What is gout?
Uric acid is a waste product made when the body breaks down substances called purines, found in our own cells and in some foods. Normally, the kidneys pass uric acid out in urine. When too much is made or too little is removed, the level in the blood rises. This is called hyperuricaemia.
In some people, high uric acid forms needle-like crystals in a joint, causing sudden, intense pain and swelling. This is gout. It is more common in men, usually after the age of 30, and in women after menopause. Many people with high uric acid on a blood test never get gout and may not need medicines.
Causes and triggers
Genes play a role, and gout often runs in families. Kidney disease reduces removal of uric acid. Some medicines, including certain water pills (diuretics) and low-dose aspirin, can raise uric acid. A gout attack is often triggered by something that changes the uric acid level suddenly. Common risk factors and triggers are:
- Alcohol, especially beer and spirits
- Red meat, organ meats like liver and kidney, and some seafood
- Sugary drinks and foods high in fructose
- Being overweight
- High blood pressure, diabetes and kidney disease
- Dehydration, fasting, sudden illness, injury or surgery
Symptoms of a gout attack
A gout attack usually starts suddenly, often at night or early morning. The joint becomes very painful, swollen, red and hot, and even the touch of a bedsheet can hurt. The big toe is most commonly affected, but gout can also affect the ankle, foot, knee, wrist, fingers or elbow. The pain usually peaks within a day.
Without treatment, an attack may settle over one to two weeks. Over years, repeated attacks can damage joints and cause hard lumps of crystals under the skin, called tophi, around the ears, fingers, elbows or feet. High uric acid can also cause kidney stones.
How gout is diagnosed
Your doctor will ask about the attack and examine the joint. A serum uric acid blood test is useful, but uric acid can be normal during an attack, so a single normal result does not rule out gout. The most certain test is to take a small sample of fluid from the swollen joint with a needle and look for crystals under a microscope.
X-rays, ultrasound and blood tests for kidney function, sugar and cholesterol may also be done. It is important to rule out a joint infection, which can look similar and needs urgent treatment, especially if there is fever. Tell your doctor about all the medicines you take, since some raise uric acid.
Treating an attack
The aim is to reduce pain and inflammation as early as possible. Doctors commonly use anti-inflammatory painkillers, colchicine or steroids, depending on your age, kidney function, stomach and heart health. Steroids and prescription anti-inflammatory medicines are taken only on a doctor's prescription. Starting treatment early in an attack works best.
Rest the joint, keep it raised, and use a cold pack wrapped in cloth for short periods. Drink plenty of water. Avoid alcohol. Painkillers like ibuprofen or diclofenac may be unsafe if you have kidney disease, stomach ulcers, heart disease or are pregnant, so check with your doctor or pharmacist first.
Preventing future attacks
If you have frequent attacks, tophi, kidney stones or joint damage, your doctor may start a long-term medicine to lower uric acid, such as allopurinol or febuxostat. These are taken only on a doctor's prescription, usually for years. They can trigger attacks in the early months, so your doctor may add a preventive medicine for a period. Do not stop them during an attack unless your doctor says so.
Lose weight slowly if needed, drink enough water, limit alcohol, red meat, organ meats and sugary drinks, and eat plenty of vegetables, dal, low-fat dairy and whole grains. Most vegetables and pulses are fine in normal amounts. Avoid crash diets and long fasts, which can trigger attacks.
Follow-up and special groups
Regular uric acid tests help your doctor adjust the dose until the target is reached. Kidney function is checked, since many gout medicines depend on healthy kidneys. Older adults and people with kidney or heart disease need extra care with painkillers and colchicine.
Gout is uncommon in young women and children, so joint swelling in these groups needs careful evaluation for other causes. Pregnant women should not take uric acid-lowering medicines unless a specialist advises it. For guidance on your medicines, diet and follow-up tests, talk to your doctor or pharmacist.
Medicines doctors commonly use
Only your doctor can decide which medicine, dose and combination is right for you.
- NSAIDs such as naproxen, ibuprofen, diclofenac or etoricoxibReduce pain and swelling during a gout attack.Can harm the stomach and kidneys and raise BP; avoid in kidney disease, ulcers, heart disease and late pregnancy unless a doctor advises.
- ColchicineReduces gout inflammation and is also used to prevent attacks when starting uric acid-lowering medicine.Only on a doctor's prescription; too much causes severe diarrhoea and vomiting, and it interacts with several medicines.
- Corticosteroids such as prednisolone, or joint injectionsCalm a severe attack when other medicines are unsuitable.Only on a doctor's prescription; can raise blood sugar.
- Uric acid-lowering medicines such as allopurinol or febuxostatLower uric acid over time to prevent attacks, tophi and kidney stones.Only on a doctor's prescription; stop and seek help urgently if a skin rash appears.
See a doctor urgently if
- A hot, swollen joint with fever or chills, which could be a joint infection
- Skin rash, blisters, mouth ulcers or fever after starting allopurinol or febuxostat
- Severe pain in the side or back with blood in urine, suggesting a kidney stone
- Several joints swollen at once, or a first attack in a woman or young person
- Severe diarrhoea or vomiting while taking colchicine
Tests that may help
This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.