Gout

Gout is a painful inflammatory condition, caused by the build-up of uric acid (urate) in your joints. It is the most common form of inflammatory arthritis worldwide, and more people in the UK are being diagnosed with it every year. ¹

Gout causes sudden attacks of pain and swelling in the affected joints, which might be accompanied by redness and tenderness. The big toe is the most common place to be affected by gout.

Many people just put up with the painful and uncomfortable symptoms of gout, not realising there are ways to manage and reduce them. ² At Circle Health Group, we offer a range of treatments to help manage and treat the causes and symptoms of gout, and many people find them extremely effective at improving their quality and enjoyment of life.

If you are struggling with gout or think you may be developing gout and would appreciate expert assessment and guidance, the staff at your local Circle hospital will be delighted to help you.

With fast, simple access to an experienced consultant rheumatologist, you will be able to get the tailored support and expert guidance you need without the wait.

Gout occurs when somebody has a higher-than-normal level of uric acid in their blood.

It is normal and healthy to have uric acid in our blood. Problems occur when the uric acid level is higher than normal, and the body is not able to bring it down to a lower level naturally. 

So why would somebody have a higher level of uric acid in their blood?

Every day, our bodies create chemicals known as purines. (Some foods and drinks also contain purines.) As our body breaks down these purines, uric acid is formed. Roughly 75% of the uric acid in our bodies comes from this breakdown of purines, with only 25% coming from food and drink.

As the level of uric acid in our body increases, it is removed by the kidneys and excreted in urine. If something causes your body to make too much uric acid, or your kidneys are not able to filter and remove enough of it from the blood, the levels of uric acid in your body will begin to increase.

Over time, this can cause urate crystals to form. These mainly develop in and around your joints, in the soft tissues such as cartilage. Occasionally, these crystals can also be deposited in the skin, leading to the formation of painful and unsightly nodules. Similar nodules can also form in the internal organs. But for the most part, gout affects the joints.

Many people with gout will find that they don’t have any symptoms on a daily basis. Symptoms often only become noticeable when they are having a flare-up (also referred to as a ‘flare’ or an ‘attack’) of gout.

A gout attack can vary in duration, ranging from a few days to a week or longer.

An attack tends to occur when a build-up of urate crystals in a joint causes some of the crystals to spill out into the space between the bones in the joint. As the joint is used, the bones move across one another and the hard, sharp urate crystals rub against the soft lining of the joint. This causes swelling, pain and inflammation inside the joint.

During an attack of gout, the main symptoms people may experience in the affected joint(s) are:

• Pain
• Redness
• Swelling
• Hot to the touch
• Tenderness

“Almost always, gout starts in either a big toe joint or an ankle,” explains Consultant Physician & Rheumatologist Dr Gerald Coakley, “The affected joint becomes intensely painful, red, hot and swollen. The skin over the joint may appear shiny and may peel. The pain increases to a peak within 24 hours and often becomes so severe that even contact with a sock or bedsheet becomes unbearable.”

Although gout will often start in a big toe or ankle, other joints that are commonly affected include:

• Knees
• Elbows
• Wrists
• Fingers

In severe cases, gout can be exceptionally painful and debilitating.

Without effective treatment, gout will tend to slowly develop in other joints in the body, such as the knees, then later to the hands and elbows.

If left untreated for a longer time, uric acid may build up in the soft tissues around the joints, eventually forming hard lumps known as gouty tophi.  These lumps are pure liquid uric acid. In some cases, these gouty tophi can discharge golden-yellow liquid through the skin.

Over time, uric acid will cause damage to a joint. Similarly, if left untreated so long that it starts to build up in the kidneys, it can cause high blood pressure and could eventually lead to kidney damage and impairment.  

High levels of uric acid may also lead to health problems such as:

• Osteoarthritis
• Kidney stones
• Narrowing of arteries

For these reasons (and many more), it is important to get treatment for gout at the earliest possible stage. Effective treatments can help:

• Manage the symptoms of gout
• Lower the levels of uric acid
• Reduce the risk of developing additional health problems in the future

Compared to many other medical conditions, gout is usually quite simple to diagnose, particularly if you have common symptoms such as pain in your big toe.

In other cases, certain diagnostic tests or investigations may be helpful in reaching a diagnosis. These may include:

• Blood tests: If high levels of uric acid are found in your blood, it can be an indicator of gout. However, it is not definitive by itself, as there are other reasons you may have raised levels
• Ultrasound: This can be helpful in detecting crystals in the joint
• CT scan: A cat scan is useful for showing damage to the joint
• X-ray: Standard (plain) X-rays may show damage in a joint that has been caused by long-term gout

Once a diagnosis of gout has been made, tailored treatment can be transformative. Treatment can help to:

• Soothe an acute attack
• Prevent future attacks

Treatment for an acute attack is focused on managing your symptoms, whereas treatment to prevent future attacks is directed at lowering levels of uric acid in the blood.

Treatment for an acute attack of gout

Managing an acute attack is usually straightforward, although a combination of medications may be required. You might be given a non-steroidal anti-inflammatory (NSAID) such as ibuprofen. In extreme cases, you might be given steroid medication.

Many people find that an ice pack applied to the affected joint helps to relieve pain and swelling. Similarly, resting the joint as much as practical can help to reduce the severity of any pain.

Your consultant rheumatologist will ensure you receive the optimal combination and dose to give you the best relief of symptoms possible.

Preventing future attacks of gout

To help prevent future attacks, uric acid lowering therapy is usually required in parallel with other medication. This helps to lower your risk of future attacks and to prevent long-term damage to the joints and kidneys that are a risk of untreated gout.  

Although it may seem like a nuisance to require life-long medication, most people who have experienced recurrent gout find this treatment is a small price to pay to avoid severe pain and disability in the future. 

Lifestyle changes to reduce your chances of gout

You may be advised to make changes to your diet, to help reduce the amount of purine you take in through foods. High-purine foods include bacon, turkey, anchovies and sardines. All alcoholic drinks are high in purine. Your consultant will advise you on appropriate dietary adjustments and may arrange for you to meet with a Circle Health Group dietician for further guidance if needed.

The very best results come from treatment that is tailored to the individual, monitored over time, and adjusted as necessary. Your Circle consultant will oversee every aspect of your care to ensure you receive the most appropriate treatment plan for your specific symptoms and needs.

There are certain things that can increase your risk of developing gout. These include:

Genetics

If you have a family history of gout, it is more likely that you will develop the condition.

Gender

Men are four times more likely to develop gout than women.

Obesity

Gout is much more common in people who are overweight. If you’re overweight, you are also more likely to develop:

• High blood pressure
• Diabetes
• High cholesterol

These conditions can lower the rate your kidneys filter out uric acid.

Menopause

The female hormone oestrogen increases how much uric acid is filtered by the kidneys. After the menopause, levels of oestrogen are reduced, causing the level of uric acid in the blood to rise. This increases the risk of developing gout.

Diet

You should moderate intake of meat and limit foods such as shellfish which are very high in purines. Sugary fizzy drinks and fruit juices in cartons which are high in fructose should be consumed in moderation.

Alcohol consumption should be kept to within the recommended limits set by the Department of Health. And keep well hydrated, particularly in hot weather.

Certain medications

Diuretics, beta blockers and ACE inhibitors all affect how effectively your kidneys can remove uric acid from the blood. In addition, when you first start taking medicine to lower your levels of uric acid, it may trigger a gout attack.

The symptoms of gout can be horrible to live with, but the right treatment can often help to significantly improve things. For most people, gout symptoms can be managed and reduced so that they’re no longer living with severe pain or lack of mobility.

Dr Daniel Fishman, a consultant rheumatologist at our Bishops Wood Hospital Northwood, says: “Gout is completely treatable with lifestyle advice and medication, which prevents the painful attacks of gouty arthritis and dissolves the nodules, preventing long-term joint and skin damage.”

Effective help for gout is available. You don’t need to struggle with frustrating and debilitating symptoms for the rest of your life.

If you would like to talk to one of our consultants, it’s very easy to book an appointment with us. Simply give us a call on 0141 300 5009 or use our easy online booking system.

References and further reading

¹Guideline for the Management of Gout, The British Society for Rheumatology

²Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study, PubMed 

Content reviewed by Dr Abbas Ismail in July 2022. Next review due July 2025.