Gout: symptoms, causes and treatment

Gout is the most common type of inflammatory arthritis, and risk increases with age. Women rarely develop the condition before the menopause, but are increasingly doing so later in life.

Gout symptoms

Gout attacks come on without warning, usually at night. The most common symptom is a sudden – and very severe – pain in one or more joints, typically the big toe. This may be accompanied by swelling and redness, as well as itchy, peeling skin.

These often debilitating symptoms tend to develop over a few hours and usually last somewhere between three and 10 days. However, 62 per cent of people will suffer a repeat attack within a year.

Gout presents in a number of ways, and you might be experiencing gout if you have any of these symptoms:

• Excruciating pain in a joint (the big toe in over half of cases) that comes on suddenly during the night. 
• The affected joint is red and swollen, and the surrounding skin often taut and shiny (it may peel too).
• In some people attacks are preceded by thirst, and may be accompanied with mild flu-like symptoms.
• The discomfort normally peaks during the first 24 hours before starting to resolve over the next few days, with the joint returning to normal within a week or two.
• The more attacks you have, the longer they tend to last.

Find out more about possible causes of joint pain

What causes gout?

Gout is caused by a build-up of a waste product called uric acid in the blood.

Ordinarily, uric acid is removed through the kidneys, but if you produce too much or excrete too little when you urinate, it can build up into a substance called sodium urate, which forms crystals in the joints or surrounding tissue. This is what leads to that painful inflammation.

Certain medical conditions, including high blood pressure, diabetes and kidney disease, can increase risk of suffering from gout because the body is less able to flush out uric acid.

Uric acid accumulates for a number of reasons. Some people have a genetic glitch in their metabolism (1 in 10 cases run in families), but high uric acid levels are also closely associated with a meat-rich diet, excessive alcohol (particularly beer), being overweight, and being male (men are five times more likely to be affected than women).

Accumulation of the uric acid is something that typically occurs over years, and the tissues of the body have to be saturated before crystals start to form in the joints. 

Factors that can trigger crystalisation and gout include binge drinking, heavy physical exercise, illness, stress, dehydration, surgery, crash dieting and some prescription-only medicines (particularly diuretics). If you have any concerns about the medication you're taking and the risk of gout speak to your GP.

Learn more about inflammation and how it affects your health

How is gout treated?

Self-help techniques include resting and raising the affected limb, and keeping the joint cool with an ice pack for around 20 minutes at a time.

Gout treatment is aimed at rapid relief of the pain using potent anti-inflammatories (such as naproxen or diclofenac) for a few days following an attack and that, along with lifestyle factors (see below), may be all that is required for one-off attacks, or those that recur infrequently. But people prone to regular attacks fare better on daily preventive medication (allopurinol) which lowers uric acid levels and help prevent the premature arthritis that can occur with recurrent attacks. 

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How can I reduce my risk of gout?

Manage your weight

Gout is closely linked to obesity because being overweight can boost your uric acid levels. Evidence suggests that our expanding waistlines are the main reason that it is on the increase, and developing in younger people (an obese man is likely to have his first attack at least a decade earlier than his slimmer peers). 

Avoid or reduce meat and seafood

Certain foods are particularly high in purines, a type of protein that is metabolised into uric acid. So it may be sensible to limit your consumption of these foods, which include red meat, offal, shellfish and oily fish.

That said, oily fish in particular offers numerous other health benefits, thanks to its high omega-3 fatty acid content, so it's still wise to aim to eat one portion a week, or seek advice from your doctor before cutting down further.

Plant-based proteins like lentils, beans and tofu not only don't raise uric acid levels, they might even protect you from gout.

How to find other sources of omega 3

Cut down on alcohol and fizzy drinks

If you have gout it's best to avoid alcoholic drinks, notably beer, red wine and port. Sugary fizzy drinks are also best avoided  - they don’t contain purines but some sugars raise uric acid levels.

Even non-alcoholic beer has been found to increase uric acid levels by 4.4%.

Stay hydrated

Hydration is another important issue. Although the amount of water you drink has no direct effect on uric acid metabolism, it helps maintain optimum hydration increasing the likelihood of the acid staying in solution, rather than precipitating as crystals in the joints and tissues. 

Unsurprisingly it is not unusual for attacks to develop during summer holidays thanks to the combination of dehydration and eating and drinking too much.

Boost your vitamin C levels

It's also a good idea to up your intake of vitamin C, as this can encourage the kidneys to excrete more uric acid.

You should be careful to choose vitamin c-filled foods that are low in fructose, such as oranges, strawberries, pineapples and grapefruit. 

How is gout diagnosed?

A gout diagnosis is normally made on the basis of the story, the appearance of the joint, and a blood test that confirms raised uric acid levels.

For more advice and information visit the UK Gout Society website at www.ukgoutsociety.org

What does a gout attack feel like?

A gout attack consists of an agonizing pain in the joint, which becomes hot, red and swollen. It often starts very quickly and can be immobilizing.

How long does a gout attack last?

The first 24 hours are usually the most uncomfortable of a gout attack. It should start to feel better after a few days and be back to normal within two weeks.

What does gout look like?

The joint becomes red and swollen, and the skin is often shiny and taut. The skin may start peeling.

Can you get gout in your knee?

Gout is most common in the big toes or other foot joints, though many joints can be affected including one or both knees.

Is gout hereditary?

Gout is often but not always inherited. If a close family member has gout you are much more likely to develop it.

What diet is best for gout?

Eat a diet high in vegetables, fruit (especially citrus) and whole grains, and avoid red meat, offal and seafood. You should also avoid alcohol (even non-alcoholic beer) and sugary drinks. Drink plenty of water to avoid being dehydrated, and feel free to enjoy your coffee and low-fat dairy drinks. 

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