Gout
Also known as Gouty arthritis, Urate crystal arthritis
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is gout?
Gout is an inflammatory arthritis caused by uric acid crystals forming in a joint. Attacks come on rapidly, often overnight, and classically affect the base of the big toe with intense pain. It is highly treatable, yet many people are managed only for attacks rather than being offered the urate lowering therapy that prevents them.
Causes
- Elevated blood uric acid leading to crystal formation
- Reduced kidney excretion of urate, the commonest mechanism
- High intake of purine rich foods and alcohol
- Fructose sweetened drinks
- Diuretic medicines
Symptoms
- Sudden severe joint pain, often starting at night
- Intense tenderness so that even bedding hurts
- Redness, warmth and swelling of the joint
- Most often the base of the big toe
- Peeling skin as the attack settles
- Firm lumps called tophi in long standing disease
Risk factors
- Male sex and postmenopausal status in women
- Obesity
- Chronic kidney disease
- Hypertension and diuretic use
- Excess beer and spirits intake
- Family history of gout
Diagnosis
- Characteristic clinical picture of rapid onset monoarthritis
- Joint aspiration showing negatively birefringent urate crystals
- Serum urate, ideally measured after the acute attack
- Exclusion of septic arthritis, which can look similar
- Ultrasound or dual energy CT in uncertain cases
Treatment
- Nonsteroidal anti inflammatory drugs, colchicine or corticosteroids for attacks
- Allopurinol or febuxostat to lower urate long term
- Treat to target urate below 360 micromol per litre, lower with tophi
- Continuing urate lowering therapy through attacks once established
- Prophylaxis with colchicine when starting urate lowering therapy
- Weight management and reduction of alcohol and sugary drinks
Self care
- Rest and elevate the joint during an attack
- Apply ice to the affected joint
- Start attack treatment as early as possible
- Drink plenty of water
- Reduce beer, spirits and sugary drinks
- Keep taking allopurinol through an attack if already established
- Lose weight gradually rather than crash dieting
When to see a doctor
Book an appointment if:
- A second attack, which is the point to discuss urate lowering therapy
- Attacks becoming more frequent
- Lumps developing around joints or ears
- Kidney stones or kidney impairment
- Ongoing joint pain between attacks
- To check whether your urate target is being met
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Take urate lowering therapy consistently once started
- Treat to a urate target rather than by symptoms alone
- Reduce alcohol, especially beer, and fructose sweetened drinks
- Lose weight steadily
- Review diuretics with your doctor
- Stay well hydrated
Outlook
Gout is one of the most treatable forms of arthritis. Sustained urate lowering therapy to target dissolves crystal deposits, stops attacks entirely and can shrink tophi over time. Left untreated it causes recurrent attacks and permanent joint damage, so the main obstacle to a good outcome is stopping treatment once attacks settle.
Common questions
Is gout caused only by diet?
Diet contributes but genetics and kidney handling of urate matter more. Many people cannot control gout by diet alone, and withholding urate lowering medicine on dietary grounds leaves them with repeated attacks.
Should allopurinol be stopped during an attack?
No, if it is already established. Stopping and restarting causes shifts in urate levels that can trigger further attacks. It is continued through the flare while the attack itself is treated.
Could a hot swollen joint be something more serious?
Yes. Septic arthritis can look identical and is a medical emergency. A hot swollen joint with fever should be assessed urgently rather than assumed to be gout, particularly if it is a first episode.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.