Gout is a type of arthritis that causes sudden, severe joint pain. See a GP for treatment to help during an attack and to stop further attacks.

Check if it's gout

The main symptoms of gout are:

sudden severe pain in a joint – usually your big toe, but it can be in other joints in your feet, ankles, hands, wrists, elbows or knees
hot, swollen, red skin over the affected joint – redness may be harder to see on black or brown skin.

See a GP if:

• you have symptoms of gout for the first time
• you have gout and your usual treatments are not helping

An attack of gout usually lasts 1 to 2 weeks if left untreated. If you do not get treatment, future attacks may last even longer. Leaving gout untreated may cause lasting damage to joints.

Ask for an urgent GP appointment or get help from NHS 111 Wales if:

You have a sudden pain and swelling in a joint and:

• the pain is getting worse
• you also have a very high temperature (you feel hot and shivery)
• you also feel sick or cannot eat

These symptoms could mean you have an infection inside your joint and need urgent medical help.

What happens at your appointment

The GP may ask about your diet and if you drink alcohol if you have symptoms of gout.

They may also do a test to measure how much uric acid is in your blood. Uric acid is a chemical that can lead to crystals forming around your joints which cause pain.

If the test is still unclear, a GP may refer you to see a specialist (rheumatologist) and arrange further tests.

This could include taking a sample of fluid from inside the affected joint, using a thin needle. If this test cannot be done or the diagnosis is still unclear, then a scan will be arranged.

Treatments for gout

Treatment for gout attacks

Attacks of gout are usually treated with a non-steroidal anti-inflammatory medicine (NSAID) like ibuprofen.

If the pain and swelling does not improve you may be given steroids as tablets or an injection.

Treatment to prevent gout coming back

Gout can come back every few months or it may be years. It can come back more often if it's not treated.

If you have frequent attacks or you have high levels of uric acid in your blood, you may need uric acid-lowering medicine.

Important

It's important to take uric-acid-lowering medicine regularly, even when you no longer have symptoms.

Things you can do to help a gout attack

If you’re having a gout attack, there are things you can do to relieve the pain:

Do

• take any medicine you've been prescribed as soon as possible – it should start to work within 2 days
• rest and raise the limb
• keep the joint cool – apply an ice pack, or a bag of frozen peas, wrapped in a towel for up to 20 minutes at a time
• drink lots of water (unless a GP tells you not to)
• try to keep bedclothes off the affected joint at night

Don’t

• put pressure on the joint – this can make the pain feel worse

Who gets gout

Gout is caused by having too much uric acid in your blood. This can lead to crystals forming around your joints, which causes pain.

It sometimes runs in families.

It's more common in men, especially as they get older.

You might have a higher chance of getting gout if you:

• are overweight
• drink alcohol
• have been through the menopause
• take medicines such as diuretics (water tablets), or medicines for high blood pressure (such as ACE inhibitors)
• have high cholesterol, high blood pressure, kidney problems, osteoarthritis or diabetes
• have had surgery or an injury

Things that can trigger a gout attack

You might get a gout attack if you:

• have an illness that causes a high temperature
• drink too much alcohol or eat a very large, fatty meal
• get dehydrated
• injure a joint
• take certain medicines

Get treatment immediately if you feel an attack starting.

Things you can do to help prevent gout coming back

Making lifestyle changes might mean you can stop or reduce further attacks.

Do

• try to lose weight if you are overweight, but avoid crash diets
• eat a healthy diet, your doctor may give you a list of foods to include or limit
• have some alcohol-free days each week - try not to drink more than 14 units of alcohol a week
• drink plenty of fluids to avoid getting dehydrated
• exercise regularly – but avoid intense exercise or putting lots of pressure on joints
• try to quit smoking
• ask a GP about vitamin C supplements

Don't

• do not have lots of sugary drink and snacks
• do not eat lots of fatty foods

Complications of gout

If you get repeated attacks of gout over a long period of time (chronic gout), and are not treated it can lead to:

• damage in your joints
• hard lumps, called tophi, under your skin, usually on your ears, fingers or elbows – they can be painful and have an impact on your daily life
• kidney stones
• chronic arthritis – but this is rare