Overview
Gout is a type of inflammatory arthritis caused by the build-up of uric acid in the blood that crystallises and deposits in joints, causing sudden, intensely painful attacks. The big toe is most commonly affected, but any joint can be involved. Attacks usually resolve within days to weeks, but recurrent gout can cause permanent joint damage.
How common is it?
Gout affects about 2.5% of UK adults, making it the most common inflammatory arthritis. Prevalence is increasing alongside rising obesity and use of diuretics.
Causes and risk factors
Uric acid is a breakdown product of purines found in food and produced naturally by the body. When blood uric acid levels are too high (hyperuricaemia), crystals form in cooler peripheral joints, triggering intense inflammation.
Common risk factors
- Diet high in red meat, seafood (especially shellfish), and organ meats
- Alcohol, especially beer and spirits
- Sugary drinks and fructose
- Obesity
- Diuretic medications (thiazides, furosemide)
- Kidney disease
- Family history of gout
- Male sex and age over 40
Symptoms
- Sudden, severe joint pain, often starting at night
- Extreme tenderness: even the weight of a sheet is unbearable
- Swelling, redness, and warmth at the affected joint
- Pain usually peaking within 12 to 24 hours
- Resolution within 1 to 2 weeks without treatment
- After repeated attacks: tophi (chalky white deposits) visible under the skin
When to see a doctor
See a doctor for a first attack of acute joint pain and swelling to confirm the diagnosis. Urgent review if you develop fever with joint inflammation, as this may indicate joint infection rather than gout.
Diagnosis
Joint aspiration (withdrawing fluid from the inflamed joint) and microscopy to identify urate crystals is definitive. Blood uric acid levels are supportive but may be normal during an acute attack.
Treatments
Colchicine or NSAIDs for acute attacks
Colchicine taken early in an attack significantly reduces severity. NSAIDs such as naproxen or indomethacin are equally effective. Start within 24 hours of attack onset for best results.
Allopurinol for long-term prevention
A xanthine oxidase inhibitor that reduces uric acid production. The cornerstone of preventive treatment. Started after acute inflammation has settled, with gradual dose titration targeting urate below 360 micromol/L.
Febuxostat
An alternative uric acid-lowering drug for patients who cannot tolerate allopurinol.
Self-care and lifestyle
- Reduce intake of red meat, organ meats, shellfish, and oily fish
- Avoid alcohol, particularly beer and spirits
- Stay well hydrated (aim for 2 litres of water daily)
- Lose weight gradually if overweight, as rapid weight loss can trigger attacks
Prevention
Dietary modification, maintaining a healthy weight, adequate hydration, and using the lowest effective dose of any necessary diuretics reduce gout risk. Long-term urate-lowering therapy is very effective at preventing recurrent attacks.