Gout
النقرس
A form of inflammatory arthritis caused by a buildup of uric acid crystals in a joint, most classically the big toe, causing sudden, severe pain, swelling, and redness. Attacks are triggered by high uric acid levels, and both acute attacks and long-term uric acid control are treatable with medication and dietary changes.
This information is for general awareness only and does not replace professional medical advice. Consult a doctor for diagnosis and treatment.
Quick answer
Gout is a form of inflammatory arthritis caused by too much uric acid in the blood, which forms sharp crystals in and around a joint. It often starts in the big toe.
Attacks cause sudden, severe pain, swelling, redness and heat in a joint, often at night. They usually settle within days to a couple of weeks, but can return.
Diagnosis uses your symptoms, blood uric acid and sometimes joint fluid analysis. Treatment relieves attacks with anti-inflammatory medicine and, for people with frequent attacks, lowers uric acid long-term. Seek prompt care for a hot, swollen joint — especially with fever, as infection must be excluded.
Symptoms
Sudden, severe joint pain
Often starts at night and peaks within hours.
Swelling and warmth of the joint
Redness and shiny skin over the joint
Big toe most commonly affected
Also ankles, knees, wrists, fingers and elbows.
Extreme tenderness
Even the weight of a sheet can be painful.
Lumps under the skin (tophi)
Seen in long-standing, poorly controlled gout.
Attacks that settle then return
Symptom-free periods may last months or years.
Symptom guides
Causes and risk factors
Causes
- High uric acid (hyperuricaemia) — Uric acid crystals form in joints when levels stay high.
- Reduced uric acid removal by the kidneys — The most common reason levels rise.
- Purine-rich foods and drinks — Red and organ meat, some seafood, sugary drinks and alcohol (especially beer) can raise uric acid.
- Certain medicines — For example some diuretics (water tablets).
Risk factors
- Being male, or a woman after menopause
- Obesity
- High blood pressure and heart disease
- Chronic kidney disease
- High alcohol and sugary-drink intake
- Family history of gout
- Use of diuretics or certain other medicines
How is it diagnosed?
Gout is often suspected from the typical pattern of symptoms; tests support the diagnosis and rule out other causes.
Symptoms and examination
A hot, swollen, tender joint, most often the big toe.
Blood uric acid
Can be normal during an attack, so it is interpreted with other findings.
Joint fluid analysis
Fluid drawn from the joint can show uric acid crystals and rule out infection — the most definitive test.
Imaging
X-ray, ultrasound or dual-energy CT may be used to look for crystal deposits or joint damage.
Treatment
Treatment has two parts: settling an attack, and — for people with recurrent attacks — lowering uric acid to prevent more. Which medicines are suitable depends on your kidneys, other conditions and other medicines, so they are chosen by your doctor.
Treating an attack
Anti-inflammatory medicines, colchicine or short courses of steroids are commonly used, started early and chosen to suit your health. Resting and cooling the joint can help.
Long-term uric-acid lowering
For frequent attacks, tophi or joint damage, daily medicines can lower uric acid. Treatment is usually continued long term and monitored with blood tests.
Diet and lifestyle
Limiting alcohol, sugary drinks and high-purine foods, keeping a healthy weight and staying hydrated.
Managing related conditions
Controlling blood pressure, kidney health and other conditions that contribute to gout.
Starting or stopping uric-acid-lowering medicines can trigger attacks; follow your doctor's plan.
When should you see a doctor?
Arrange a medical assessment if
- A hot, swollen, painful joint that appears suddenly
- Repeated attacks
- Lumps forming near joints
- Gout with kidney disease, heart disease or use of diuretics
- Side effects from gout medicines
Seek urgent care if
- A hot, swollen joint together with fever or chills (possible joint infection)
- Severe joint pain that stops you moving the joint or bearing weight and does not settle
- Signs of an allergic reaction (rash, facial swelling, breathing difficulty) after starting a medicine
Prevention
Limit alcohol
Especially beer and spirits.
Reduce sugary drinks
Fructose-sweetened drinks can raise uric acid.
Moderate purine-rich foods
Red and organ meats and some seafood.
Maintain a healthy weight
Gradual weight loss lowers uric acid; crash diets can trigger attacks.
Stay hydrated
Frequently asked questions
What is gout?
A type of arthritis caused by uric acid crystals building up in a joint, causing sudden pain, swelling and redness.
What triggers a gout attack?
Common triggers include alcohol, large purine-rich meals, dehydration, illness, injury or surgery, and starting or stopping certain medicines.
Is gout the same as high uric acid?
No. Many people with high uric acid never develop gout, and uric acid can be normal during an attack. Doctors look at symptoms and other tests.
Can gout be cured?
It cannot be cured in the usual sense, but long-term treatment can lower uric acid, prevent attacks and reduce joint damage.
Does gout only affect the big toe?
The big toe is the classic site, but gout can affect other joints such as the ankle, knee, wrist and fingers.
Can gout damage the kidneys?
High uric acid can contribute to kidney stones and, with long-standing disease, kidney problems. Gout and kidney disease also often occur together.
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