Gout is a condition that cause swelling and pain in your joints, usually in your arms or legs.
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Gout is a type of arthritis, which causes inflammation of your joints. It causes pain and swelling, usually in one joint in your body – commonly your big toe. However, it can affect any of your joints, including those found in your:
- feet and ankles
- hands, fingers and wrists
Gout is caused by a build up of uric acid crystals in your affected joints.
It's more common in men, particularly those aged 30 to 60, and in older people.
You may only ever have gout once in your life and it may go away without any treatment.
The first symptoms of gout in your affected joint include:
- severe pain
- swelling and warmth around the area
- red and shiny skin around the area, which may peel later on
You may also have a mild fever.
If you have gout that reoccurs over many years, you may have further symptoms. This can include firm, white lumps developing beneath your skin – these are made of uric acid crystals and are called tophi. Tophi usually take up to 10 years to develop from your first episode of gout. Having tophi can lead to a range of problems, including:
- the tophi becoming inflamed, which can cause discomfort
- tophi breaking down and leaking out a white, paste-like substance
You may want to discuss with your GP treatments to ease discomfort from having tophi. However, taking antibiotics for inflamed or leaking tophi won’t help because tophi aren’t caused by bacteria.
These symptoms may be caused by problems other than gout. If you have any of these symptoms, see your GP for advice.
Having gout won’t always lead to further problems, but you can reduce your risk of having complications by having treatment and making changes to your lifestyle and diet.
The most common complication of gout is progressive joint damage, which leads to long-term pain, deformed joints and eventually, disability. This may be prevented by changes to your diet and by taking medicines that lower your uric acid levels. There is also some evidence that prolonged high levels of uric acid in your body can increase your risk of vascular diseases, which may lead to a heart attack or stroke.
Other complications that you may have are as follows.
- Gout affecting several of your joints (called polyarticular gout). This happens more often in older people with gout.
- Getting kidney stones (if uric acid crystals collect in your urinary tract). This happens to between one and three in 10 people who have gout.
- Damage to your kidneys (if uric acid crystals collect in your kidney tissue).
You can develop gout if you have too much uric acid in your body. Uric acid is a chemical that everyone has in their blood. It's a waste product formed from substances called purines, which are found in every cell in your body and certain foods. Uric acid is formed in your body when the purines in foods you eat are broken down. It’s also formed when old cells in your body are broken down and replaced by new cells. Excess uric acid is passed through your kidneys and out of your body in your urine. However, the level of uric acid in your blood can rise if:
- your kidneys don't pass uric acid quickly enough
- your body produces too much uric acid
If the level of uric acid in your body is too high, it can form tiny crystals that collect in your tissues, particularly in and around your joints. This is what may cause your swelling and pain. These crystals tend to form at a cooler body temperature, which is why gout is more common in your fingers and toes.
You may have high levels of uric acid, but not get gout, or you may get gout, but not have high levels of uric acid. It's not known why some people develop gout and others don't. However, there are certain factors that can increase your likelihood of getting gout. You're more likely to get gout if you:
- are a man aged 30 to 60
- are a woman who has been through the menopause
- eat a diet that contains high levels of purines, which are found in red meat, seafood and some other foods
- drink too much alcohol, especially beer
- don’t drink enough fluids daily and become dehydrated
- take certain medicines, such as diuretics (water tablets), which increase the flow of urine from your body
- have a family history of gout
- have kidney disease meaning that your kidneys don't pass enough uric acid out in your urine
- are overweight, have diabetes or high blood pressure
- have psoriasis (itchy, dry and flaky skin), which can sometimes cause your body to produce too much uric acid
- are taking certain types of cancer medicines
Your GP will ask about your symptoms and examine you. He or she will also ask you about your medical history and that of your family. Your GP will usually take a sample of your blood, which will be sent to a laboratory to measure the levels of uric acid. Your blood sample may also be tested to find out whether there may be another reason for your symptoms.
Your GP may refer you to a rheumatologist (a doctor specialising in conditions that affect the joints) for further tests.
Your doctor may remove some fluid from your swollen joint with a needle. This usually causes no more discomfort than a blood test. If uric acid crystals can be seen in the fluid under a microscope, you have gout. If calcium crystals are seen, you have a similar condition called pseudogout. The crystals formed when you have pseudogout are made of a calcium salt called calcium pyrophosphate. See our frequently asked questions for more information. You may need to have an X-ray of your joint in order to rule out other conditions and to find out if any damage has occurred, but this isn’t used to diagnose gout.
You will usually have symptoms of gout for up to two weeks and then they will go away, even without treatment. You may only have one episode of gout in your lifetime, but it might return. If you have no treatment to prevent gout, the risk of it returning within three years is over eight in 10. If you don’t have treatment, having gout may become more frequent and last for longer.
There are a number of steps you can take to reduce the pain and swelling from having gout.
- Raise and rest your joint. Don’t do any vigorous physical activity. Rarely, your doctor may give you a splint to wear to stop you moving your joint.
- Keep your joint cool and don't cover it. Ice the affected joint using an ice pack or ice wrapped in a towel for about 20 minutes at a time to reduce swelling and bruising. Don’t apply ice directly to your skin as it can damage it. If you need to repeat this, let your joint return to its normal temperature first.
- Drink enough water.
There are medicines your doctor can prescribe to help to ease your pain and swelling from gout.
Your doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, which may relieve pain and inflammation. If you have a heart condition, high blood pressure, kidney or lung disease, or if you're over 65, these medicines may be harmful, so you need to talk to your doctor before taking them. Don’t take aspirin because this medicine can affect your uric acid levels and make your gout last longer.
If NSAIDs aren't suitable for you, your doctor may prescribe a medicine called colchicine instead. Colchicine also reduces inflammation, but in a different way to NSAIDs. You may have side-effects from this medicine including diarrhoea, but this can be reduced by taking lower doses.
Occasionally, your doctor may prescribe steroid tablets if you can't take NSAIDs or colchicine. Alternatively, he or she may recommend a steroid joint injection if you have gout in a large joint (such as your knee).
Identifying things that cause you to have gout symptoms can help you to eliminate these triggers and reduce your chances of having it again. Gout can be prevented from reoccurring so often and so severely by making changes to your diet and taking medicines if needed.
What you choose to eat and drink can have an impact on gout. There are some foods that are very high in purines, which can increase the amount of uric acid in your blood. It’s best not to eat much of these foods very often. These include:
- liver and kidneys
- oily fish, such as mackerel, sardines and anchovies
- shellfish, including mussels, crab and shrimp
- certain vegetables, such as asparagus, cauliflower, lentils, mushrooms and spinach
- oats and oatmeal
If you’re planning to make changes to your diet, ask your doctor or a dietitian for advice to ensure you still get all the nutrients you need. Eating a well-balanced diet will help you to manage your symptoms. See our frequently asked questions for more information.
Aim to drink less alcohol – especially cutting out beer, stout, port and fortified wines because these can have the greatest effect on causing gout symptoms. Drinking enough water every day will help to dilute your blood and urine, lowering the uric acid levels in your body.
If you need to lose excess weight, doing regular exercise will help you towards your goal. The recommended healthy level of physical activity is 150 minutes (two and a half hours) of moderate exercise over a week in bouts of 10 minutes or more. You can do this by carrying out 30 minutes on at least five days each week.
In addition to changing your diet, you may need medicines to prevent gout. These help control the levels of uric acid in your blood. The aim is to prevent you getting gout again and if you do, make it last for a shorter time and be less severe. These medicines aren't used to treat symptoms of gout and are usually prescribed several weeks after your last gout symptoms have gone.
Your doctor may prescribe you a medicine called allopurinol to take daily. An alternative is febuxostat if there is a reason why you can’t take allopurinol. Both of these medicines prevent gout by stopping the formation of uric acid. Both allopurinol and febuxostat may actually cause more symptoms of gout when you first start taking them. To help prevent this happening, your doctor may prescribe NSAIDs, colchicine or steroid tablets for you to take alongside allopurinol or febuxostat for up to three months. Make sure you drink enough fluids when taking these medicines.
Your doctor may prescribe you other medicines, such as probenecid, to increase the amount of uric acid that is removed from your body in your urine.
Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.
1. I've been diagnosed with gout. Are there any foods I shouldn’t eat?
To reduce your gout symptoms and how often you get it, you can help yourself by not eating foods that contain very high levels of purines. Purines are substances that are broken down into uric acid and can make gout worse. Foods that contain high levels of purines include certain meats, seafood and pulses.
Gout is caused by a build up of uric acid, a waste product formed from purines (which are found in every cell in your body and certain foods). Your diet plays an important role in causing gout and making changes can reduce your risk of it coming back.
If you have gout, certain foods that are very high in purines can make it worse. These foods include:
- meats, such as red meat and offal (eg liver and kidneys)
- game (eg pheasant and rabbit)
- seafood (shellfish including mussels and shrimp)
- oily fish, such as sardines and herring
- yeast-containing food and drink, such as Marmite and beer
- mushrooms and foods made from mushrooms (eg Quorn)
- certain vegetables (eg cauliflower, asparagus and spinach)
- beans and pulses (eg lentils)
There is no need to cut out all of these foods completely because they still contain other essential nutrients (for example, protein and iron in red meat), but reducing how much of them you eat can help with gout. Instead, you could eat more sources of protein that are low in purines, such as milk, cheese and eggs.
You may find that other foods make your gout worse. These can include strawberries, oranges and tomatoes. If these foods affect you, it's probably best not to eat them. If you have gout, cutting down on how much alcohol, especially beer, you drink can improve your symptoms. Drinking excessive amounts of alcohol can trigger symptoms of gout, even if you’re already taking medicines to prevent it.
Reducing how much food and drink you have that contains high levels of fructose, such as sugar-sweetened soft drinks, fruit juice and sweet fruits like raisins, can help to prevent gout. This is because fructose can raise the level of uric acid in your blood, which makes gout worse.
Maintaining a low purine, healthy, balanced diet will help you to manage your gout symptoms. However, depending on your condition, you may need to take medicines prescribed by your doctor to help treat your symptoms and prevent gout from coming back again.
2. I've been diagnosed with pseudogout. What's the difference between that and 'real' gout?
You're diagnosed with pseudogout when the pain and swelling in your joint is caused by a build up of different crystals to the ones that cause 'real' gout. Pseudogout may also be called calcium pyrophosphate crystal arthritis.
You can develop gout if you have too much uric acid in your body. Uric acid is a chemical that everybody has in their blood. If the level of uric acid in your body is too high, it can form tiny crystals that collect in your tissues, particularly in and around your joints. This is what may cause your swelling and pain.
The crystals formed when you have pseudogout aren't uric acid crystals, as they are with 'real' gout. They are made of a calcium salt called calcium pyrophosphate. These crystals can often be seen on an X-ray of your affected joints.
Pseudogout is most common in people over 65, with men and women affected in equal numbers. Any joint can be affected, but often it will be your knee or wrist. Pseudogout usually starts with severe pain, stiffness and swelling, and settles on its own, getting better within two weeks. Sometimes, if you have another illness, it can set off pseudogout, but often there is no apparent reason for it starting.
Like gout, pseudogout can return, or become a long-term (chronic) condition. A chronic illness is one that lasts a long time, sometimes for the rest of the affected person’s life. When describing an illness, the term ‘chronic’ refers to how long a person has it, not to how serious a condition is.
Although you can be treated for pseudogout with similar medicines to those used for gout, if you get chronic pseudogout, there are fewer treatment options to prevent it or reduce the frequency of it happening. Some patients may need to take NSAIDs or steroids long term because there is no treatment to lower the levels of the crystals that cause pseudogout.
If you think you may have gout or pseudogout, contact your GP for advice.
3. I have had gout a few times and I am now taking allopurinol. Can I expect any serious side-effects?
In general, serious side-effects from allopurinol are very rare and this medicine is suitable for long term use. However, as with any medicine, look out for anything unusual and see your GP if you're worried.
Allopurinol is a medicine that prevents gout by stopping the formation of uric acid.
You may get symptoms of gout during the first few months after you first start taking allopurinol. Your GP or rheumatologist (a doctor who specialises in conditions that affect the joints) may prescribe you a non-steroidal anti-inflammatory drug (NSAID), or a medicine called colchicine to take alongside allopurinol to try to prevent this.
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This leaflet is for information only. For a detailed opinion or personal advice, please consult with your own doctor
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