Gout

What is gout?

Gout is a painful and usually short-term type of inflammatory arthritis. The onset of gout is sometimes described as a gout attack.

Gout happens when you have a high level of uric acid, a natural chemical that your body makes and also gets from food. Your kidneys help control your uric acid levels by getting rid of the excess in your pee.

If you build up a high level of uric acid over time or your kidneys aren’t getting rid of it fast enough, the uric acid can turn into crystals that cause the sudden pain of gout. This usually happens around a joint but can also occur under the skin.

What are the symptoms of gout?

Gout symptoms usually come on suddenly. The signs to look out for are:

• Severe pain in a joint – the big toe usually starts to hurt first, but your feet, knees, hands, wrists or elbows can also be affected

• Redness, heat and swelling at the painful joint

A gout attack usually lasts for 5 to 7 days. If the pain gets worse or you develop a high temperature, nausea or appetite loss, speak to a GP immediately. These are signs of an infection.

What causes gout?

Gout can be caused by:

• Having a fever

• Drinking too much alcohol or eating a high-fat meal

• Dehydration

• Injuring a joint

• Certain medications

How common is gout?

Gout mainly affects older people and is more common in men. Women can also get gout, and it’s more likely after menopause. It can run in families, and lifestyle plays a big part in whether you’re likely to get it.

Your risk of getting gout is higher if you’re:

• Overweight

• Drink alcohol

• On medication for high blood pressure or if you take diuretics (water tablets)

• Experiencing kidney problems, high blood pressure, high cholesterol, diabetes or osteoarthritis

• Injured or have recently had surgery

How is gout diagnosed?

A GP will want to know about your eating and drinking habits. They may want to do a blood test to check your uric acid levels, or they might advise you to have a scan. Occasionally, they may refer you to a gout specialist (rheumatologist).

You may need to have a small amount of fluid taken from your joint. This is done by inserting a thin needle into the area.

Gout treatment

Gout treatment focuses on reducing pain and swelling. GPs usually recommend ibuprofen first, which is a non-steroidal anti-inflammatory (NSAID).

If the pain and swelling continue, they may prescribe steroid tablets. In some cases, you may need a steroid injection.

While you’re having treatment for gout, avoid putting pressure on the joint. It’s essential to rest and raise the affected joint and avoid covering it with bedding or blankets to reduce heat around the area.

You should also:

• Take your prescribed medicine according to the GP’s instructions as soon as possible after getting it

• Use an ice pack regularly, or hold a bag of frozen peas wrapped in a cloth on the joint for up to 20 minutes

• Stay well hydrated with water unless a GP has said otherwise

If you have repeated gout attacks or tests show that you have high levels of uric acid, you might need urate-lowering therapies (oral medicines known as ULTs). You’ll need to take these gout treatments even when your symptoms have improved.

How can I prevent gout?

Gout can come back if your uric acid levels remain high or rise again in the future.

You can reduce your risk of developing gout again by making positive lifestyle changes and sticking to them. These include:

• Eating a well-balanced diet – a GP might advise certain foods to avoid

• Working towards maintaining a healthy weight, but without using crash diets

• Going alcohol-free for a few days each week

• Staying well hydrated

• Getting regular exercise – low impact activities like walking and swimming are ideal

• Stopping smoking

• Taking supplements – ask the GP to advise you which ones

Healthy diet changes

Certain foods can increase the level of uric acid in your blood and increase your risk of gout. You don’t need to avoid them altogether, but you should avoid eating them in large quantities.

Foods to eat in moderation are:

• Red meat and offal, like kidneys or liver

• Oily fish and shellfish, like anchovies and sardines

• Sugary drinks and snacks

• High-fat meals and snacks

• Yeast extracts

Alcohol and gout

Alcohol, particularly beer, can increase your uric acid levels.

It would help if you aimed to drink no more than 14 units of alcohol a week and spread it across seven days.

The GP might advise that you drink less than this for a while.

Complications of gout

If you get gout regularly (sometimes called chronic gout), your joints may become damaged.

Chronic gout can also result in small, white painful lumps on your fingers, elbows and ears called tophi. If your uric levels are high, kidney stones are another possible complication. You can reduce your risk by following the treatment for gout advised by a GP.

How can Livi help?

A Livi doctor will ask you questions about your symptoms. They’ll make an individual assessment, recommend a treatment or refer you to a specialist if needed.