Gout

Gout is a form of arthritis caused by the build-up of uric acid crystals in a joint, leading to sudden, severe attacks of pain, redness, and swelling, most classically affecting the big toe.

• Sudden onset of intense pain, often overnight, most classically in the joint of the big toe
• Redness, warmth, and swelling of the affected joint
• The joint is often extremely tender, sometimes to the point that even light touch, such as bedsheets, is painful
• Attacks typically peak within 24 hours and then gradually improve over days to about two weeks, even without treatment
• Recurrent attacks can affect other joints, such as the ankle, knee, or fingers

• Results from elevated uric acid levels in the blood, which can crystallise within joints and trigger intense inflammation.
• Risk is increased by a diet high in certain foods (such as red meat, organ meats, and some seafood), excessive alcohol intake (particularly beer), obesity, and certain medicines such as some diuretics.
• Family history and underlying kidney disease can also contribute to elevated uric acid levels.

• Often diagnosed clinically based on the characteristic rapid onset of severe pain and swelling in a classic joint, such as the big toe.
• Blood testing for uric acid level can support the diagnosis, though levels can be normal during an acute attack.
• Joint fluid analysis, where available, showing characteristic uric acid crystals provides definitive confirmation, particularly if the diagnosis is uncertain.

Acute attacks are treated with an anti-inflammatory medicine, such as an NSAID or, where NSAIDs are not suitable, a short course of corticosteroids, started as early as possible in the attack for best effect.

Rest and elevation of the affected joint, along with avoiding pressure on it, help ease discomfort during an acute attack.

For people with recurrent attacks, long-term uric acid-lowering medicine (such as allopurinol) may be started once the acute attack has settled, to prevent future episodes and joint damage — starting it during an acute attack can sometimes worsen symptoms temporarily.

Addressing modifiable risk factors — diet, alcohol intake, and weight — supports long-term prevention alongside any prescribed medicine.

• Limit intake of foods high in purines, such as red meat, organ meats, and certain seafood.
• Limit alcohol intake, particularly beer.
• Maintain a healthy body weight.
• Stay well hydrated.
• Take long-term uric acid-lowering medicine consistently if prescribed, even between attacks, since stopping it can allow uric acid levels and attack risk to rise again.