You wake up to a sharp pain in your big toe that feels as though someone has dropped a rock on it. The slightest movement, or lightest contact with the duvet, causes you to wince or cry out. This is what a gout attack feels like.
What is gout?
Gout is a form of arthritis sometimes called gouty arthritis. It causes swelling in the joints resulting in discomfort, severe pain and tenderness.1a It can occur in all your joints, particularly those near the end of a limb, such as your hand, wrist, elbow, knee, ankle or foot, but more commonly starting in the big toe.2a
What causes gout?
A popular untruth is that gout happens only to obese people or people that drink too much alcohol.3a While alcohol and an unhealthy diet contribute to gout, the real cause is how effectively your body breaks down purines into uric acid.4
How gout develops
Purines are substances made naturally in your body.5a They are also found in certain foods.5b
Your liver breaks down purines into waste called uric acid, which is released into your bloodstream.6a The uric acid gets filtered by your kidneys and passed out of your body through your urine.6b If your body makes too much uric acid or cannot get rid of uric acid properly, it builds up in your blood. This causes small sharp crystals to form in and around the joints, which leads to gout.4b
Purine-rich foods include red meat and organ meat like kidney and liver, seafood, and sugary drinks such as sodas and juices. 1b, 5c
Who gets it?
Gout usually affects middle-aged or older people, men especially, and women after menopause, but occasionally young adults and children get it too.
Risk factors that may increase uric acid levels in your body:
- Family history of gout
- Other medical conditions
- Recent surgery
- Purine-rich diet
- Drinking alcohol
- Certain medications5d, 7a
Signs and symptoms
Signs and symptoms usually happen suddenly, often at night, typically lasting 3-10 days. Some people have a gout attack every few weeks whereas others have them every few years.1c
Typical symptoms include:
- Severe joint pain – usually most intense in the first 4 to 12 hours
- The joint feels hot and tender
- Swelling occurs in and around the affected joint
- The skin covering the joint is red and shiny
- Joint stiffness or difficulty moving your joint normally2b, 5e
How gout is diagnosed
See your doctor if you suddenly experience pain and or swelling in one or more of your joints.1d, 7b He will likely ask you for details on your gout attack such as where it occurred in your body, and how quick and intense the episode was. He will also ask about medications you are taking, other medical conditions, your diet, alcohol intake, and whether you have a family history of gout.1e A physical examination will follow to inspect the affected joint and look for any signs of tophi.1f
Untreated gout may result in uric acid crystals forming under the skin, in and around the affected joint. These are called tophi.
Tests to diagnose gout may include:
- Joint fluid test which involves taking a fluid sample from the affected joint to examine microscopically for uric acid crystals
- Blood and urine tests to measure uric acid levels in your bloodstream – you may need additional blood and urine tests to check if your kidneys are working properly
- X-ray imaging to rule out other possible causes of joint inflammation1g, 5g
Treatment and prevention
Your doctor will likely prescribe medication for pain and swelling. You may also require long-term medication to either reduce your uric acid production or improve your body’s ability to remove uric acid from your system.8a
More than 50% of people who have a first attack of gout will have a second.1h Untreated gout can cause infection or lead to permanent damage to your joints and kidneys.5h Proper treatment and self-care can prevent permanent damage to your joints.
To prevent gout attacks:
- Limit your intake of alcohol and purine-rich foods
- Follow a healthy diet, exercise and keep your body at a healthy weight
- Drink plenty of fluids, especially water to stay hydrated5i, 7c, 8b
⦁ Harvard Health Publishing. Gout. Available at: https://www.health.harvard.edu/a_to_z/gout-a-to-z. Accessed 19 September 2019.
⦁ NHS inform. Gout. Available at: https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/gout. Accessed 19 September 2019.
⦁ American Kidney Fund. Gout myths and facts. Available at: http://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/complications/gout/gout-myths-and-facts/. Accessed 19 September 2019.
⦁ Arthritis Foundation. Gout Diagnosis. Available at: https://www.arthritis.org/about-arthritis/types/gout/diagnosing.php. Accessed 19 September 2019.
⦁ Mayo Clinic. Gout. Available at: https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897. Accessed 19 September 2019.
⦁ Arthritis health. What Are Purines? Available at: https://www.arthritis-health.com/types/gout/what-are-purines. Accessed 19 September 2019.
⦁ National Institute of Arthritis and Musculoskeletal and Skin Diseases. Gout. Available at: https://www.niams.nih.gov/health-topics/gout. Accessed 19 September 2019.
⦁ Rush. 5 Facts About Gout. Available at: https://www.rush.edu/health-wellness/discover-health/5-facts-about-gout. Accessed 19 September 2019.