Medically Reviewed by: Hussain Abdeh MPharm: 2211840
Updated on: 01/07/2021
What is gout?
Gout is a form of arthritis caused by excessive uric acid in the bloodstream. It can cause sudden bouts of swelling, pain, tenderness, and redness in the joints.
Gout attacks can occur very quickly and usually occur in the middle of the night. The joint at the base of the big toe is a common location for gout.
The excessive amount of uric acid that is present in the body forms crystals, particularly in a number of joints throughout the body. The symptoms of gout that are caused as a result of this is the body’s natural response trying to prevent and fight against a gout attack.
Gout can be extremely painful and can cause lasting damage to the surrounding tissue in the inflamed area. Gout is most common in men, although women can also be affected by it, particularly after they have gone through the menopause.
Individuals who suffer from gout are also at a greater risk of developing serious health problems like hypertension, cardiovascular disease, and obesity.
The four stages of gout
Before the gout attack
This is the stage before experiencing a gout attack. At this stage there are usually no symptoms, although uric acid levels are high and are starting to crystallise in the joints. The forming of the crystals is known as asymptomatic hyperuricemia.
This stage is where the uric acid levels within the body have now crystallised and are moving around the joint. The gout attack may be triggered by an injury (such as stubbing your toe), elevated alcohol consumption, drugs or an underlying illness or infection. The attack will usually start at night and will progressively worsen over the next few hours. In some cases, it can take around 10 days for the pain and discomfort to ease.
This stage is the time in between gout attacks.
For people who have a high uric acid level for a prolonged period of time (usually 10 years or more), the gout attacks will occur more frequently.
What are the early signs and symptoms of gout?
The symptoms of gout typically arise quickly and can be commonly experienced at night. Early symptoms include:
- Severe joint pain, usually affecting the big toe's large joint (but any joint can be affected)
- Swelling, tenderness, and redness of the affected joints
- Discomfort, which can last for days or weeks
- An inhibited range of motion in the affected joints
Gout can affect the following areas of the body:
- Big toes
You should see a GP if you experience any of the symptoms listed above.
If spotted and treated early enough, gout will not cause any lasting damage to your joints or surrounding tissue.
Causes and triggers of gout
The direct cause of gout is the accumulation of uric acid in the body, which later develops into crystals; this then leads to severe pain and inflammation. These crystals typically form when uric acid levels in the blood are high.
There are other indirect causes and triggers, such as certain foods. This is because uric acid is produced when purines in the body are broken down. These natural purines are also found in meat and seafood, meaning that they could constitute as triggers. Beer and drinks containing fruit sugars are high in uric acid and could also bring on gout attacks.
High uric acid levels can occur due to the kidneys not excreting enough uric acid, or the body producing too much. As a result, if uric acid is not excreted from the body, this can cause needle-like crystals to develop. This can result in intense pain and severe inflammation of the joint and surrounding tissue.
There are several known risk factors which can increase the chances of developing gout due to high uric acid levels. These factors include:
- Obesity, which can lead to more uric acid production and make it harder for the kidneys to excrete uric acid
- Diet and lifestyle – Alcohol can interfere with the kidneys’ natural function, which can affect the body’s ability to remove uric acid from the body
- Genetics and family history of gout
- Age and gender – Gout is more common in men between the ages of 30 and 50 and postmenopausal women
- Surgery and untreated medical conditions like diabetes, kidney disease, heart disease and high blood pressure
- Suffering from a different form of arthritis such as rheumatoid arthritis or psoriatic arthritis
How is gout diagnosed?
There are several methods for diagnosing gout. A joint fluid test can be employed to view urate crystals in fluid drawn from the affected joint, using a microscope.
Blood test results can also measure uric acid levels. Furthermore, imaging tests such as ultrasounds, x-rays and dual-energy CT scans are other ways to detect urate crystals and rule out other possible problems.
How is it treated?
Medication is a primary method of treating gout. Gout attacks can be treated with a range of medicines, including:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen 250mg and 500mg tablets
- Colchicine (a pain reliever)
- Corticosteroids like prednisone, taken as pills or as an injection (generally used for people who cannot take colchicine or NSAIDs)
Typically, if the pain and discomfort does not subside after three or four days, your doctor may choose to give you a steroid in the form of a tablet or injection.
There are also medicines which can be taken to prevent gout. These include xanthine oxidase inhibitors (XOIs) like allopurinol and febuxostat, which work to block uric acid.
Medicines classed as uricosurics like lesinurad and probenecid, which serve to reduce uric acid levels and prevent gout, may also be prescribed. They can have side effects including stomach pain and rashes.
Furthermore, you can make changes to your lifestyle or use home remedies to treat gout. Try limiting the number of alcoholic drinks you consume each week, as well as steering clear of drinks which have been sweetened with fructose. Substitute these drinks with water.
Exercise regularly and aim to lose any excess weight. Avoid foods which are high in purines, such as red meat and seafood.
The Anti-Inflammatory Diet is known to help with other forms of arthritis and inflammation. While this may not cure your gout, a complete lifestyle and diet overhaul can dramatically decrease the likelihood of a gout attack.
If the treatments suggested above have largely proven ineffective, you may wish to try an alternative approach. Some alternative methods that you may find beneficial include supplements and foods that can lower uric acid levels. These include:
- Vitamin C supplements - A study found that Vitamin C intake reduced the risk of gout by 44%
Talk to your doctor before you start using these alternative treatment methods.
Gout prevention tips
There are several ways in which you can help to prevent gout. These include:
- Limiting alcohol intake or avoiding alcoholic drinks altogether
- Drinking a lot of water
- Cutting down on the amount of red meat, poultry, and fish you eat – substitute with low-fat dairy products
- Maintaining a healthy bodyweight