Gout
Gout is a type of arthritis that brings sudden, severe joint pain, often in the big toe. With early diagnosis and the right treatment, it is one of the most controllable forms of arthritis.
What is this disease?
When urate, also called uric acid, stays high in the blood for a long time, needle-shaped crystals can form in and around a joint. These crystals cause inflammation and pain. Uric acid comes from the breakdown of purines, which are found in the body’s tissues and in many foods, and it normally leaves the body in urine.
Gout is more common in men and usually starts in middle age. In women it is seen mostly after the menopause.
What are the signs?
- Sudden, severe pain in one joint, usually the big toe. The foot, ankle, knee, hand, wrist and elbow can also be affected.
- A hot, swollen, red joint
- Often a start at night, with pain that wakes you
An attack usually settles in a week or two, and between attacks there are no symptoms. Without treatment, attacks become more frequent and last longer, and they may cause lasting joint damage. After a long time, hard lumps called tophi can form under the skin. Kidney stones can also come from high uric acid.
What raises the risk?
- Being overweight, high blood pressure, high cholesterol, diabetes and kidney disease
- Alcohol and sugary drinks such as soda
- Purine-rich foods, mostly from animal sources
- Some medicines, such as diuretics and low-dose aspirin
- A family history
An illness with a fever, dehydration, a very large meal or a joint injury can also set off an attack.
How is it checked?
Your doctor asks about your symptoms, diet and medicines and measures uric acid in your blood. If the diagnosis is unclear, joint fluid is taken with a thin needle or imaging is needed.
What does treatment generally look like?
During an attack: anti-inflammatory medicines and, if pain and swelling do not improve, steroids as tablets or an injection. Start your prescribed medicine as soon as you can.
To prevent attacks: if attacks are frequent or uric acid is high, you may need uric acid-lowering medicine. It has to be taken regularly, even when you have no pain.
What can you do during an attack?
- Rest the joint and keep it raised.
- Wrap an ice pack in a towel and apply it for up to 20 minutes at a time.
- Drink plenty of water, unless your doctor has limited it.
- Keep pressure off the joint and keep bedclothes off it at night.
To prevent attacks, a healthy weight, avoiding alcohol and sugary drinks and cutting down on purine-rich foods all help.
When should you get help urgently?
If a joint suddenly becomes painful and swollen and the pain is getting worse, or you have a fever and shivers, or you feel ill and cannot eat, it may be a joint infection. Do not mistake this for gout. Get help the same day.
Frequently asked questions
My uric acid is high but I have no pain. Do I have gout?
Not everyone with high uric acid gets gout. Whether you need medicine is for your doctor to decide, based on your situation.
My uric acid was normal during an attack. So it is not gout?
That alone does not rule out gout. If the diagnosis is unclear, joint fluid is sometimes taken with a thin needle and tested.
I feel well. Should I keep taking my uric acid medicine?
Yes. It needs to be taken regularly, even when you have no symptoms. Talk to your doctor before you stop.
Do women get gout?
Yes, but less often, and usually after the menopause.
The first step: putting the signs together.
Go to the booking page or talk to support. Have your earlier test results and your medicine list ready.