Gout: all you need to know

Gout is a common and often painful form of arthritis that affects millions worldwide, particularly impacting middle-aged and older adults. Characterised by sudden, intense joint pain, swelling, and redness, gout is caused by the build-up of uric acid in the body, which forms crystals in the joints. These flare-ups can be incredibly disruptive but are manageable with proper treatment and lifestyle adjustments.

We speak to a leading rheumatologist who helps you to understand the causes, symptoms, and treatments for gout.

How does gout develop?

Gout is a type of arthritis that leads to painful joint inflammation, often starting in the big toe. It occurs when the body builds up too much uric acid—a by-product that forms when we digest certain foods. Uric acid usually dissolves in the blood and is flushed out through the kidneys, but if there’s too much in the body, it can crystallise in the joints, causing sudden and intense pain.

What triggers gout attacks?

Several factors increase the likelihood of developing gout. Genetics can play a significant role, as it often runs in families. Diet also matters; foods high in purines, such as red meat, certain seafood, and alcohol, particularly beer, can raise uric acid levels. Other contributing factors include obesity, high blood pressure, kidney disease, and certain medications like diuretics (also called "water pills"), which can elevate uric acid levels and increase the risk of gout attacks.

What are the symptoms to look out for?

The main symptom of gout is sudden, intense pain in a joint, often the big toe but sometimes in the ankles, knees, wrists, or fingers. The affected joint becomes swollen, red, warm, and extremely tender—sometimes even a light touch can feel painful. This severe pain commonly begins at night and can last several hours. Although symptoms may improve within a week, untreated gout can lead to more frequent and severe attacks over time, potentially resulting in chronic joint damage and the formation of hard uric acid deposits called tophi under the skin.

How do doctors diagnose gout?

If you experience symptoms of gout, it’s essential to consult a healthcare provider. A diagnosis is often made based on a physical examination and your medical history. Blood tests can measure uric acid levels, though high levels alone don’t always indicate gout. Sometimes, a doctor may take a small fluid sample from the affected joint to check for uric acid crystals under a microscope. This joint aspiration is a highly effective way to confirm gout.

What treatments are available?

Gout is highly treatable, and managing it effectively can reduce both the frequency and severity of attacks. During an acute gout flare-up, doctors may prescribe medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids to relieve pain and inflammation. To prevent future attacks, long-term medications that reduce uric acid levels, like allopurinol or febuxostat, may be recommended.

Making lifestyle changes is also crucial in managing gout. Limiting foods high in purines, staying hydrated, reducing alcohol intake, and maintaining a healthy weight are helpful steps. Regular but moderate exercise during pain-free periods can also help control gout.

When should you seek medical help?

If you experience a sudden and intense joint pain, it’s wise to seek medical advice, as it could be a gout attack or another condition. Early diagnosis and treatment can alleviate pain and reduce the risk of complications.

Recurrent gout attacks may indicate a need for ongoing treatment to keep uric acid levels in check. With proper medical care and lifestyle adjustments, gout can be effectively managed, allowing you to lead a more comfortable life.