Health A to Z
Gout is a type of arthritis in which small crystals form inside and around the joints. It causes sudden attacks of severe pain and swelling.
It's estimated that between one and two in every 100 people in the UK are affected by gout.
The condition mainly affects men over 30 and women after the menopause. Overall, gout is more common in men than women.
Gout can be extremely painful and debilitating, but treatments are available to help relieve the symptoms and prevent further attacks.
Any joint can be affected by gout, but it usually affects joints towards the ends of the limbs, such as the toes, ankles, knees and fingers.
Signs and symptoms of gout include:
Symptoms develop rapidly over a few hours and typically last three to 10 days. After this time the pain should pass and the joint should return to normal.
Almost everyone with gout will experience further attacks at some point, usually within a year.
Read more about the symptoms of gout.
See your GP if you suspect you have gout and it hasn't been previously diagnosed, particularly if the pain keeps getting worse and you also have a high temperature (fever).
It's important that a diagnosis is confirmed because other conditions that require urgent treatment, such as an infected joint, can sometimes cause similar symptoms.
If you've already been diagnosed with gout and you have an attack, see your GP if any medication you've been prescribed (see below) doesn't start working within a couple of days.
Read more about diagnosing gout.
Gout is caused by a build-up of a substance called uric acid in the blood.
If you produce too much uric acid or your kidneys don't filter enough out, it can build up and cause tiny sharp crystals to form in and around joints. These crystals can cause the joint to become inflamed (red and swollen) and painful.
Things that may increase your chances of getting gout include:
Read more about the causes of gout.
If you have gout, treatment is available from your GP to:
With treatment, many people are able to reduce their uric acid levels sufficiently to dissolve the crystals that cause gout – and as a result have no further attacks. However, lifelong treatment is usually required.
Read more about treating gout.
Sometimes gout can lead to further problems, particularly if it's left untreated.
These can include:
Read more about the complications of gout.
Pseudogout is a similar condition to gout, but usually affects the knee joint first. It's a form of arthritis that causes pain, stiffness, tenderness, redness, warmth and swelling in one or more of your joints - commonly the knee or wrist.
The main symptom of gout is a sudden attack of severe pain in one or more joints, typically your big toe.
Other symptoms can include:
The intense pain can make getting around difficult. Even the light pressure of a bed cover or blanket can be unbearable.
Gout can affect almost any joint and can occur in more than one joint at the same time.
The joints towards the ends of the limbs tend to be affected more often, including the:
If gout is left untreated, it's likely to affect more joints over time.
Attacks of gout tend to:
It's difficult to predict how often attacks will occur and when exactly they will happen.
See your GP if you suspect you have gout and it hasn't been previously diagnosed.
Contact your GP immediately or call NHS 111 if you have both:
This could mean you have an infection inside the joint (septic arthritis).
If you've already been diagnosed with gout and you have an attack, see your GP if any medication you've been prescribed doesn't start working within a couple of days.
Gout is caused by small crystals forming in the joints, resulting in severe pain, tenderness and swelling.
These crystals can grow when a waste product called uric acid starts to build up to high levels in the body.
Uric acid is created when the body breaks down chemicals known as purines.
If your kidneys don't filter out enough uric acid, or your body is producing unusually high levels of it, it can build up in the body and turn into microscopic crystals.
These crystals usually form in and around the joints, possibly because the temperature in these areas is slightly lower than the rest of the body. If they get into the space between joints, the crystals can cause painful inflammation (redness and swelling).
A high level of uric acid in the blood is the main factor that increases your risk of developing gout. However, it's still uncertain why some people with a high level of uric acid in the blood develop gout, while others with an equally high level don't.
Other factors that may increase your risk of developing gout are outlined below.
Some underlying medical conditions can increase your risk of developing gout, including:
Certain medications can increase your uric acid levels and your risk of developing gout. These include:
Uric acid is created when the body breaks down purines. Eating foods that contain a high level of purines can increase your risk of gout.
Foods naturally high in purines include:
Alcoholic drinks can raise the level of uric acid in the blood.
Beer, fortified wines like port, and spirits do this more than wine. Moderate consumption of wine – one or two glasses a day – shouldn't significantly increase your risk of gout.
Certain sugary drinks may also increase your risk of gout.
Some research has found that drinking sugar-sweetened soft drinks and drinks with high levels of fructose (a naturally occurring sugar found in many fruits) had an increased risk of gout.
Studies have shown that gout often runs in families. Around one in five people with gout have a close family member with the condition.
Your GP may suspect gout based on your symptoms. Sometimes further tests will be needed to confirm the diagnosis and rule out other possible causes.
See your GP if you experience symptoms of gout for the first time.
Your GP will ask about your symptoms and medical history, and examine the affected area, to help make a diagnosis.
They may also ask you about your diet, particularly your intake of beer, spirits and foods high in purines, such as red meat and seafood.
Many conditions can cause gout-like symptoms.
Your GP may be unable to make a firm diagnosis straight away and you may be referred for further tests. These will either confirm the diagnosis of gout or rule out other conditions.
A sample of fluid may be taken from the affected joint. The fluid can be checked for the small crystals that cause gout, and it can be tested for infection to rule out septic arthritis.
A blood test known as a serum uric acid test may be used to measure the amount of uric acid in your blood. A high level or uric acid is often associated with gout.
It’s sometimes best to wait until two to four weeks after an attack of gout before this test is carried out, as the level of uric acid in your blood is often not raised at the time of an attack. This is because the level of uric acid in your blood can drop when uric acid crystals form in the joints.
An X-ray is rarely used to diagnose gout because the condition isn't usually detectable using this method.
However, an X-ray is sometimes used to help rule out similar conditions that affect the joints, such as chondrocalcinosis (a build-up of calcium crystals in the joints) or to assess whether there has been any joint damage due to repeated or persistent attacks of gout.
An ultrasound scan of an affected joint is a simple and safe investigation that's increasingly used to detect crystals in the joints. It can also detect crystals deep in the skin that aren't obvious during a physical examination.
Treatment for gout includes pain relief to help you cope with a gout attack, as well as medication and lifestyle changes to prevent further attacks.
Apply the ice pack to your joint for around 20 minutes. Don't apply ice directly to your skin and don't apply it for more than 20 minutes at a time because this could damage the skin.
If necessary, you can keep reapplying an ice pack to your skin during an attack, but you should wait until your skin has returned to a normal temperature first.
Non-steroidal anti-inflammatory drugs (NSAIDs) are usually recommended as the first treatment for gout. They work by reducing pain and inflammation during an attack.
NSAIDs used to treat gout include naproxen, diclofenac and etoricoxib.
If you've been prescribed NSAIDs, it's a good idea to have them with you at all times so you can use them at the first sign of a gout attack. Continue to take your medication throughout the attack and for 48 hours afterwards.
Your GP may also prescribe a medication called a proton pump inhibitor (PPI), to take alongside your NSAID. This reduces the risk of the NSAID causing indigestion, stomach ulcers and bleeding from the stomach.
If you're unable to take NSAIDs or if NSAIDs are ineffective, a medicine called colchicine can be used instead.
Colchicine reduces some of the swelling and pain associated with a gout attack.
It's best to have it with you at all times so you can use it at the first sign of a gout attack. Your GP will tell you how long to take it for and how often.
When taken in high doses, side effects of colchicine include feeling sick, abdominal (tummy) pain and diarrhoea.
Corticosteroids are sometimes used to treat severe cases of gout if other treatments don't work or you're unable to take an NSAID or colchicine.
A short course of steroid tablets often provides relief, but they can't be used long-term in high doses as they cause side effects, including:
Corticosteroids can also be given by injection to provide rapid pain relief. This can be either into a muscle, a vein or directly into the affected joint.
You can reduce your chances of having further gout attacks by taking medication and making lifestyle changes to reduce the level of uric acid in your body.
Medication to reduce uric acid levels – known as urate-lowering therapy (ULT) – is usually recommended if you have recurrent attacks of gout or you have complications of gout.
Most people with gout will eventually need to have ULT, so you may want to discuss the advantages and disadvantages of this treatment with your doctor as soon as you've been diagnosed with gout.
They should explain that while ULT can significantly reduce your risk of having further attacks, the medication needs to be taken on a daily basis for the rest of your life and there's a small risk of side effects.
If you decide to start ULT, a medicine called allopurinol is usually tried first. If this isn't suitable or doesn't work, other medications may be used instead. These medications are described below.
Allopurinol helps reduce the production of uric acid. It can help prevent gout attacks, although it won't help relieve symptoms during an attack.
Allopurinol is a tablet taken once a day. When you first start taking it, your dose will be adjusted to make sure the level of uric acid in your blood is low enough. Regular blood tests will be needed to monitor this until the most effective dose is found.
Allopurinol can sometimes cause a gout attack soon after you start taking it and it can take up to a year or two before no further attacks occur. It's important to persevere with treatment even if you do have attacks during this time.
To help relieve attacks, your doctor will prescribe one of the pain relieving medications described above to take alongside your allopurinol at first.
Most people taking allopurinol won't experience any significant side effects. However, side effects can include:
Like allopurinol, febuxostat is a medication taken once a day that reduces the body's production of uric acid. It's often used if allopurinol isn't suitable or causes troublesome side effects.
As with allopurinol, febuxostat can make your symptoms worse when you first start taking it. Your doctor will initially prescribe one of the pain relieving medications described in case you experience attacks.
Side effects of febuxostat can include:
Less commonly used ULT medications include benzbromarone and sulfinpyrazone.
These types of medication tend to only be used if people are unable to take allopurinol or febuxostat. They need to be prescribed under the supervision of a specialist.
Certain lifestyle changes can also help reduce your risk of experiencing further attacks of gout, including:
There's some evidence to suggest that taking regular vitamin C supplements can reduce gout attacks, although the effect may only be small. Talk to your GP first if you're thinking about taking vitamin C supplements, as they aren't suitable or safe for everyone.
Complications of gout can include small lumps forming under the skin (tophi), joint damage and kidney stones. These are more likely to occur if gout is left untreated.
Gout is caused by a chemical called uric acid forming small crystals in and around the joints. These crystals also often build up under the skin and form small white or yellow lumps known as tophi.
Tophi are usually painless, but they can form in awkward places, such as at the ends of your fingers and around your toes. Sometimes they can make everyday tasks such as preparing food or getting dressed difficult.
They can also can become inflamed and produce a toothpaste-like discharge.
Tophi can develop anywhere in the body, but usually form on the:
It normally takes several years after the first attack of gout for tophi to develop, but some people develop them even before experiencing an attack. They're usually a sign of severe gout and a good reason to start treatment to reduce the level or uric acid in your body.
Successful treatment will prevent the tophi from getting any bigger, and long term treatment often gradually shrinks them.
If you have very large or painful tophi, they may have to be surgically removed.
Without treatment, gout attacks may become more frequent and prolonged, and your likelihood of developing permanent joint damage will increase.
In the most serious cases, surgery may be required to repair or replace a damaged joint.
Occasionally, high levels of uric acid can lead to the formation of kidney stones.
Some kidney stones interfere with the flow of urine, resulting in pain when you pass urine, and can make you feel that you need to pass urine more often.
Some kidney stones interfere with the flow of urine, resulting in pain when you pee, and can make you feel that you need to pee more often.
You may be prescribed medication to make your urine less acidic, which should help dissolve any kidney stones that have developed. Read more about treating kidney stones.
Gout can also affect your mood, work and home life. The severe pain that gout causes can make it difficult to do everyday tasks and to get around, which in turn can lead to feelings of depression or anxiety.
If gout is affecting your mood or making everyday life difficult, talk to your GP. They will be able to offer treatment and support.
Read more advice about living with pain.
Doctors were surprised when Gina Beauchamp came to them at the age of 37 showing signs of gout, as it's rare for younger women to get it. That was more than 20 years ago, and she has now shared her unusual story.
"I was 37 years old when my fingers started to curl up like claws and my toes felt so painful that I couldn't move. I just thought I was extremely tired.
"My symptoms showed all the signs of gout, yet the doctors were unconvinced. Gout is rare in women and usually occurs after the menopause, when oestrogen levels have fallen.
"Eventually, my GP recognised that I had gout, probably a result of the hysterectomy I'd had one year before. It's thought that oestrogen protects women from gout, and my oestrogen levels had dropped after my ovaries were removed. My GP prescribed allopurinol, a medication that reduces the levels of uric acid (urate) in the blood and controls gout attacks. It really worked.
"I still take one tablet of allopurinol a day and I've managed to keep my gout under control for the last 10 years. I also eat very carefully. I don't have too much protein, like meat and fish, and I drink white wine rather than beer, which can trigger gout.
"Apparently, cherries are very good at preventing gout attacks, so I have these with porridge for breakfast every day. I also drink plenty of water and herbal teas to keep hydrated.
"However, I had a bad attack recently. I went to friends' houses for meals and ended up eating beef three nights in a row and drinking alcohol.
"The following Monday morning, I could hardly move. The gout seemed to affect all my joints, not just my fingers and toes. I felt like I'd been run over by a car, and my eyes felt as if they'd been punched out.
"For the next few days, I ate only vegetables and drank plenty of water, but I felt dreadful for days. The gout was so painful I couldn't even bear the bedclothes touching my skin.
"It's made me even more determined to identify what I can and can't eat. But other than my recent attack, the gout hasn't really affected my lifestyle."
Patrick Hanmer was 32 and living life to the full when he had his first attack of gout. Over 20 years later, he eats, drinks and exercises and, thanks to effective medication, keeps his gout under control.
"I was a 32-year-old aid worker in Somalia when I experienced my first attack of gout. I woke suddenly in the night to an unbearable pain, as if someone had stamped on the ball of my foot. An area of my foot was shining red, like a snooker ball, and was very sensitive and inflamed. I was amazed. I didn't know what it was.
"I think the hot climate triggered the attack, and I was dehydrated and drinking far too much beer. I'm a very active person and would motorcycle across the desert, not drinking enough water, and then go to lots of parties afterwards.
"The nurse at the British Embassy looked at my foot and told me that I had gout. I was prescribed a medication called colchicine, which helps clear the uric acid (urate) from your blood.
"Three years later, I got my second attack. Again, I was drinking too much, overeating and getting dehydrated, and I was stressed. The urate level in my blood was so high, it felt like my blood was congealing. As the years went by, I had attacks every two weeks.
"I was still taking colchicine, but it gave me diarrhoea if I took too much. I would take the medication during the attacks, which would subside after three to five very painful days. During that time, I'd be lying down, unable to walk. It was very depressing.
"In February 2007, I was walking along a street in London and my foot suddenly seized up. I tripped over the pavement and nearly fell under a bus. That's when I thought, something's seriously wrong here.
"The doctors told me so many urate crystals had accumulated in my blood that a hard white lump called a tophus had formed under the skin on my foot. A surgeon removed it and the other white residue in the joints of my big toe. He said it was one of the worst cases of gout he'd ever seen.
"I started taking a drug called allopurinol, which reduces urate in the blood and helps prevent further attacks. I hadn't taken it before as it tended to trigger attacks, but I now take two tablets a day. It has controlled the gout and I feel great. My joints don't creak any more.
"I've lost weight and my quality of life is great. I can do everything I used to do, although I have to avoid extreme exercise as this produces a lot of metabolites (breakdown products) in my blood, which can trigger an attack.
"I still get gout occasionally, but it's just a quick attack that finishes within one day. Keeping hydrated is the key. I drink a pint of water every morning before I leave my bedroom. I also eat more sensibly and avoid foods like kidney and certain types of fish, which increase my blood urate levels."