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 | health information | health factsheets
Gout
This factsheet is for people who have gout or for people who wish to learn more about gout.
Gout is an arthritic (meaning inflammation of the joint) condition that causes inflammation and swelling, usually in one joint in the body - commonly the big toe.
Gout affects about one in every 200 adults and is most common in men between 40 and 60 years old. Gout can also affect women but this is less common and is usually after the menopause. Occasionally young people and children can get gout but this is rare.
What is gout?
Gout is a painful condition that causes swelling and pain (see "Symptoms" below).
Gout most commonly affects the big toe. However it can affect any of your joints including those in your:
- instep
- heel
- ankle
- knee
- finger
- wrist
- elbow
Some people only ever have one attack of gout in their lifetime, but for many people it does return.
Symptoms of gout
People usually have 'attacks' of gout - it may affect you for a period of time and then go away eventually, even without treatment. The symptoms include:
- severe pain in the joint(s) that develops within a few hours - the pain may be so severe that even the light pressure of bedclothes can feel unbearable
- red and shiny skin around the joint - in some cases the skin will peel
- fever
Without treatment, an attack usually lasts up to about two weeks. With treatment, this can be reduced to two to seven days.
Left untreated, attacks of gout may become more frequent and last longer.
Complications of gout
It is uncommon for gout to cause any further problems but potential complications include:
- progressive damage to the joints which could lead to permanent damage and disability
- white lumps of urate crystals called tophi can form in the tissue, which become inflamed and damage surrounding bone
- kidney stones can form if urate crystals collect in the urinary tract
- the kidney may be damaged if crystals collect in the kidney tissue - although this is rare
Causes of gout
Gout is caused if you have too much urate in your body.
Urate (also called uric acid) is a chemical which everybody has in their blood. It travels in the clear part of the blood (the plasma) in the form of a salt.
Urate is normally harmless and the body usually passes excess urate out of the body through the kidneys into the urine.
However, in people who are prone to gout, the level of urate can:
- build up - if the kidneys do not excrete urate fast enough
- rise if the body produces too much urate - this can happen due to other illnesses such as blood disorders or because of diet - see "Risk factors" below
If the level of urate is too high, it can form tiny crystals that collect in the tissues, particularly in and around joints.
Not everybody with high levels of urate gets gout and some people get gout but do not have high levels of urate.
The exact reason why some people develop gout and others don't is not currently known, but there are risk factors.
Risk factors
There are certain factors that can affect your likelihood of getting gout. You are more likely to have gout if you:
- are a man, as the plasma urate level normally tends to be higher in men than women
- consume high levels of a substance called purine in your diet
- drink lots of alcohol, which interferes with how your body passes out urate
- take certain medicines, such as diuretics, which increase the flow of urine from the body
- have a family history of gout
- have a family history of kidney disease causing the kidneys to not pass enough urate out in the urine>
- are overweight
- have a medical condition such as psoriasis which can sometimes cause your body to produce too much urate - for more information on psoriasis please see the separate BUPA factsheet, Psoriasis
- have high blood pressure - for more information please see the separate BUPA factsheet, High blood pressure
- injure a joint
- have a surgical operation
- have some chemotherapy drugs
Diagnosis
If you think you have gout, consult your GP. He or she will ask you about your symptoms and examine you.
Your doctor may do one or all of the following tests or refer you to a hospital specialist (rheumatologist) for them.
- A blood test will measure the levels of urate in your blood (as plasma urate), but high levels are not necessarily related to gout - the level may also be high in healthy people who do not have gout.
- Fluid (synovial fluid) may be removed from your swollen joint with a needle. This usually causes no more discomfort than a blood test. If urate crystals can be seen in the fluid under a microscope, you have gout.
- An X-ray of your affected joint may be taken to rule out other medical conditions, but this is less common.
Treatment
Home treatment
There are a number of steps you can take to reduce the pain and inflammation of the gout attack.
- Rest your joint.
- Apply an ice pack or a bag of frozen peas (both wrapped in a towel) to the joint for 20 minutes to help reduce the swelling, then take it off. You should not apply ice directly to your skin as it can give you an 'ice burn'. You can reapply the ice pack after the temperature of the joint has returned to normal.
Drug treatments
There are also drug treatments that your doctor can prescribe for you to help alleviate the pain and swelling. You should start treatment within 24 hours of your gout attack.
- Non-steroidal anti-inflammatory drugs (NSAIDS) such as naproxen (eg Arthroxen) may relieve pain and inflammation. If you have recurring attacks of gout, you should have these drugs on hand to be used as soon as you feel the first symptoms. In some people, such as those with heart conditions, high blood pressure or the elderly, these drugs may be harmful so you should consult your GP.
- If you are unable to take NSAIDS, then colchicine is an alternative which can relieve the symptoms of gout within hours. It works by reducing the build-up of uric acid and in turn reducing inflammation, pain and swelling. Many people who take it have side-effects however such as nausea, vomiting and/or diarrhoea.
- Steroid tablets are also an option if you cannot take NSAIDS or colchicines, but these are used infrequently.
Prevention
There are also a number of steps you can take to prevent further attacks of gout.
Diet and lifestyle
Gout can be managed by dealing with the things that make it worse (see "Risk factors" above). Identifying and avoiding the things that bring on an attack of gout are an essential part of your overall treatment plan.
For example, you should:
- avoid foods that are very high in purine - ask your doctor or a dietician for advice
- moderate alcohol intake - especially beer, port, lager and some red wines
- eat a well-balanced calorie-controlled diet and exercise to lose excess weight - for more information about maintaining your weight and a healthy diet, please see the separate BUPA factsheets Healthy weight for adults and Healthy eating
- if gout is caused by another condition (such as psoriasis) managing that condition may prevent gout
Preventive drug treatments
If you have repeat attacks of gout there are also drug treatments that can help to prevent gout.
- A medicine called allopurinol, taken every day, prevents gout by lowering the level of urate in your blood. However, it does take two to three months before it becomes fully effective. It may actually cause an attack of gout when it is first taken, because the level of urate will rise a bit before it falls. Therefore, the treatment is not normally started during a gout attack but three to four weeks after an attack has settled.
- Another medicine called colchicine may be given alongside allopurinol for the first one to three months.
Further information
References
- Simon C, Everitt H, Birtwistle J, Stevenson B. Oxford Handbook of General Practice. Oxford: Oxford University Press, 2002.
- PRODIGY Guidance - Gout. UK Department of Health. PRODIGY.
www.prodigy.nhs.uk
accessed 7 November 2005.
- Gout. Arthritis Research Campaign.
www.arc.org.uk
accessed 7 November 2005.
- BNF British National Formulary 50, September 2005.
Reviewed by Dr James Quekett, Bsc.MB Ch.B MRCGP DRCOG DFFP. partner/principal general practitioner at Rowcroft Medical Centre.
Published by BUPA's health information team, healthinfo@bupa.com February 2006.
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