Gout causes inflammation of the joints, causing them to look bright red and swollen, and they will feel hot and painful. It most often affects the base of the big toe (the ball of the foot), but it can also inflame the fingers, knees, wrists and elbows. Symptoms tend to come on very quickly, usually worsening over a day and causing excruciating pain. Gout is caused by high levels of a substance called uric acid. The levels are affected by our diet, medical conditions, but also our genetics. Some people are just genetically worse at getting rid of uric acid than other people. When uric acid builds up, it forms crystals in the joint, which produces the pain and inflammation. Gout is not contagious and cannot be passed on.
If you’ve suffered from gout before, you’ll usually recognise a new attack, and it usually lasts just a few days. If you have not been diagnosed with gout before, you should have this confirmed by a doctor. With gout, prevention is better than the cure. It is best to avoid getting another attack, and the trick to this is diet, lifestyle advice, and in some cases taking medication to prevent the levels of uric acid from getting too high. For an acute flare-up, drink plenty of water to avoid dehydration, and apply warmth to the area, to improve circulation to help aid the clearance of the uric acid crystalised deposits, since they tend to develop in areas with poorer circulation such as the big toe. Gout can be caused by the build-up of uric acid in the blood as a by-product of metabolising foods high in purines, such as red meat and some seafood. Gout is more likely to develop in the following people: - middle-aged men and women after menopause - certain conditions such as high blood pressure, kidney disease, thyroid disease, diabetes or have high levels of cholesterol - taking certain medication such as diuretics (water tablets) for blood pressure - have parents, siblings, or other family members with gout - being overweight - drinking alcohol, especially beer You cannot do much about genetic or age-related factors relating to gout, however, you do have the power to control environmental and lifestyle factors, to reduce your chances of getting gout attacks. To prevent gout from returning: - Try to drink plenty of fluids (especially water) to avoid dehydration, and try to minimise alcohol intake by incorporating a few alcohol-free days each week. Aim for less than 14 units of alcohol per week. - Exercise regularly to improve your circulation and maintain a healthy weight, alongside a healthy balanced diet with plenty of vegetables. - Try to increase your daily intake of vitamin C. Studies show it can lower your chances of getting gout, and in addition, it helps to remove excess uric acid from the body through the kidneys. Aim for between 500 to 1500mg per day, ideally through your diet or with a supplement. - Reduce the amount of purine-rich foods such as red meat, offal such as kidneys, liver, or seafood, especially mussels, crab, shrimps and other shellfish, fish roe, and caviar. - Moderate the amounts of dairy products in your diet to around three portions of dairy products daily. This can look like a 200ml glass of milk, a pot of yoghurt and a 30g (matchbox-sized) piece of hard cheese. - Avoid or minimise fried or fatty food, sugary drinks, and processed foods and snacks. - Try to stop smoking, to improve your circulation.
Pain relief is key to getting through you flare-up of gout. Taking a maximal dose of ibuprofen (400mg three times a day for a few days) can act to reduce pain and inflammation. Make sure you take this with food, and speak to your pharmacist or doctor if you get any heartburn or indigestion. You should only take this for a few days as a time, unless under medical advice. Speak to your doctor or pharmacist if you have any existing kidney or uncontrolled blood pressure, asthma or circulatory disease or you are taking other medicines. In addition, paracetamol, and codeine combined with paracetamol, such as in Solphadeine Plus, can give additional pain relief. Avoid pain killers containing aspirin, as counter-intuitively they can increase the accumulation of uric acid and make things worse.
If you have gout, you may be fit for work depending on your pain levels and the nature of your work.
If you have not had gout before, you should have it confirmed by a doctor. It can be confirmed in hospital by using a needle to get some fluid out of the joint. You can also do blood tests to look at uric acid levels in your blood, although these can be normal during an attack so can be misleading. Treatment is usually with strong anti-inflammatories and pain killers, and a few days of treatment usually gets on top of the symptoms. If you have severe pain that fits with gout, you should arrange an urgent appointment to see your doctor, or seek advice from 111 on the phone. Gout does not usually make you feel unwell in yourself or feverish. If you have a fever alongside a hot painful joint, you should seek an urgent visit with your doctor or attend the emergency department out of working hours. This is because it may not be gout, and in some cases, bacterial infections of the joint can cause similar symptoms to gout, and this requires urgent confirmation and antibiotics. If you get recurring episodes of gout, seek a routine appointment with your doctor. Your doctor could prescribe strong pain relief to have in case, and may prescribe a tablet to protect the stomach from the heartburn anti-inflammatory tablets can cause. Your doctor might consider prescribing allopurinol tablets, which prevents uric acid crystals from forming and therefore reduces the risk of future flare-ups – but it’s only safe to start this once you’re over any current episode. The doctor will ask about your symptoms and, if you are comfortable, examine you. Depending on the possible diagnosis, you may be offered a blood test that can look for high uric acid levels, a needle can be used to get fluids from the joint and sent for testing, or imaging (ultrasound, X-ray, CT scan) could be carried out, or you may be referred to a specialist department. Your doctor may prescribe stronger pain relief if symptoms are particularly severe or persist for more than a few days. This may be a stronger ibuprofen-type tablet or a short course of colchicine tablets.