Patient information from BMJ

Gout

Last published:Aug 06, 2021

Gout can be very painful. But most gout attacks go away within 10 days, even without treatment. Treatments can help with pain and may cut your chances of having more attacks.

What is gout?

Gout causes bad pain and swelling in your joints. It happens when you get a lot of a chemical called urate in your blood. Urate is made in the body when you digest certain foods. It's usually harmless. But in some people, it builds up and forms crystals. The crystals can collect in your joints, causing swelling and pain.

Not everyone with high levels of urate gets gout. But the more urate you have, the more likely you are to get gout.

These are some of the things linked to too much urate in the blood:

• Drinking too much alcohol, especially beer

• Eating a lot of certain foods, especially red meat and shellfish

• Being very overweight (obese)

• Some illnesses, including heart disease, high blood pressure, diabetes, and high cholesterol

• Some medicines, including diuretics and daily aspirin.

What are the symptoms?

You get bad pain in one of your joints. It comes on suddenly, over a few hours, often during the night. The pain may wake you up. Even the weight of bedclothes over a joint with gout can be painful.

You are most likely to get gout in your big toe. Other joints that may be affected include other joints in your foot, ankle, knee, wrist, finger, and elbow. 

A joint with gout usually swells up. The skin around it may look red and shiny. It may feel stiff and warm to touch. The pain will be worse if you bump the joint.

Urate crystals can also form under the skin on your hands, knees, wrists, elbows, or ears. They look like white bumps. Doctors call these bumps tophi.

Your doctor may diagnose gout by examining you and asking about your symptoms. Your doctor may take a sample of fluid from your joint to look for urate crystals, although this is not always needed.

You may also need a blood test to check how much urate you have in your blood. However, you won't usually have this until after your symptoms have gone away, because urate levels are often normal during an attack of gout. 

What treatments work?

Several medicines are used to treat and prevent attacks of gout. And there are some things you can try yourself.

Things you can do for yourself

It may help to put an ice pack around the painful joint. You can make an ice pack by wrapping a bag of frozen peas in a tea towel. To keep the bedclothes off your joint at night, make a protective cover for your joint (from a cardboard box, for example).

You are more likely to get gout if you eat certain foods or drink a lot of beer. Changing what you eat and drink may help prevent more attacks of gout. Things that can help prevent attacks of gout include:

• losing weight (if you're overweight)

• eating less seafood

• drinking less alcohol, and

• consuming more dairy products.

Medicines to treat gout attacks

You may be given painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs) to control the pain. They can cause bleeding, especially at high doses. You might need another medicine alongside them, to protect your stomach from bleeding.

A medicine called colchicine has been used for many years to treat gout. Your doctor may prescribe it if you can’t take NSAIDs. It is likely to work, but it doesn't work for everyone.

Many people who take it get vomiting and diarrhoea. You can't take high doses of colchicine for long, because it can cause dangerous side effects. 

If you can't take other medicines, your doctor may prescribe a short course of corticosteroid tablets, or a corticosteroid injection into the inflamed joint.

Medicines to prevent gout

These medicines reduce the amount of urate in your body. They are called urate-lowering drugs. They can help reduce the chance of another attack of gout. 

Once you have started, you may need to keep taking these medicines for life. If you stop them, you are likely to get another attack of gout.

Before you start, you may want to think about how much your gout bothers you, how often you get attacks, and whether you are prepared to keep taking tablets every day.

There are several different urate-lowering drugs. Like all medicines, they can cause side effects in some people. Your doctor should explain to you carefully how you should take these medicines, and what side effects they might cause.

Tell your doctor if you have side effects. If one medication causes you problems, you might be able to switch to another.

What will happen to me?

Your gout attack should go away in about 10 days. Some people get only one attack of gout in their lives. But most people who've had one attack get more.

A few people get frequent attacks of gout. This is sometimes called chronic gouty arthritis. It's not very common. The symptoms are the same as for normal gout, but you get them more often. If you get frequent attacks of gout, the urate crystals can damage your joints. This makes them feel stiff.