Gout 

Introduction 

Gout: Patrick's story

Patrick, 54, was diagnosed with gout (a form of arthritis) 22 years ago. He describes the symptoms, treatment options and how he learned to live with the condition.

Media last reviewed: 02/10/2013

Next review due: 02/10/2015

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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.

Page last reviewed: 13/01/2014

Next review due: 13/01/2016

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The 10 comments posted are personal views. Any information they give has not been checked and may not be accurate.

modfather said on 09 April 2014

i have had gout since i was twenty, and over the years , have tried everything, some work most dont, but for me coconut milk does the trick, i had a bad bout, in greece and was out of tablets, and an old greek lady came to my rescue with this, she also told me people in greece who drink ozuo and rakie get it and those who dont , dont. but what i have found through the years what works for some does not work for others , i have given up drink for the last two years and eat healthy but still get the odd attack,

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pressplay said on 16 January 2014

My first gout attack happened in my mid - late 30's when I at one of my fittest points in my life. I did drink (prob more than recommended) beer and about 6 cups of coffee a day.
My longest gout attack has been about 2 weeks and the shortest just over a day. I have had it in big toe, whole foot, knees and wrists (wrist attacks only last a matter of hours).
I find that I get gout more often and more severe when I do regular fitness (90 mins 4 -5 times a week). During my more sedatory periods (fitness 3-4 @ 60 min) I have gone 18 months - 2 years without any serious attack ( any chance that uric acid can be a bi-product cell/muscle use).
The problem is most gout sufferers and doctors have a very subjective view and assumptions of cause and cures/remedies. Being as this is now much more common in the population, surely it is time for an extensive study with daily diary inputs from gout sufferers. Then at least there will be some meta-data information on which gout sufferers can call upon.
BE WELL EVERYONE

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netty177 said on 28 July 2013

My brother is 37 yrs old and has gout in his knees and elbows but also has Aspergers Syndrome. He currently has long hair and is struggling to brush it so much so that we had to have clumps of his hair cut out yesterday as it was too knotted. Does anyone have ant suggestions to help us to help him bearing in mind he can be hard to communicate to due to the Asdpergers.
Thanks in anticipation

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pinkpixie said on 07 March 2013

Im a 36 yr old female , i first experienced a bout of gout in my big toe around 5 yrs ago , ive had numerous bouts over the yrs , but over the last year ins now appearing in my ankles , wrists , , showing as swelling of my feet , ankles , fingers , and severe joint pain mainly affecting my ankles , toes , but also moderate pain in my wrists , i was prescribed dicloflex , which does help sometimes , was also prescribed a medication , that i cannot recall the name of , but gp said it could make things worse before they get better , long story made short , i was experiencing maybe 1 or 2 bad bouts a year affecting just my toe joint , but once i started this drug i was in pain all the time , I could just about cope with the bouts when it was confined to my toe joint , but now its affecting main joints , a few days ago i could not get out of bed , the pains in my ankles were excruciating , at present the pain is moderate , but my hands/fingers , feet / toes are so swollen , I dont eat much red meat , I do drink white wine , i am a little over weight , i dont exercise that much ,, Any advice or help would be great ,, i also find heat makes things worse , even a moderately warm room makes the pain and swelling worse , i cant go on like it much more , each bout is worse than the last , and they seem so frequent these days ,, its like one bout on top of another !!!!

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Gouter said on 28 December 2012

What resolved my serious Gout was giving up Coffee, it went immediatly.

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Gouter said on 28 December 2012

I am 60 years old and have suffered from Gout for 20 Years. I have had it in the classic Toe plus Feet, Knees and Elbow .

I used to drink Beer everyday, so in desperasion stoped drinking assuming this must be the problem. This did not work, so the next step was to give up the Six cups of Coffee a day, replacing with De Caff Tea,this worked nearly immediatly.

Whether I had a deyhydration problem I dont know. I drank some Dr Peppers and got Gout feelings, and on checking this contains mainly caffeen, further proof.

Ironicaly I can now drink Beer with no affect,

I would strongly reccoment it if you are a Gout sufferer give up any caffeen ingestion.

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Sharpleft said on 28 December 2012

I think the mistake being made here in my opinion, given the comments made, is the difference between what is acidic and what is acid causing once processed by our body. Lemons for instance are very acidic in their raw state but are actually alkaline forming when we eat them so will never cause an acidifying affect on us. The vast majority of fruit and vegetables have the same alkaline affect and will not cause gout or gout attacks, whereas red meat and alcohol will. I agree with Paul though that small amounts of alcohol shouldn't cause a problem.
A tip which works - A dessertspoon each of manuka honey and organic cider vinegar dissolved in water (warm dissolves it better obviously) and taken twice a day is very good for reducing joint inflammations over time. Must be organic cider vinegar and must be manuka honey though.

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Kate AJ said on 16 July 2011

Cubby, I think you will find that many apples are in fact acidic, having an average pH of 4.5
Avoid beer. Nobody needs alcohol anyway!
Paul, you need to read more & try to get someone to explain things to you if you don't understand. Having acid in a food does not mean they are acidic. (Milk has lactic acid but does not have a low pH value & is not therefore said to be acidic) Many of the food you point out have some acid in them but that does not mean they are bad for Gout sufferers. Amino acids are present in all protein foods & are essential to our nutrition, so if you don't really know what you are talking about please be very careful when giving out your advice.

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cubby said on 04 March 2011

I think Paul J some of what you write needs to be taken with a 'pinch of salt'!! Apples are not acidic. Citrus fruit is acidic. Apples are fine, and actually can assist with heartburn. Wine is acidic.

Drink plenty of water. Eat less acidic foods. Alcohol is not recommended for people with gout. My father suffered with gout, and so I do have quite a bit of knowledge of this unpleasant condition.

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Paul J said on 16 December 2010

It is misleading to only blame alcohol.

Gout is caused by the uric acid crystals.

Gout attacks can be caused by:-

1. Too many apples because they are acidic. An apple a day will not keep the gout away.

2. Drinking squashes and other so-called soft drinks because they contain acids.

3. Fried sausages

4. Insufficient daily physical exercise.

5. Factory made jams and marmalades.

6. Jelly Babies (chewy) sweets

7. Too much beer (more than 2 pints per occasion and more than 2 occasions a week).

8. Some 'healthy' green vegetables.

Modest amounts of wine are OK so too are small amounts of dark rum.

Experiment with your food intake and discover which foods give you, personally, gout.

Alter your diet and avoid animal fats - try boiling meat for 10 minutes and pouring away the fatty water before cooking the meat normally.

It is only small changes you will need to make but those changes are likely to make you healthier and fitter.

Paul J.

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