Gout

What is gout, and how common is it?

Gout (also called gouty arthritis) is a type of arthritis caused by urate crystals building up in a joint¹. When there's too much urate (also called uric acid) in the body, crystals can form in the joints and lead to inflammation and damage². It's the most common inflammatory arthritis³.

A flare brings sudden, severe pain, swelling, redness and warmth. The big toe is the joint most often affected, but gout can affect any joint¹³. Reported rates range from about 0.9% to 5.1% of people, depending on the country⁴⁵. It's more common in men and in older people⁶.

What causes gout, and who gets it?

Gout starts with high urate in the blood. Crystals can form slowly over months or years, usually without symptoms, and then trigger a sudden flare¹. Many people with high urate never get gout⁷.

Your risk is higher if you're older or male⁶, have a family history of gout, drink alcohol or sugar-sweetened drinks, or eat a diet rich in purines (usually from animal sources)⁷. Some medicines, including diuretics (fluid tablets) and low-dose aspirin, can raise the risk⁷. Please don't stop a prescribed medicine on your own; talk with whoever prescribes it.

Gout also goes along with heart disease, kidney disease and diabetes⁸. These are links, not proof that one causes the other. Genes also play a strong part³, so diet alone is rarely the whole explanation.

What does gout feel like, and how is it diagnosed?

A flare usually comes on quickly, often at night, with severe pain, swelling, warmth and redness over a joint that's very sore to touch¹². It's usually one joint at a time, often the big toe, but it can be another toe, the ankle or the knee⁹. Pain tends to peak within 24 hours and settle in 1–2 weeks². Redness may be harder to see on black or brown skin¹⁰.

A definite diagnosis comes from finding urate crystals in fluid taken from the joint. Guidelines recommend looking for them whenever gout is suspected¹¹. A blood urate test on its own isn't enough: it can be normal during a flare, and a high result doesn't prove gout⁶¹¹. If crystals can't be found, imaging such as ultrasound can help¹¹. A podiatrist or GP can refer you to a doctor for testing.

What helps a gout flare first?

A doctor's prescribed medicines are the main treatment for a flare. Guidelines recommend colchicine (a gout medicine), anti-inflammatory medicines (NSAIDs) or corticosteroids (steroid medicines), or a combination¹². Treatment is usually continued for a few days, typically 3–5 days¹³.

Starting early matters: guidelines advise treating a flare as early as possible, preferably within 12 hours of the first warning signs¹³. It can help to agree a flare plan with your doctor ahead of time.

Which medicine suits you depends on your other health conditions and how you've responded before¹³. Colchicine can cause diarrhoea and headache¹⁴. Anti-inflammatories can upset the stomach and possibly affect the heart⁶, and are best avoided with kidney problems¹³. Check with your doctor or a pharmacist first if you've had ulcers or heart or kidney disease.

What helps if that isn't enough?

If flares keep coming despite treatment, or your medicines cause side effects, go back to your doctor for a medicine review. It's also reasonable to ask about seeing a rheumatologist (a doctor who treats arthritis). Antibody medicines that block an inflammation signal are generally recommended for flares when other drugs have caused side effects or haven't worked². These are started by a doctor.

How long does gout last, and can I stop it coming back?

Each flare usually gets better within a week or two, and you often have no symptoms in between⁹. Left untreated, flares may come more often and last longer, and tophi (hard urate lumps under the skin) can develop over time⁹.

For long-term control, guidelines advise considering urate-lowering medicine from your first presentation, alongside education and non-drug steps¹². Your doctor prescribes it, adjusts it to your kidney function and monitors it¹². Keep taking it as directed, and talk with your doctor before changing it.

Weight loss is recommended if your BMI is above 25 kg/m2¹³. Alcohol and sugary drinks are linked with gout, so cutting back may help⁷. Because gout goes with heart and kidney conditions, guidelines recommend checking your blood pressure, kidneys and cardiovascular risk¹¹.