Gout is a type of arthritis that causes sudden and extremely painful attacks in the joints – most commonly in the big toe, ankles and knees – but can affect any other joints too. It is the most common form of inflammatory arthritis worldwide. Long-term complications of gout include joint damage and kidney stones. Almost a quarter of people with gout have chronic kidney disease (see our information sheet on gout and other health problems).

Gout affects between 2 and 3 in every 100 people in the UK. It usually occurs in men over 30 and women after menopause – and is over five times more common in men than women. It is very rare in children. In around 20 percent of cases there is a family history of the disorder.

Gout is caused by excess uric acid (also known as urate) in the bloodstream. All the cells in the human body, and many of the foods we eat, contain substances known as purines. As old cells are broken down, or as foods are digested, these purines are converted to uric acid.

Most people with gout have high levels of uric acid because it is not efficiently removed by the kidneys and washed out in the urine. It can also be caused by producing too much uric acid in the body – for example, from the breakdown of old cells, from purine-rich foods (e.g. shellfish) and alcohol, or by certain drugs (e.g. water tablets). Some inherited (genetic) abnormalities are also known to lead to high levels of uric acid in the blood.

When there is too much uric acid in the body, it starts to make urate crystals, which can form in and around the joints, under the skin (known as tophi), or in the kidneys. The body can react to these crystals and produce intense inflammation.

Attacks of gout often develop very suddenly (acutely), and most commonly begin during the night or in the early hours of the morning. This can cause severe pain in the affected joints. The skin may be red and shiny, and the inflammation may be so severe that the skin may peel. A mild fever, a loss of appetite and a feeling of tiredness can also accompany acute attacks of gout.

The pain of a gout attack usually reaches a peak within a few hours, often making even the touch of bed clothes on the affected joint unbearable. An untreated attack generally lasts for a few days, then settles down and the joint gradually returns to normal. While some people never experience another attack, most people will have further attacks if the uric acid level remains high. Untreated attacks can become more frequent and more prolonged and may result in damage to the cartilage and bone.

If you think you are experiencing your first attack of gout, visit your GP as soon as possible. They will be able to check whether you have gout and, if so, prescribe the drug that is most appropriate for you to relieve the pain and swelling (our information sheet on gout treatments). Similarly, if you already have a diagnosis of gout and develop a bad attack, you feel unwell, or are concerned about your symptoms, then speak to a doctor as soon as possible.

A blood test (or multiple blood tests) can be done to check the uric acid levels in your blood, which are usually high in people with gout. This can help to guide treatment. However, a blood test alone will not prove that an attack of joint pain is due to gout.

Sometimes, your doctor might recommend taking a sample of fluid from the affected joint using a needle and syringe (known as joint aspiration). This fluid can be examined under a special type of microscope. The presence of needle-like, urate crystals is strongly suggestive of a diagnosis of gout.

In some people, scans (e.g. x-rays, ultrasound or CT scans) are needed to help confirm the diagnosis of gout and to assess for any damage. However, scans are not necessary in everyone with gout, and it is often possible to diagnose gout from symptoms and examination alone.

The UK Gout Society does not recommend the use of uric acid self-testing kits or endorse any over-the-counter uric home testing kits, although we recognise the desire for people to self-manage their own condition.

We strongly recommend that you visit your GP or specialist to obtain an accurate and validated blood test (see above).  Only a health professional can determine the correct uric acid (urate) lowering medication and appropriate dosage you require.

All approved medications for gout in the UK can only be obtained via prescription from your doctor.

However, it is very useful to be aware of your serum urate level.  For your information, the British Society of Rheumatology’s recommends that your urate is reduced and maintained at or below a target level of 300 µmol/l (micromoles per litre).

If you have a sudden gout attack, the most important thing is for your doctor to treat the pain and inflammation as soon as possible using painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or steroids. Ideally, keep off the joint and ice it regularly.

Once the attack has passed, the next step is to help prevent the attacks returning. If overweight, you may be advised to lose weight slowly, reduce alcohol consumption and eat smaller amounts of purine-rich foods such as red meat, offal and seafood.

Finally, if you are suffering from repeated attacks, long-term treatment to lower the level of uric acid or urate in the blood will be required. You should speak to your doctor about currently available therapies.

For more details on treatments for gout, visit our treatment section here.