin C might help to reduce levels of uric acid in the blood. You should be able to get enough vitamin C through your diet – though if you can’t, it’s best to speak to your GP first if you’re thinking of taking supplements, as they aren’t suitable for everyone.
Medication to reduce uric acid levels
If you have recurrent flares of gout or complications such as tophi (small bumps under the skin), your doctor may prescribe you some medication to help lower your uric acid levels.
These may include…
- Allopurinol – taken once a day and followed up with regular blood tests to check uric acid levels.
- Febuxostat – taken once a day and often used if allopurinol isn’t suitable.
- Benzbromarone and sulfinpyrazone – may be used if the first two medications aren’t suitable, but must be prescribed under the supervision of a specialist.
Final thoughts…
While gout can be incredibly painful to live with, the positive news is that there are things you can do to help manage and control it. An important step in this can be understanding the link between gout and uric acid levels, and speaking to your doctor about what measures you can take to reduce levels if they’re high.
It’s also important to see your GP if you think you might be having a gout flare so that you can get the right treatment and prevent lasting damage to joints.
For more tips on improving your bone health, head over to the general health section of our website.