Gout
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- The key to controlling gout is a daily uric-acid-lowering medicine, taken to a target blood level and kept up long term. This is what stops attacks for good.
- Allopurinol is the usual first-choice medicine, started at a low dose and slowly increased. Starting low lowers the risk of side effects and of setting off an attack.
- When you first start a uric-acid-lowering medicine, attacks can happen more often for a while, so your team gives a second medicine alongside it for at least a few months to prevent them.
- An attack is treated with an anti-inflammatory medicine such as colchicine, an NSAID, or a steroid, started early. Which one is chosen depends on you and your other conditions.
- Cutting back on alcohol, on foods very high in purines, and on drinks with high-fructose corn syrup can help, and losing weight helps if you carry extra. These support the medicine rather than replace it.
Understanding this condition
What gout is
Gout is a form of arthritis. It happens when the level of uric acid in the blood stays high, and tiny needle-shaped crystals form in and around the joints. When the body reacts to these crystals, the joint becomes suddenly red, hot, swollen, and very painful. This is called a flare or attack. Over time, if the uric acid is not lowered, the crystals build up and can cause lasting joint damage and lumps called tophi. Gout is very treatable.
Common symptoms
The classic attack is sudden and severe pain in one joint, often the base of the big toe, which becomes red, hot, and swollen, sometimes overnight. Attacks can also hit the ankle, knee, midfoot, or fingers. Early on, attacks come and go with pain-free gaps in between. If gout is not treated over years, attacks can become more frequent, affect more joints, and hard lumps of crystals called tophi can form under the skin.
Who gets it
Gout is common, and it is more common in men and in older adults. In the United States it affects about 4 in 100 adults. Things that raise uric acid make gout more likely, including kidney problems, some blood-pressure medicines, being overweight, and a diet high in alcohol, red meat, shellfish, and sugary drinks. A family history can play a part too.
How it is diagnosed
Gout is often recognised from the pattern of a sudden, very painful, red joint, along with a blood test for uric acid. The most certain way to confirm it is to take a small sample of fluid from the joint and look for the crystals under a microscope. Imaging such as ultrasound or a special CT scan can also show crystal deposits. Your team decides which tests you need.
What to expect over time
With the right treatment, the outlook for gout is very good. Lowering uric acid to target and keeping it there stops attacks and, over time, dissolves the crystals so that many people become attack-free. Left untreated, gout tends to get worse, with more frequent attacks, more joints involved, tophi, and joint damage. Gout also often travels with high blood pressure, kidney disease, and heart problems, which is why the whole picture is looked at.
Living with and treating it
The goals of treatment
There are two goals. First, settle an attack quickly when it happens. Second, and most important for the long term, lower your uric acid with a daily medicine to a target level and keep it there. Reaching and holding that target is what stops future attacks and clears the crystals.
Treatment options
For an attack, anti-inflammatory medicines settle the pain: colchicine, an NSAID, or a steroid, chosen to fit you. For the long term, a uric-acid-lowering medicine is the mainstay. Allopurinol is usually first choice, started low and slowly increased to reach your target. When you first start it, a second medicine is given alongside for a few months to prevent attacks. Cutting back on alcohol, high-purine foods, and sugary drinks, and losing weight if needed, all help support the medicine.
Monitoring and check-ups
Because gout is treated to a target, your uric acid is checked with blood tests, more often while the dose is being adjusted and then to make sure it stays at target. Your team also keeps an eye on your kidneys and other conditions. Some people are offered a blood test before starting allopurinol to check for a gene that raises the risk of a serious reaction.
Flares and how they are treated
A flare is a sudden attack of a hot, swollen, very painful joint. Treat it early: colchicine, an NSAID, or a steroid all work, and applying ice can help alongside the medicine. Starting your uric-acid-lowering medicine does not need to wait for the attack to fully settle. Once you are on a lowering medicine at target, flares become rarer and eventually stop.
Living well with gout
Staying on your uric-acid-lowering medicine every day, even when you feel fine, is the single most important thing. Alongside it, limiting alcohol, cutting back on foods very high in purines such as red meat and shellfish, reducing drinks with high-fructose corn syrup, staying well hydrated, and losing weight if you carry extra all help. These support your medicine rather than replace it, and small steady changes work best.
Related conditions to watch for
Gout often comes with high blood pressure, kidney disease, diabetes, and heart problems, so your team looks after the whole picture. Some blood-pressure medicines can raise uric acid, so where it is practical your doctor may switch one, and a blood-pressure medicine called losartan is sometimes preferred because it also lowers uric acid a little. If you take low-dose aspirin for your heart, it is generally not stopped just because of gout.
What to expect at your appointment
At a visit for gout, expect questions about your attacks, your other health conditions, and your medicines, and an examination of the affected joints looking for swelling or tophi. You may have blood tests for uric acid and kidney function, and sometimes fluid is taken from a joint or a scan is arranged. You and your team then set a plan built around lowering your uric acid to target and managing attacks. Your care may involve a team, which can include your rheumatologist or family doctor, a specialist nurse or advanced practice provider, and a pharmacist, working together in whichever model your clinic uses.
The target in gout is a blood uric acid level below 6. Your daily medicine is adjusted until you reach it, and then kept up long term to hold it there. Staying below the target is what stops attacks and slowly clears the crystals. Your team checks it with blood tests.
Track your urate level and flaresRecord your blood urate against the target and keep a simple flare diary, save and print for your visit→How treatment is stepped up
- 1
Treat the flare
When an attack strikes, treat it early. Colchicine, an anti-inflammatory (NSAID), or a steroid all work well, and the choice is made to fit you and your other conditions. Applying ice to the joint can help alongside the medicine.
- 2
Start urate-lowering therapy when indicated
If you have frequent attacks, tophi, or joint damage from gout, a daily uric-acid-lowering medicine is recommended. Allopurinol is usually first choice. It is started at a low dose and slowly increased.
- 3
Prophylaxis and titrate to target
When you start the uric-acid-lowering medicine, your team gives a second medicine alongside it for at least a few months to prevent attacks while your levels settle. The dose of the main medicine is adjusted using blood tests until your uric acid is below the target, then kept there.
- 4
Alternatives and refractory disease
If allopurinol is not suitable or not enough, other uric-acid-lowering medicines such as febuxostat or probenecid can be used. For severe gout with many tophi that has not responded to the usual medicines, an infused medicine called pegloticase may be considered.
Medication guides
Plain-language guides to the medicines used for this condition. Each has a patient and a clinician view.
The numbers, in plain terms
about 4 in 100
In the United States, about 4 in 100 adults have gout, which makes it the most common form of inflammatory arthritis.
Living well, beyond the diagnosis
The whole-person side of living with a rheumatic disease, the parts patients tell us matter most. These guides apply across conditions.
When to get medical help
- A hot, swollen, very painful joint with a fever or feeling unwell. A joint infection can look like a gout attack and needs urgent assessment to tell them apart.
- A rash, especially with fever, mouth sores, or peeling skin, after starting allopurinol or another new medicine. This can be a sign of a serious drug reaction and needs prompt medical attention.
- Severe stomach pain, vomiting, or diarrhoea while taking colchicine, or if you take other medicines that can interact with it, since colchicine can build up to harmful levels.
- Black or bloody stools, stomach pain, or unusual bruising while taking an anti-inflammatory (NSAID), which can point to bleeding.
- Attacks that keep happening or get worse despite treatment, or new lumps (tophi) appearing, so your plan can be adjusted.