Gout

Gout is a type of arthritis where small crystals form inside and around the joints. The crystals cause sudden flares of severe pain and swelling.

The pain can be very bad, but there are treatments that help relieve the symptoms and prevent further flares.

Gout can affect any joint, but it usually shows up in joints towards the ends of the limbs, like:

• toes, especially the big toe
• ankles
• knees
• fingers

The signs and symptoms of gout include:

• severe pain in 1 or more joints
• the joint feeling hot and very tender
• swelling in and around the affected joint
• red, shiny skin over the affected joint

Almost everyone with gout will have further flares at some point, usually within a year.

Gout flares tend to follow a pattern:

• they often happen at night, but they can come at any time
• they develop quickly, over a few hours
• they last between 3 and 10 days
• they come back, and you may have flares every few months or every few years
• they become more frequent over time if gout isn't treated

After a flare, the affected joint should start to return to normal. But the problem can persist if treatment isn't started early.

It's hard to predict how often gout flares will happen, or exactly when. Repeated flares can lead to joint pain and joint deformities.

• severe, worsening joint pain and swelling
• a high temperature (fever) of 38C (100.4F) or above

This could mean you have an infection inside the joint (septic arthritis). If your doctor's chamber is closed, call a doctor or the 16263 health line.

• you have symptoms of gout for the first time
• you have gout and your usual treatments don't start working within a couple of days

Your doctor will start by asking about your symptoms and medical history, and will examine the affected area. They may also ask about your diet and whether anyone in your family has had gout.

Sometimes further tests are needed to confirm the diagnosis and rule out other possible causes.

A sample of fluid may be taken from the affected joint. This fluid can be checked for the small crystals that cause gout. It can also be tested for infection, to rule out septic arthritis.

A blood test called a serum urate test may be used to measure the amount of urate in your blood. A high level of urate is often linked with gout. Your doctor may wait 4 weeks after a flare of gout before doing this test. The level of urate in your blood often falls during a flare, so a level measured after you've recovered gives a better idea of your risk of future flares.

You may also have a test to check the levels of C-reactive protein (CRP) in your body. High CRP levels can be found in patients with acute inflammation, and this is frequently seen in patients who are having gout flares.

An X-ray is rarely used to diagnose gout, because the condition isn't usually detectable this way. But an X-ray is sometimes used to help rule out similar conditions that affect the joints, like chondrocalcinosis, which is a build-up of calcium crystals in the joints. It can also be used to assess whether repeated or persistent flares of gout have caused any joint damage.

An ultrasound scan of an affected joint is a simple and safe investigation, and it's increasingly used to detect crystals in the joints. It can also pick up crystals deep in the skin that aren't obvious during a physical examination.

Gout is caused by your body reacting to urate crystals that form in and around the joints. Urate is normally present in your blood, but if the level rises too high, tiny sharp crystals can build up. In a flare of gout, your body reacts to these crystals, and the joint becomes painful, red and swollen.

Some things may raise your chances of getting gout:

• obesity, high blood pressure and/or diabetes
• having a close relative with gout
• kidney problems
• eating foods that cause a build-up of urate, like red meat, offal and seafood
• drinking too much beer, spirits, fruit juices or sugary drinks
• some medicines, like diuretics, beta-blockers, niacin and some chemotherapy medicines

If you have gout, your doctor can treat it in two ways:

• relieve symptoms during a flare
• prevent further flares by taking urate lowering medicines like allopurinol

During a flare, you can ease the symptoms with ice packs and with medicines like:

• non-steroidal anti-inflammatory drugs (NSAIDs)
• colchicine
• corticosteroids

Preventative treatment, like allopurinol, helps many people bring their urate levels down enough to dissolve the crystals that cause gout. That means no more flares. But you will usually need to stay on treatment for life.

• Take any medicine your doctor has prescribed as early as you can after you notice a flare. It should start to work within 2 or 3 days.
• Rest, and raise the limb.
• Avoid knocking or damaging the affected joint.
• Keep the joint cool. Take off any clothing covering it and apply an ice pack, such as a bag of frozen peas wrapped in a towel.
• Make sure you drink enough fluids and stay well hydrated.

When you use an ice pack, put it on the joint for around 20 minutes. Don't put ice directly on your skin, and don't leave it on for more than 20 minutes at a time, because this could damage the skin.

If you need to, you can keep reapplying an ice pack during a flare. But wait until your skin has gone back to a normal temperature first.

Some practical changes to your daily routine can also lower your risk of more flares of gout. These are the main ones:

• losing weight if you're overweight
• keeping to a healthy weight
• avoiding foods high in purine (the chemical involved in making urate), such as red meat, offal, oily fish, seafood and foods containing yeast extract
• avoiding sugary drinks and snacks
• taking regular exercise, and choosing activities that don't put too much strain on your joints
• drinking plenty of water, because staying well hydrated lowers the risk of crystals forming in your joints
• cutting down on alcohol, especially beer and spirits, and not binge drinking

There's evidence that taking regular vitamin C supplements can lower your urate levels, though the effect may only be small. If you're thinking about taking them, talk to your doctor first, as they aren't suitable or safe for everyone.

Gout can sometimes lead to further problems, especially if it's left untreated. These can include:

• kidney stones
• small firm lumps of urate crystals under the skin, called tophi
• permanent joint damage

Gout can also affect your mood, your work and your home life. The pain is severe, and it can make everyday tasks hard and getting around harder. That can lead to feelings of depression or anxiety.

If gout is affecting your mood or making daily life difficult, talk to your doctor. They can offer treatment and support.

There are also organisations that give information and advice to people who have gout, including arthritis organisations.

Pseudogout can look and feel like gout, but the cause is different. It comes from a reaction to another kind of crystal in the joints. The knees or wrists are the places it affects more often.