Everything you need to know about gout

What is gout?

Gout is a type of arthritis that leads to sudden and severe swelling in your joints — this is known as a gout attack. These attacks typically last between 5-7 days. Gout most commonly affects your hands, feet, wrists, elbows, and knees.

Gout is also linked to other medical conditions — like type 2 diabetes and high blood pressure.

What are the symptoms of gout?

The most common symptoms of gout include:

• joint redness and swelling — your joints might feel warm to touch
• joint pain and stiffness
• visible changes in the shape of your joints 

If you think you have gout, you should seek advice from a healthcare professional to get treatment and rule out any other medical conditions.

What causes gout?

Gout is mainly caused by high uric acid levels in your blood. Your body naturally produces uric acid when you digest foods containing purines — like red meat. Usually, your kidneys remove uric acid and it’s passed in your urine. When uric acid levels become too high, it can sometimes lead to painful crystals forming in your joints.

What are the risk factors for gout?

Certain medical conditions and lifestyle factors can increase your risk of developing gout. The most common ones include:

• eating red meat and organ meat — like kidney and liver 
• drinking excess amounts of alcohol — particularly beer
• carrying excess weight
• high blood pressure — as well as medication for this
• high cholesterol
• very-low-calorie diets
• diuretics (water tablets) — like aspirin 

What foods cause gout?

If you have gout, it’s essential to limit purine-rich foods that contribute to high uric acid levels in your blood.

The most common high-purine foods include:

• red meat
• organ meat 
• some seafood — like prawns, mussels, and clams
• refined sugars — like fizzy drinks and biscuits 

Instead, you should aim to eat a diet low in purines, like:

• dairy — milk, cheese, yoghurt, and butter
• eggs
• whole grains — like oats, brown rice, and whole-grain bread 
• fruit — particularly cherries
• vegetables — research shows that eating high-purine vegetables are safe as they're not linked to gout attacks

How to get a gout diagnosis

If you think you might have gout, it's best to speak to your GP. Diagnosis can involve joint fluid tests, x-rays, and ultrasounds as it's also possible to have normal uric acid levels with gout.

How to treat gout attacks

Sudden (acute) gout attacks are usually treated with nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen. It’s a good idea to speak to your GP for advice before taking any medication.

To help relieve the pain, you should also:

• rest the affected joint in an elevated position
• apply an ice pack to your skin (covered by a towel)
• increase your water intake to 16 glasses a day — check with your GP about doing this

Gout attacks can last between 5-7 days. It’s essential to get treatment quickly if you feel an attack coming on, as if you get regular gout attacks (chronic gout), they can cause long-term damage to your joints. Chronic gout also causes tiny white lumps (tophi) to form under your skin — these might be visible on your ears, fingers, or elbows.

You should see your GP straight away if the pain and swelling doesn’t subside after 7 days, or if you feel sick and have a temperature over 38C.

How to prevent gout attacks

By making some healthy lifestyle changes, like reducing your uric acid levels, you can lower your risk of developing gout. You can check your uric acid levels at home with a finger-prick blood test.

You can lower your uric acid levels by:

• limiting your alcohol intake to no more than 14 units a week  — also aim for a few alcohol-free days
• managing your weight safely — avoid very-low-calorie diets 
• exercising at least twice a week
• staying hydrated — aim to drink 2 litres (8 glasses) of water each day

Gout treatment and medication

If you have chronic gout, your GP might recommend urate-lowering therapy (ULT) to help reduce your uric acid levels. Usually, this can be done with a medication called allopurinol. 

Allopurinol is effective at reducing the amount of uric acid in your blood. It also helps prevent damage to your joints when taken regularly. Your GP will advise you to start taking allopurinol a week after an acute gout attack has settled. It might take several months before you start to feel the effects of allopurinol, and you might get more gout attacks when first starting treatment — NSAIDs can help with this. 

Allopurinol isn’t suitable for some people — your GP will be able to advise if it’s the right medication for you and will explain the risks and benefits of taking it.