Gout

What is Gout?

It’s a form of arthritis that causes severe pain, swelling and tenderness in one or more joints. The most common place to get gout is where the joint of the big toe meets the foot. Around 56-78% of people with the condition will experience gout in this joint. However, any joint can be affected such as the ankle, knee, fingers, wrist, and elbow. 

People will often experience sudden and intense swelling and pain in and around the joint known as a gout attack. People will often describe gout pain as feeling like the area is on fire. During this time, movement or any weight on the area can be excruciating. It can also cause the skin around the swollen joint to become hot and red.

The condition comes and goes meaning it will go through periods when the condition is active, known as a gout flare, and periods when there are no symptoms. An attack usually lasts around 5 to 7 days before improving. When there are no symptoms it’s important that you implement strategies to prevent flares.

Gout is more common in men and becomes more common with increasing age. 

Gout Diagnosis

If you experience symptoms, you must seek medical advice as soon as possible. Untreated gout may result in joint damage and unnecessary extension of intense pain. 

When diagnosing gout, your GP may ask about your family history, diet, alcohol intake and other factors. Sometimes your GP may refer you to a specialist called a rheumatologist. In some cases, a doctor may extract some fluid from your joint with a needle to test it for uric acid crystals.

What Causes Gout?

Gout is caused by the accumulation of uric acid crystals in the joints. This happens because of a build-up of uric acid in the blood. Uric acid can accumulate in and around a joint, leading to sharp and painful uric acid crystals. Uric acid is a normal waste product the body produces when it breaks down purines, a common substance in many foods.  

Uric acid will normally be removed from the blood by the kidneys, however, when high levels of purine-rich foods are eaten, the body can struggle to remove the uric acid from the blood before it crystallises in a joint causing gout.

Foods that are high in purines include offal (like liver and kidney), game (such as pheasant and venison), sugary soft drinks, seafood, and alcohol.

Not everyone who has high blood levels of uric acid, or a diet high in purines, will develop the condition. Other factors increase your risk such as a family history of gout, being overweight, kidney problems, a high alcohol intake, and taking certain medicines.

Gout Treatment

Treatment for the condition can be split into two major types for gout patients in the UK. The first focuses on helping with inflammation and pain during an attack. The other type of treatment is to prevent future attacks from flaring up.  

Colchicine is used as an acute gout tablet in the UK to treat the pain and swelling caused by an attack of gout. The usual dose is one tablet taken 2 to 4 times a day and no more than 12 tablets in a treatment course. However, your doctor may prescribe a different dose and you should take it exactly as your doctor has told you to. It can also be used to treat kidney stones.

Other treatments used for immediate gout pain relief include paracetamol and NSAIDs (nonsteroidal anti-inflammatory drugs) like naproxen, ibuprofen and etoricoxib.

The first-line gout treatment in the UK to prevent gout attacks is allopurinol. This works to treat gout by reducing uric acid levels in the body to prevent the buildup of uric acid crystals around joints. It’s a medication that’s taken long-term every day.

Prevention

Your lifestyle choices are one of the most important factors in preventing gout. The gout diet is often adopted by those with the condition as it can often limit purine intake enough to prevent flares. 

The diet involves avoiding foods and drinks that are high in purines or result in an increased risk of a flare-up. See this NHS document discussing dietary advice in gout for further information.

A healthy diet and exercise, in general, can improve your condition by limiting excess weight as a risk factor as well as potentially improving other risk factors such as diabetes, high blood pressure and high cholesterol. You should speak to your doctor or dietician about ways to assist with a diet and exercise plan for you and your conditions.

Gout Symptoms

The condition often starts rapidly and causes severe pain which becomes very intense within 24 hours. The affected joint(s) can become swollen, red and warm to the touch. Many people find there is limited movement of the joint during an attack. An attack usually lasts a few days to a week before it gets better. 

You should call your doctor immediately if you experience other symptoms like a high temperature, worsening pain, and you feel generally unwell (e.g. you feel sick or can’t eat). Alongside a painful and swollen joint, these symptoms can indicate that you have septic arthritis, which needs to be treated immediately.

What is the best medicine for gout in the UK?

Several medicines can be prescribed to treat an acute attack. Effective treatments include colchicine, steroid medicines, and NSAID medicines like naproxen and ibuprofen. 

What tablets can I buy over the counter for gout?

The only medicines that you can buy over the counter to help with gout are paracetamol and ibuprofen. Paracetamol can be helpful to improve pain and ibuprofen can help with the pain and swelling. However, other medicines which may be more effective for gout can only be prescribed by a doctor or healthcare professional. 

What foods cause gout?

Foods that are high in purines can be a factor that leads to this condition. Foods that are high in purines include offal (like liver and kidney), game (such as pheasant and venison), sugary soft drinks, seafood, and alcohol. Poultry, red meat and fish can be eaten in moderation.

What is the main cause of gout?

The main cause is high levels of uric acid in the body, called hyperuricemia. This leads to a build-up of uric acid crystals in and around joints and leads to the pain and swelling associated with the condition. However, not everyone with high uric acid levels will develop the condition.