Gout is a type of arthritis that causes sudden and extremely painful attacks in the joints of the foot, knee, ankle, hand and wrist – especially the big toe.

It is a common joint disease affecting one in 14 men and one in 35 women. In men, it can occur any time after puberty, whereas in women it is uncommon before the menopause. In around one in ten cases, there is a family history of the disorder. It is rare in children.

Gout is caused by excess uric acid in the bloodstream. All of 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, which is carried in the blood as a salt called urate.

Most people with gout have high levels of urate in their blood because they do not pass enough urate in their urine. It can also be caused by too high levels of uric acid in the diet, crash dieting, stress, prolonged illness, injury, or by some drugs e.g. aspirin or water tablets. Much less commonly, people with gout produce too much uric acid in the first place, due to an inherited (genetic) abnormality or a disorder associated with increased production of cells in the body. An overload of uric acid in the body means that urate crystals start to form in and around the joints and also under the skin e.g. on the ear, as small white pimples (known as tophi). In severe cases, this can lead to deformity. Occasionally, stones may form in the kidneys.

For many, gout can be a painful and debilitating medical condition which can limit the performance of simple, everyday activities and lead to lost working days.

Gout can also be associated with numerous other diseases and medical conditions. These include diabetes, high blood pressure, stroke, angina, kidney disease, poor circulation and psoriasis. A diagnosis of gout could be the first sign of an underlying medical condition you were previously unaware of.

For further information download our All About Gout and other health problems factsheet here.

A sudden, unexpected (acute) attack of gout often develops during the night or early hours of the morning.

It reaches a peak within a few hours, often making even the touch of bed clothes on the affected joint unbearable. 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. An untreated attack generally lasts for a few days, then dies down and the joint gradually returns to normal. Some people never experience another attack. If the uric acid level remains high, most will have a second attack between six months and two years after the first. Untreated attacks will become more frequent and more prolonged and may result in damage to the cartilage and bone, resulting in deformity.

A simple blood test (or multiple blood tests) to ascertain uric acid levels in your blood can be carried out by your GP. However, a blood test alone will not prove that an attack of joint pain is due to gout.

A more specific test is the analysis of the fluid in the affected joint. Fluid from the space between the joint is aspirated (removed through a needle and syringe) and then examined under a special type of microscope. The presence of needle-like, uric acid crystals confirms the diagnosis of gout.

There is a three-step approach to managing gout: treating the acute attack, reducing the likelihood of attacks through diet and lifestyle, and lowering uric levels to prevent further attacks.

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. The joint will also need to be immobilised.

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 in the blood will be required.

For further information on treatments for managing gout, download our All About Gout and Treatment factsheet here.

Visit your GP as soon as possible.

Your doctor 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. If you experience repeated attacks of gout, you may require long-term treatment and referral to a gout expert (rheumatologist).

Ice packs may ease swelling and pain of a sudden gout attack as well as placing the affected joint in a cold bath

Rest the joint and keep it elevated as much as possible

If you are overweight, try shedding a few pounds gradually. Avoid crash dieting and fasting as this can lead to uric acid retention by the kidneys.

Drink lots of fluids (e.g. 8-10 glasses of water each day) to prevent dehydration
Avoid binge eating and drinking

Reduce consumption of alcohol, particularly beer, lager and fortified wines and also sugar sweetened drinks

Avoid foods rich in purines particularly red meat, offal and seafood

For further advice on diet and lifestyle to strategies to help you manage your gout, download our All About Gout and Diet or All about Gout and Treatment factsheets.