Gout: Symptoms, Treatment and Preventing Attacks

The body produces uric acid, also called urate, when it breaks down substances called purines. Purines come from the body's own cells and from some foods and drinks.

Urate normally dissolves in the blood and leaves the body through the kidneys, in urine.

If the level of urate in the blood stays too high, sharp crystals can slowly form in or around joints. When these crystals are disturbed, they can trigger sudden inflammation — severe pain, heat and swelling.

A high blood urate level does not always cause gout. Many people with a raised level never have an attack. Equally, gout cannot be confirmed from one symptom, one test or one episode alone — a clinician looks at the whole picture.

A gout attack can involve:

• sudden, severe joint pain
• pain that often begins overnight or in the early hours
• heat and swelling around the joint
• extreme tenderness, so even light touch hurts
• skin over the joint that looks red, purple or unusually dark
• difficulty wearing a shoe, walking, or letting bedding touch the area
• peeling, itching or lingering discomfort as the swelling settles

Changes in skin colour can be harder to see on brown or black skin. Heat, swelling, tenderness and any change from the person's usual skin appearance are all important, whatever their skin tone.

An untreated attack often lasts around one to two weeks. Later attacks may last longer or affect more joints, which is one reason it is worth getting gout assessed rather than waiting each episode out.

The joint at the base of the big toe is the best-known site, but gout may also affect:

• other toe and foot joints
• ankles
• knees
• fingers
• hands
• wrists
• elbows

Gout can affect more than one joint, either at the same time or over the years.

Not all foot pain or joint pain is gout. Many other conditions cause similar symptoms, so an assessment matters.

Please contact a GP if:

• there are possible gout symptoms for the first time
• gout is already diagnosed but the usual treatment is not helping
• attacks are becoming more frequent
• the diagnosis is uncertain
• lumps are developing around joints or under the skin
• pain or stiffness continues between attacks
• gout is affecting walking, sleep, work or everyday life
• the person has kidney disease or kidney stones
• a medicine is causing side effects or is difficult to manage

Ask for an urgent GP appointment or contact NHS 111 if pain is worsening and there is a high temperature, shivering, sickness, an inability to eat, or the person feels seriously unwell. This could be a joint infection.

A healthcare professional may use a combination of:

• the pattern and speed of the symptoms
• examination of the affected joint
• medical and family history
• the medicines currently being taken
• a blood test to measure urate
• a sample of fluid taken from the joint
• an ultrasound scan, X-ray or other imaging when needed

A urate blood test taken during a flare can sometimes come back below the usual level used to support a diagnosis. NICE advises repeating the test at least two weeks after the flare has settled if gout is still strongly suspected.

Please do not try to interpret blood-test results without a clinician. Numbers only make sense alongside symptoms, history and other tests.

A hot, painful, swollen joint can have several causes, including:

• septic arthritis — an infection inside the joint
• calcium pyrophosphate crystal arthritis, sometimes called pseudogout
• injury
• osteoarthritis
• rheumatoid arthritis or another inflammatory arthritis
• bunions or other foot problems

Septic arthritis is the urgent concern. If a joint infection is suspected, it needs immediate professional assessment — not home treatment and not a wait-and-see approach.

Treatment is chosen according to the person's medical history, kidney function and other medicines. What suits one person may be unsuitable or unsafe for another.

Treatments a healthcare professional may prescribe or recommend include:

• a non-steroidal anti-inflammatory drug, known as an NSAID
• colchicine
• corticosteroid tablets or an injection

No one treatment is right for everybody. NSAIDs may be unsuitable for some people, particularly those with kidney, stomach, heart or blood-pressure problems, or people taking certain other medicines.

This page does not include medicine dosages. Follow the instructions given by the prescriber and the information supplied with the medicine.

Never use someone else's medication, and do not combine painkillers without checking first with a pharmacist, GP or prescriber.

• take prescribed treatment as directed, and as early in the attack as advised
• rest the affected joint
• raise the painful limb when possible
• avoid pressure, knocks and tight footwear
• keep bedding away from the painful joint if contact hurts
• apply a cold pack wrapped in a towel for up to 20 minutes
• let the skin return to its normal temperature before applying cold again
• drink enough water, unless a doctor or other clinician has advised limiting fluids

Please also note:

• Never apply ice directly to the skin.
• Do not use a cold pack for more than 20 minutes at a time.
• People with poor circulation, reduced skin sensation or diabetes should ask a healthcare professional before using cold treatment.
• Seek professional advice if symptoms are getting worse or are not settling as expected.

Medicine used to settle a painful flare is different from long-term treatment intended to prevent future attacks.

Medicines such as allopurinol or febuxostat are examples that may be prescribed to lower urate levels. Which one, if any, is suitable is a decision for the prescriber.

Long-term treatment gradually dissolves the urate crystals already in the body and can reduce or prevent future attacks. It may need to be taken for life.

• Take prescribed urate-lowering medicine regularly, even when there are no symptoms.
• Do not stop or change it without speaking to the prescriber.
• Starting or changing urate-lowering treatment can sometimes trigger a flare at first. This does not necessarily mean the medicine is failing.
• Blood tests may be needed so the dose can be adjusted safely.
• Please attend monitoring appointments.

NICE describes urate targets that clinicians use to guide and monitor prescribed treatment. They are not instructions for people to self-treat or adjust their own medicine.

Gout can be more likely in people who:

• have kidney problems
• have high blood pressure
• have high cholesterol
• have diabetes
• have osteoarthritis
• are overweight
• have been through the menopause
• have a family history of gout
• have had an operation, an injury or a serious illness

Some medicines may raise urate levels, including certain diuretics, sometimes called water tablets.

• Never stop a prescribed medicine because you think it caused gout.
• Ask a GP or pharmacist for a medication review instead.
• Bring an up-to-date list of medicines to appointments.
• Mention kidney disease and every other medicine before receiving treatment for a flare.

Gout is a medical condition, not a personal failing. Nobody should be blamed for developing it.

No single food causes every case of gout, and diet alone is not always enough to control urate levels. NICE states that there is not enough evidence to recommend one specific diet for preventing flares or lowering urate.

A healthy, balanced eating pattern is worth aiming for, with professional advice where it is needed.

Things that some people find are linked with attacks, and sensible limits, include:

• large or unusually rich meals
• frequent or heavy alcohol consumption, particularly beer and spirits
• sugary drinks
• large amounts of red meat or offal
• some seafood
• dehydration
• crash dieting or rapid weight loss

It can help to:

• eat regular, balanced meals
• lose weight gradually if that has been recommended
• avoid crash diets
• drink enough water, unless fluid intake has been restricted on medical advice
• have alcohol-free days
• stay within current UK lower-risk alcohol guidance
• ask a GP or dietitian for individual advice

Please do not cut out major food groups or start supplements without professional guidance.

A gout flare can make standing, walking, dressing, washing, sleeping and preparing food genuinely difficult, sometimes for a couple of weeks.

Practical things that may help:

• keep prescribed medicine within safe reach
• use loose, supportive footwear when it can be tolerated
• arrange help with meals, shopping or collecting prescriptions during a severe flare
• reduce trip hazards if walking is difficult
• use a walking aid only if it has been properly adjusted for the person
• ask a pharmacist about prescription delivery or easier medicine packaging
• request reasonable communication support at appointments
• take a trusted person, or a written record of symptoms, if communication is difficult

If someone suddenly cannot walk safely or care for themselves, please seek both medical advice and practical help rather than trying to manage alone.

• avoid tight shoes that press on the affected joint
• use wide, soft footwear once it can be tolerated
• do not massage a severely inflamed joint
• avoid intense exercise or pressure on the joint during a flare
• return to movement gradually as pain and swelling settle
• ask about podiatry or physiotherapy if pain, footwear or mobility remains difficult

People with diabetes, poor circulation, numbness, broken skin or a foot wound should seek professional foot-care advice rather than treating the problem themselves.

• take urate-lowering medication consistently when it has been prescribed
• attend blood tests and reviews
• stay hydrated, unless advised otherwise on medical grounds
• maintain a healthy weight without crash dieting
• limit alcohol
• avoid personal triggers identified over time
• discuss medicines with a clinician if you think one may be contributing
• treat associated health conditions such as blood pressure, diabetes or kidney disease
• keep a simple record of attacks, possible triggers and how treatment worked

Lifestyle changes support treatment. They are not a replacement for prescribed urate-lowering medication when it is needed.

• more frequent or longer attacks
• lasting joint damage
• chronic gouty arthritis
• reduced mobility
• urate deposits called tophi
• kidney stones

Tophi are firm deposits of urate that may develop around fingers, toes, elbows, ears or other areas after long-term uncontrolled gout.

Please ask for a medical review rather than trying to squeeze, cut or drain any lump. Doing so risks infection and further damage.

Before contacting a GP surgery, pharmacy or other service, it can help to:

• write down when the pain started
• note which joint is affected
• record any temperature, sickness or shivering
• list current medicines and any allergies
• photograph visible swelling or colour changes, if that feels appropriate
• ask for information in writing
• take someone trusted to an appointment
• ask for communication adjustments if they would help

Sixpence Support UK can help draft a letter or email to a GP surgery, pharmacy, employer, housing provider or other service about gout-related support or communication needs. We do not give legal or medical advice.

Urgent NHS advice differs across the UK:

• England: contact NHS 111 by phone on 111 or use NHS 111 online.
• Scotland: contact your GP practice, or phone 111 when the practice is closed. NHS inform gives health information but is not an assessment service.
• Wales: contact NHS 111 Wales by phone on 111, or use the NHS 111 Wales website.
• Northern Ireland: contact your GP practice, or the GP out-of-hours service when the practice is closed. Details are on nidirect.

In an emergency, or if someone becomes seriously unwell, call 999.

These are official or well-established UK sources. Details can change, so please check each organisation's own website for the latest information.