Gout

Gout | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Gout Gout About gout Causes of gout Symptoms of gout Diagnosing gout Treating gout Complications of gout About gout 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. Its estimated that between one and two in every 100 people in the UKare 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. Signs and symptoms of gout Any joint can be affected by gout, but it usually affects jointstowards the ends of the limbs, such as the toes, ankles, knees and fingers. Signs and symptoms of gout include: severe pain inone or morejoints the joint feeling hot and very tender swelling in and around the affected joint red, shiny skin over the affected joint Symptoms develop rapidlyover a few hours and typically lastthree to 10 days. After this time the pain should pass and the jointshould 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 . When to see your GP See your GP if you suspect you have gout and it hasnt been previously diagnosed, particularly if the pain keeps getting worse and you also have a high temperature (fever). Its important that a diagnosis is confirmed because other conditions that require urgent treatment, such as an infected joint, can sometimes cause similar symptoms. If youve already been diagnosed with gout and you have an attack, see your GP if any medication youve been prescribed (see below) doesnt start working within a couple of days. Read more about diagnosing gout . What causes 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 dont 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: obesity , high blood pressure and/or diabetes having a close relative with gout kidney problems eating foods that causea build-up of uric acid, such as red meat, offal and seafood drinking too much beeror spirits Read more about the causes of gout . Treatments for gout If you have gout, treatment is available from your GP to: relieve symptomsduring an attack this can be done using ice packs and by taking medications such as non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or corticosteroids preventfurther attacks  through a combination oflifestyle changes, such as losing weight or changing your diet, and taking medicationthat lowers uric acidlevels, such asallopurinol 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 . Can gout cause further problems? Sometimes gout can lead to further problems, particularly if its left untreated. These can include: kidney stones small firm lumps of uric acid crystals under the skin called tophi permanent joint damage Read more about the complications of gout . Whats pseudogout? Pseudogout isa similar condition to gout,but usuallyaffects the knee joint first. Its 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. Causes of gout 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 inthe body. Uric acid Uric acid is created when the body breaks down chemicals known as purines. If your kidneys dont 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). What can increase your risk? A high level of uric acid in the blood is the main factor that increases your risk of developing gout. However, its still uncertain why some people with a high level of uric acid in the blood develop gout, while others with an equally high level dont. Other factors that may increase your risk of developing gout are outlined below. Medical conditions Some underlying medical conditions can increase your risk of developing gout, including: high blood pressure diabetes kidney disease high levels of fat and cholesterol in your blood obesity metabolic syndrome(acombination of diabetes, high blood pressure and obesity) psoriasis (a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales) osteoarthritis Medication Certain medications can increase your uric acid levels and your risk of developing gout. These include: diuretics (water tablets) used to treat high blood pressure or an abnormal build-up of fluid in your body certainmedicines used to treat high blood pressureincluding beta-blockers and ACE inhibitors low-dose aspirin  used to reduce the risk of blood clots niacinused to treat high cholesterol ciclosporin used to treat conditions such aspsoriasis some chemotherapy medicines Diet 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: red meat such as beef, lamb and pork seafood especially shellfish and oily fish offal such as liver, kidneys and heart Alcohol 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  shouldnt significantly increase your risk of gout. Sugary drinks Certain sugary drinks may also increase your risk of gout. Some research hasfound that drinking sugar-sweetened soft drinks and drinks with high levels of fructose (a naturally occurring sugar found in manyfruits)had anincreased risk of gout. Family history Studies have shown that gout often runs in families. Aroundone in five people with gout have a close family member with the condition. Symptoms of gout 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 joint feeling hot and very tender, to the point ofbeing unable to bear anything touching it swelling in and around the affected joint red, shiny skin over the affected joint peeling, itchy and flaky skin as the swelling goes down The intense pain can make getting around difficult. Even the light pressure of a bed cover or blanket can be unbearable. Which jointscan beaffected? 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: toes particularly the big toe joint midfoot (where your shoelaces sit) ankles knees fingers wrists elbows If gout is left untreated, itslikely to affect more joints over time. Pattern of symptoms Attacksof gout tend to: occur at night, although they canhappen at any time developquickly over a few hours last between three and 10 days  after this time, the affected joint should start to return to normal, but the problem can persist if treatment isnt started early come backyou mayexperience attacks every few months or years become more frequent over time if not treated Its difficult to predict how often attacks will occur and when exactly they will happen. When to seek medical advice See your GP if you suspect you have gout and it hasnt been previously diagnosed. Contact your GP immediately or call the 111 serviceif you have both: severe, worsening joint pain and swelling a high temperature (fever) of 38C (100.4F) or above This could mean you have an infection inside the joint (septic arthritis). If youve alreadybeen diagnosed with gout and you have an attack, see your GP ifany medication youve been prescribed doesnt start working within a couple ofdays. Read more about diagnosing gout and treating gout . Diagnosing gout 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. Seeing your GP See your GP if you experience symptoms of gout for the first time. Your GP willask aboutyour symptoms andmedical history, and examine the affected area, to help make a diagnosis. Theymay also ask you about your diet, particularly your intake of beer, spirits and foods high in purines, such as red meat and seafood. Further tests 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. Joint fluid test 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. Blood test A blood test known as aserum uric acid testmay be used to measure the amount of uric acid in your blood. A high level or uric acid is often associated with gout. Its 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. X-ray An X-ray is rarely used to diagnose gout because the condition isnt 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. Ultrasound scan An ultrasound scan of an affected joint is a simple and safe investigation thats increasingly used to detect crystals in the joints. It can also detect crystalsdeepin the skin that arent obvious during a physical examination. Treating gout 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. Pain relief for a gout attack What to do during an attack You should: take any medication youve been prescribed as early as possible after you notice an attack (see below)  this should start to have an effect within two or three days rest and raise the limb avoid knocking or damaging the affected joint keep the joint cool  remove surrounding clothing and apply an ice pack, such as a bag of frozen peas wrapped in a towel ensure youre well hydrated Apply the ice pack to your joint for around 20 minutes. Dont apply ice directly to your skin and dont 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. NSAIDs Non-steroidal anti-inflammatory drugs (NSAIDs) are usually recommended as the firsttreatment for gout. They work by reducing pain and inflammation during an attack. NSAIDs used to treat gout include naproxen, diclofenac and etoricoxib. If youve been prescribed NSAIDs, its a good ideato 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. Thisreduces the risk of the NSAID causing indigestion , stomach ulcers and bleeding from the stomach. Colchicine If youre unable to take NSAIDs or if NSAIDs are ineffective, a medicine calledcolchicine can be used instead. Colchicine reduces some of the swelling and pain associated with a gout attack. Its 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 Corticosteroids are sometimes used to treat severe cases of gout if other treatments dont work or youre unable to take an NSAID or colchicine. A short course of steroid tablets often provides relief, but they cant be used long-term in high doses as they cause side effects, including: weight gain thinning of the bones ( osteoporosis ) easy bruising muscle weakness 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. Medication and lifestyle changes to prevent further attacks You can reduce your chances of having further gout attacks by taking medication and making lifestyle changes toreduce the level ofuric acid in your body. Medication 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 youve 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 theres a small risk of side effects. If you decide to start ULT, a medicine called allopurinol is usually tried first. If this isnt suitable or doesnt work, other medications may be used instead. These medications are described below. Allopurinol Allopurinolhelps reduce the production of uric acid. It can help prevent gout attacks, although it wont help relieve symptoms during an attack. Allopurinol is a tablettaken 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 themost effective dose is found. Allopurinol can sometimes cause a gout attack soon after you start taking it and itcan take up to a year or two before no further attacks occur. Its important to persevere with treatment even if you do have attacks during this time. To helprelieve attacks, your doctor will prescribe one of the pain relieving medications described above to take alongside your allopurinol at first. Most people taking allopurinol wont experience any significant side effects. However, side effects can include: a rash  this is usually mild and goes away on its own, but it can be a sign of anallergy; if you develop a rash, stop taking the medication immediately and contact your GP for advice indigestion headaches diarrhoea Febuxostat Like allopurinol, febuxostatis a medication taken once a day thatreduces the bodys production of uric acid. Its often used if allopurinol isnt 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: diarrhoea feeling sick headaches arash Othermedications 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. Lifestyle changes Certain lifestyle changes can also help reduce your risk of experiencing further attacks of gout, including: avoiding foods containing high levels of purine (the chemical involved in the production of uric acid), such as red meat, offal, oily fish, seafood and foods containing yeast extract. avoiding sugary drinks and snacks  these are associated with an increased risk of gout maintaining a healthy weight follow a balanced diet ; dont crash diet or tryhigh-protein, low-carbohydrate diets taking regular exercise  try activities that dont put too much strain on your joints, such as swimming drinking plenty of water keeping yourself well hydrated will reduce the risk of crystals forming in your joints cutting down on alcohol  avoid beer and spirits in particular and dont binge drink Theres some evidence to suggest that taking regular vitamin C supplements can reduce gout attacks, although the effectmay only be small. Talk to your GP first if youre thinking about taking vitamin C supplements, as they arent suitable or safe for everyone. Complications of gout 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. Tophi Gout is caused by a chemical called uric acid forming small crystals in and around the joints. These crystals also oftenbuild upunder 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 makeeveryday tasks such as preparing food or getting dressed difficult. They can alsocan become inflamed and produce a toothpaste-like discharge. Tophi can develop anywhere in the body, but usually form on the: toes heels knees fingers ears forearms elbows 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. Theyre 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. Joint damage 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. Kidney stones Occasionally, high levels of uric acid canlead 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. 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 . Psychological and emotionaleffects 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. There are also a number of organisations that offer information and advice for people who have gout, including Versus Arthritis . Source: MSK Expert Panel - Opens in new browser window Last updated: 19 October 2023 How can we improve this page? 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