Along with the big toe, joints that are commonly affected are the lesser toe joints, the ankle, and the knee. Top of Page. Gout is caused by a condition known as hyperuricemia, where there is too much uric acid in the body. The body makes uric acid when it breaks down purines, which are found in your body and the foods you eat.
When there is too much uric acid in the body, uric acid crystals monosodium urate can build up in joints, fluids, and tissues within the body. Hyperuricemia does not always cause gout, and hyperuricemia without gout symptoms does not need to be treated.
A medical doctor diagnoses gout by assessing your symptoms and the results of your physical examination, X-rays, and lab tests. Gout can only be diagnosed during a flare when a joint is hot, swollen, and painful and when a lab test finds uric acid crystals in the affected joint.
The disease should be diagnosed and treated by a doctor or a team of doctors who specialize in care of gout patients. This is important because the signs and symptoms of gout are not specific and can look like signs and symptoms of other inflammatory diseases. Doctors who specialize in gout and other forms of arthritis are called rheumatologists.
To find a provider near you, visit the database of rheumatologists external icon on the American College of Rheumatology website. Once a rheumatologist has diagnosed and effectively treated your gout, a primary care provider can usually track your condition and help you manage your gout. Gout can be effectively treated and managed with medical treatment and self-management strategies. This content does not have an Arabic version.
Overview Gout is a common and complex form of arthritis that can affect anyone. Gout Open pop-up dialog box Close. Gout Gout causes intense pain and swelling around one or more joints. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Gout. Centers for Disease Control and Prevention. Accessed Dec. Goldman L, et al. Crystal deposition diseases. In: Goldman-Cecil Medicine. Elsevier; Ferri FF.
In: Ferri's Clinical Advisor American College of Rheumatology. Caffo AL. Diagnosing gout 5. Treating gout 6. Complications of gout. About gout Gout is a type of arthritis in which small crystals form inside and around the joints. It's estimated that between one and two in every people in the UK are affected by gout. Signs and symptoms of gout Any joint can be affected by gout, but it usually affects joints towards the ends of the limbs, such as the toes, ankles, knees and fingers.
Signs and symptoms of gout include: severe pain in one or more joints the joint feeling hot and very tender swelling in and around the affected joint red, shiny skin over the affected joint Symptoms develop rapidly over a few hours and typically last three to 10 days.
Almost everyone with gout will experience further attacks at some point, usually within a year. When to see your GP See your GP if you suspect you have gout and it hasn't been previously diagnosed, particularly if the pain keeps getting worse and you also have a high temperature fever. What causes gout? Gout is caused by a build-up of a substance called uric acid in the blood.
Treatments for gout If you have gout, treatment is available from your GP to: relieve symptoms during an attack — this can be done using ice packs and by taking medications such as non-steroidal anti-inflammatory drugs NSAIDs , colchicine or corticosteroids prevent further attacks — through a combination of lifestyle changes, such as losing weight or changing your diet, and taking medication that lowers uric acid levels, such as allopurinol With treatment, many people are able to reduce their uric acid levels sufficiently to dissolve the crystals that cause gout — and as a result have no further attacks.
Can gout cause further problems? Sometimes gout can lead to further problems, particularly if it's left untreated. These can include: kidney stones small firm lumps of uric acid crystals under the skin called tophi permanent joint damage Read more about the complications of gout. What's pseudogout? Symptoms of gout The main symptom of gout is a sudden attack of severe pain in one or more joints, typically your big toe.
Other symptoms can include: the joint feeling hot and very tender, to the point of being unable to bear anything touching it swelling in and around the affected joint red, shiny skin over the affected joint peeling, itchy and flaky skin as the swelling goes down The intense pain can make getting around difficult. Which joints can be affected? Gout can affect almost any joint and can occur in more than one joint at the same time.
The joints towards the ends of the limbs tend to be affected more often, including the: toes — particularly the big toe joint midfoot where your shoelaces sit ankles knees fingers wrists elbows If gout is left untreated, it's likely to affect more joints over time. Pattern of symptoms Attacks of gout tend to: occur at night, although they can happen at any time develop quickly over a few hours last between three and 10 days — after this time, the affected joint should start to return to normal, but the problem can persist if treatment isn't started early come back — you may experience attacks every few months or years become more frequent over time if not treated It's difficult to predict how often attacks will occur and when exactly they will happen.
When to seek medical advice See your GP if you suspect you have gout and it hasn't been previously diagnosed. Contact your GP immediately or call the service if you have both: severe, worsening joint pain and swelling a high temperature fever of 38C Causes of gout Gout is caused by small crystals forming in the joints, resulting in severe pain, tenderness and swelling. Uric acid Uric acid is created when the body breaks down chemicals known as purines.
What can increase your risk? Other factors that may increase your risk of developing gout are outlined below. Medical conditions Some underlying medical conditions can increase your risk of developing gout, including: high blood pressure diabetes kidney disease high levels of fat and cholesterol in your blood obesity metabolic syndrome a combination of diabetes, high blood pressure and obesity psoriasis a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales osteoarthritis Medication Certain medications can increase your uric acid levels and your risk of developing gout.
These include: diuretics water tablets — used to treat high blood pressure or an abnormal build-up of fluid in your body certain medicines used to treat high blood pressure — including beta-blockers and ACE inhibitors low-dose aspirin — used to reduce the risk of blood clots niacin — used to treat high cholesterol ciclosporin — used to treat conditions such as psoriasis some chemotherapy medicines Diet Uric acid is created when the body breaks down purines.
Foods naturally high in purines include: red meat — such as beef, lamb and pork seafood — especially shellfish and oily fish offal — such as liver, kidneys and heart Alcohol Alcoholic drinks can raise the level of uric acid in the blood. Sugary drinks Certain sugary drinks may also increase your risk of gout. Family history Studies have shown that gout often runs in families. Diagnosing gout Your GP may suspect gout based on your symptoms.
Further tests Many conditions can cause gout-like symptoms. Joint fluid test A sample of fluid may be taken from the affected joint. Blood test A blood test known as a serum uric acid test may be used to measure the amount of uric acid in your blood. X-ray An X-ray is rarely used to diagnose gout because the condition isn't usually detectable using this method.
Ultrasound scan An ultrasound scan of an affected joint is a simple and safe investigation that's increasingly used to detect crystals in the joints. Treating gout Treatment for gout includes pain relief to help you cope with a gout attack, as well as medication and lifestyle changes to prevent further attacks. Pain relief for a gout attack What to do during an attack You should: take any medication you've been prescribed as early as possible after you notice an attack see below — this should start to have an effect within two or three days rest and raise the limb avoid knocking or damaging the affected joint keep the joint cool — remove surrounding clothing and apply an ice pack, such as a bag of frozen peas wrapped in a towel ensure you're well hydrated Apply the ice pack to your joint for around 20 minutes.
NSAIDs used to treat gout include naproxen, diclofenac and etoricoxib. Colchicine reduces some of the swelling and pain associated with a gout attack. Corticosteroids Corticosteroids are sometimes used to treat severe cases of gout if other treatments don't work or you're unable to take an NSAID or colchicine.
A short course of steroid tablets often provides relief, but they can't be used long-term in high doses as they cause side effects, including: weight gain thinning of the bones osteoporosis easy bruising muscle weakness Corticosteroids can also be given by injection to provide rapid pain relief.
Medication and lifestyle changes to prevent further attacks You can reduce your chances of having further gout attacks by taking medication and making lifestyle changes to reduce the level of uric acid in your body.
Medication Medication to reduce uric acid levels — known as urate-lowering therapy ULT — is usually recommended if you have recurrent attacks of gout or you have complications of gout. Allopurinol Allopurinol helps reduce the production of uric acid. However, side effects can include: a rash — this is usually mild and goes away on its own, but it can be a sign of an allergy; if you develop a rash, stop taking the medication immediately and contact your GP for advice indigestion headaches diarrhoea Febuxostat Like allopurinol, febuxostat is a medication taken once a day that reduces the body's production of uric acid.
Side effects of febuxostat can include: diarrhoea feeling sick headaches a rash Other medications Less commonly used ULT medications include benzbromarone and sulfinpyrazone. Lifestyle changes Certain lifestyle changes can also help reduce your risk of experiencing further attacks of gout, including: avoiding foods containing high levels of purine the chemical involved in the production of uric acid , such as red meat, offal, oily fish, seafood and foods containing yeast extract.
Complications of gout Complications of gout can include small lumps forming under the skin tophi , joint damage and kidney stones. Tophi Gout is caused by a chemical called uric acid forming small crystals in and around the joints.
They can also can become inflamed and produce a toothpaste-like discharge. Tophi can develop anywhere in the body, but usually form on the: toes heels knees fingers ears forearms elbows It normally takes several years after the first attack of gout for tophi to develop, but some people develop them even before experiencing an attack. If you have very large or painful tophi, they may have to be surgically removed.
Joint damage Without treatment, gout attacks may become more frequent and prolonged, and your likelihood of developing permanent joint damage will increase. In the most serious cases, surgery may be required to repair or replace a damaged joint. Kidney stones Occasionally, high levels of uric acid can lead to the formation of kidney stones. Psychological and emotional effects Gout can also affect your mood, work and home life. Tweet Click here to share this page on Twitter This will open a new window.
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