Gout

Gout is a type of arthritis where crystals of sodium urate form inside and around joints.

The most common symptom is sudden and severe pain in the joint, along with swelling and redness. The joint of the big toe is commonly affected, but it can develop in any joint. 

Symptoms develop rapidly and are at their worst point in just 6 to 24 hours. Symptoms usually last for 3 to 10 days (this is sometimes known as a gout attack).

After this time, the joint will start to feel and look normal again, and the pain of the attack should disappear completely.

Almost everyone with gout will have further attacks in the future.

Read more about the symptoms of gout.

What causes gout?

Gout is caused by a build-up of uric acid in the blood. Uric acid is a waste product made in the body every day and excreted mainly via the kidneys. It forms when the body breaks down chemicals in the cells known as purines.

If you produce too much uric acid or excrete too little when you urinate, the uric acid builds up and may cause tiny crystals of sodium urate to form in and around joints.

These hard, needle-shaped crystals build up slowly over several years. You will not know this is happening.

Eventually, when there is a high concentration of crystals in your joints, the crystals may cause two problems:

• some may spill over from the joint cartilage and inflame the soft lining of the joint (synovium), causing the pain and inflammation of an acute attack of gout
• some pack together to form hard, slowly expanding lumps of crystals (tophi), which can cause progressive damage to the joint cartilage and nearby bone; this eventually leads to irreversible joint damage, which causes pain and stiffness when the joint is being used

Factors that increase your risk of gout include:

• age and gender – gout is more common when you get older and is three to four times more likely in men
• being overweight or obese
• having high blood pressure or diabetes
• having close relatives with gout (gout often runs in families)
• having long-term kidney problems that reduce the elimination of uric acid
• a diet rich in purines, such as frequently eating sardines and liver
• drinking too much beer or spirits – these types of alcoholic drinks contain relatively high levels of purines

Read more about the possible causes of and risk factors for gout.

Treating gout

There are two main goals in treating gout:

• relieving symptoms – this can be done by using ice packs and taking non-steroidal anti-inflammatory drug (NSAID) painkillers; in some cases, alternative medications such as colchicine or corticosteroids may also be needed
• preventing future gout attacks – through a combination of lifestyle changes, such as losing weight if you are overweight, and taking a medication such as allopurinol, which lowers uric acid levels 

It is important to take any prescribed medication as directed and make any recommended lifestyle changes, such as losing weight.

Many people are able to reduce their uric acid levels sufficiently to dissolve the crystals that cause gout, resulting in their gout being "cured" with no further attacks.

Read more about treating gout.

Who is affected?

Gout is more common in men than in women. This is mainly because the female hormone oestrogen, which is released during the female reproductive cycle, reduces a woman's levels of uric acid by increasing the excretion of uric acid via the kidneys.

After the menopause, uric acid levels rise in women and they too can become liable to getting gout.

It is estimated that, overall, 1 in 45 people in the UK have gout. However, gout is more common in older adults, affecting 1 in 7 older men and 1 in 16 older women. This makes it the most common type of arthritis after osteoarthritis.

Gout symptoms usually occur after the age of 30 in men and after 60 in women. 

Complications

Complications of gout are uncommon but can include:

• kidney stones – high levels of uric acid can also lead to stones (uric acid and calcium stones) developing inside the kidneys
• tophus formation – tophi are small to large firm lumps sometimes visible and easily felt under the skin
• permanent joint damage – caused by ongoing joint inflammation between the acute attacks, and by formation of tophi within the joint that damage cartilage and bone; this is usually only a risk if gout is left untreated for many years

Read more about the complications of gout.