Gout
Gout is the most common inflammatory arthritis in the UK — caused by uric acid crystal deposition. UK guide to symptoms, causes, risk factors and diagnosis.
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Gout: What It Is, Symptoms & Causes UK
A clinical overview of gout — what it is, how an attack happens, common triggers, risk factors, related health conditions, and the treatments available.
Key fact: Gout is the most common inflammatory arthritis in the UK, affecting around 1 in 40 adults. It is caused by uric acid crystals forming in joints. Treatment is highly effective — both for acute attacks (NSAIDs, colchicine) and for prevention (allopurinol). NICE and BSR now recommend offering allopurinol after the first attack in most people.
What Is Gout?
Gout is a form of inflammatory arthritis caused by tiny crystals of uric acid (monosodium urate) forming in joints. When these crystals build up inside the joint space, they trigger a sudden inflammatory response — the body recognises them as foreign, sending immune cells to attack them. The result is the intensely painful, hot, red, swollen joint that defines a gout attack.
Uric acid is a normal waste product. Most of us make it constantly from breaking down purines — building blocks in our cells and in food. In most people, uric acid is excreted by the kidneys without issue. Gout happens when uric acid levels in the blood rise high enough, for long enough, that crystals start forming in joint fluid.
Gout is not caused by ‘wear and tear’ like osteoarthritis. It is not an autoimmune disease like rheumatoid arthritis. It is fundamentally a problem of uric acid metabolism — which is why treatment that lowers uric acid (allopurinol) can prevent future attacks so effectively.
Symptoms of a Gout Attack
The classic gout attack starts suddenly, often at night. The affected joint becomes:
- Intensely painful — many people describe the worst pain they have ever experienced
- Hot to the touch — the inflammation generates warmth
- Red or purplish — skin over the joint is discoloured
- Swollen — obvious puffiness around the joint
- Tender to even the lightest touch — the weight of a bedsheet can be unbearable
- Stiff and hard to move — the joint feels ‘locked’
Pain typically peaks within 12 to 24 hours and gradually resolves over 3 to 10 days, even without treatment. About 70% of first attacks affect the base of the big toe (called podagra). Other commonly affected joints include the ankle, midfoot, knee, wrist, finger, and elbow. Attacks usually involve a single joint at a time, particularly the first attack.
Causes and Risk Factors
The underlying cause of gout is persistently high uric acid (hyperuricaemia). Risk factors include:
Genetics
Variations in genes affecting uric acid handling are the biggest single factor. Family history of gout substantially increases risk.
Male sex & age
Gout is around three times more common in men. Risk rises with age, particularly after 30 in men and after menopause in women.
Kidney function
The kidneys remove most uric acid from the body. Reduced kidney function increases risk substantially.
Diet
High intake of purines (organ meats, oily fish, shellfish), fructose-sweetened drinks, and alcohol (especially beer and spirits) raises uric acid levels.
Body weight
Higher body weight is associated with higher uric acid. Weight loss reduces uric acid and gout risk.
Medications
Diuretics (water tablets) are a particularly important risk factor — especially thiazides. Low-dose aspirin and ciclosporin also raise uric acid.
Other health conditions
High blood pressure, type 2 diabetes, metabolic syndrome, and cardiovascular disease are strongly linked with gout.
Postmenopausal status
Oestrogen has a uric-acid-lowering effect. After menopause, women’s gout risk rises closer to men’s.
Common Triggers of Acute Attacks
People with hyperuricaemia don’t have an attack every day — something usually triggers an individual attack. Common triggers include:
- Alcohol — especially beer (which is high in purines) and spirits
- Dehydration — reduces uric acid clearance by the kidneys
- Large meals — particularly those high in red meat, organ meats, or oily fish
- Fructose-sweetened drinks — sugary soft drinks, fruit juice
- Sudden weight loss — including fasting and very-low-calorie diets
- Surgery or hospital admission — stress, dehydration, medication changes
- Illness or fever — the inflammatory state can trigger attacks
- Joint injury — even minor trauma can trigger an attack
- Starting uric-acid-lowering treatment — allopurinol can paradoxically trigger attacks in the first 3 to 6 months as crystals shift
- Starting or stopping diuretics or other gout-relevant medications
Stages of Gout
Gout typically progresses through stages, though not everyone moves through all of them.
| Stage | What's happening | What to do |
|---|---|---|
| Asymptomatic hyperuricaemia | Uric acid is high but no attacks have occurred. No crystals yet visible in joints. | Usually not treated unless very high or other risk factors. Lifestyle measures recommended. |
| Acute gout attack | Crystal formation triggers a sudden inflammatory attack. | NSAID (e.g. naproxen) or colchicine for the attack. After it settles, consider long-term prevention. |
| Intercritical period | Between attacks. No symptoms, but uric acid stays high and more crystals are forming silently. | This is the best window for starting urate-lowering therapy (allopurinol) to prevent future attacks. |
| Chronic tophaceous gout | Long-standing untreated gout: visible firm lumps (tophi) form under the skin and joint damage develops. | Urgent specialist input. Aggressive urate-lowering treatment. |
Related Health Conditions
Gout rarely occurs in isolation. A gout diagnosis is an opportunity to assess and address related conditions:
- Cardiovascular disease — people with gout have higher rates of heart attack and stroke
- High blood pressure — both a risk factor for gout and worsened by it
- Type 2 diabetes — strongly associated; metabolic risk factors overlap
- Chronic kidney disease — cause and consequence; kidneys are key to uric acid handling
- Metabolic syndrome — central obesity, high cholesterol, high blood pressure, insulin resistance
- Kidney stones — high uric acid increases urate stone risk
Managing these together — and offering urate-lowering therapy when needed — substantially reduces long-term complications.
How Gout Is Diagnosed
Most gout is diagnosed clinically — the typical pattern of sudden severe pain in the big toe, with the classic appearance, is usually enough. A blood test for uric acid is often taken, but uric acid can actually fall during an attack, so a normal level does not rule out gout.
The definitive diagnostic test is joint aspiration — taking fluid from the affected joint and looking for uric acid crystals under a polarised microscope. This is particularly useful when the diagnosis is uncertain or to rule out septic arthritis (joint infection), which can look similar and is an emergency.
Gout Treatment Overview
Gout treatment has two strands: managing the acute attack, and preventing future attacks.
Acute attacks
NICE NG219 recommends offering a full-dose NSAID (such as naproxen) or colchicine as first-line. NSAIDs are usually first choice if there are no contraindications (kidney disease, gastric ulcer, heart failure). Colchicine is the alternative, particularly if NSAIDs are not suitable. Steroids are an option where neither is appropriate. Treatment works best when started within 24 hours of attack onset.
Long-term prevention
For people who have had a gout attack, NICE and the British Society for Rheumatology now recommend considering allopurinol after the first attack in most cases — particularly if there are tophi, chronic kidney disease, or other risk factors. Allopurinol is started at a low dose (usually 100mg) and gradually increased, aiming for a serum urate target below 360 μmol/L (or below 300 in some cases).
Lifestyle measures
Diet, weight management, hydration and alcohol moderation all reduce uric acid and gout attack frequency. Lifestyle measures alone usually lower urate by about 10–15% — helpful but rarely sufficient to control gout without medication if attacks are recurring.
Explore Gout Treatment Options
Access Doctor provides prescription gout treatment online — naproxen and colchicine for acute attacks, and allopurinol for long-term prevention — following a short consultation with GPhC-registered pharmacist independent prescribers.
View Gout Treatments →When to See a Doctor About Gout
Seek urgent medical care if you have a hot, swollen, very painful joint with a high fever — this could be septic arthritis (joint infection), which is a medical emergency and can look very similar to gout.
Otherwise, see your GP or use an online prescriber for:
- A first attack of pain that might be gout — confirmation matters; it could be another type of arthritis or an infection
- Recurrent attacks (more than 2 a year)
- Pain that does not respond to over-the-counter painkillers
- Firm lumps developing under the skin near joints (possible tophi)
- Worsening kidney function or known kidney disease
- Any uncertainty about whether to start long-term prevention
Gout Guides
In-depth guides on specific aspects of gout treatment:
Frequently Asked Questions
What is gout?
Gout is a form of inflammatory arthritis caused by tiny crystals of uric acid (monosodium urate) building up in and around joints. When these crystals form inside a joint, they trigger a sudden, intensely painful attack — typically affecting the base of the big toe, but also the ankle, knee, wrist, finger or elbow. Gout is the most common inflammatory arthritis in the UK, affecting around 1 in 40 adults. It is more common in men and in people over 30.
What causes gout?
Gout is caused by high levels of uric acid in the blood (hyperuricaemia). Uric acid is a waste product from breaking down purines, which the body produces naturally and which are also found in certain foods (organ meats, oily fish, some seafood). When uric acid levels are persistently high, crystals can form in joints. Whether you develop gout depends on a combination of genetics, kidney function (kidneys remove most uric acid), body weight, diet, alcohol intake, and medications such as diuretics.
What are the symptoms of a gout attack?
A gout attack typically starts suddenly, often at night. The affected joint becomes intensely painful, hot, red, and swollen — even the weight of a bedsheet can be unbearable. Pain usually peaks within 12 to 24 hours. The skin over the joint may look shiny and feel hot to the touch. Untreated, an attack typically lasts 3 to 10 days. The base of the big toe is the classic site, but gout can affect any joint, including the ankle, knee, wrist, finger, or elbow.
What triggers gout attacks?
Common triggers include alcohol (especially beer and spirits), dehydration, large meals high in purines (organ meats, red meat, some seafood), fructose-sweetened drinks, stress, sudden weight loss, surgery, illness, and starting or stopping medications that affect uric acid — including diuretics and, paradoxically, the beginning of uric-acid-lowering treatment such as allopurinol. Many attacks have no clear single trigger and are caused by a combination of factors.
Is gout serious?
Acute gout attacks are intensely painful but are not usually dangerous in themselves. However, long-standing untreated gout can cause permanent joint damage, tophi (firm urate crystal deposits under the skin), and kidney stones or kidney damage. Gout is also linked with cardiovascular disease, type 2 diabetes, chronic kidney disease, and metabolic syndrome — so a gout diagnosis is an opportunity to assess and address these too.
When should I see a doctor about gout?
See your GP or use an online prescriber if: this is your first attack of joint pain that might be gout (confirmation matters — it could be something else); attacks are recurring; pain is not responding to over-the-counter painkillers; you develop firm lumps under the skin (tophi); or you have other symptoms such as fever. Seek urgent care for very severe pain, high fever with a hot swollen joint (could be septic arthritis), or if you have kidney disease.
Can gout be cured?
Gout cannot be cured, but it can be very well controlled. Acute attacks are treated with NSAIDs (such as naproxen) or colchicine. Long-term, urate-lowering treatment with allopurinol can prevent future attacks by keeping uric acid levels low. Combined with lifestyle changes — weight management, hydration, limiting alcohol and high-purine foods — most people achieve very good control. NICE and the British Society for Rheumatology recommend considering allopurinol after the first attack in most people, rather than waiting for repeat attacks.
Get the Right Gout Treatment Online
If gout is affecting your life, a short online consultation with our GPhC-registered pharmacist independent prescribers can help you access the right treatment — from acute attack medication to long-term prevention.
View Gout Treatments →References
- NICE NG219. Gout: diagnosis and management. nice.org.uk/guidance/ng219
- NICE CKS. Gout. Clinical Knowledge Summaries. cks.nice.org.uk/topics/gout
- British Society for Rheumatology. Guideline for the management of gout. rheumatology.org.uk
- NHS. Gout. nhs.uk/conditions/gout
- UK Gout Society. Patient information. ukgoutsociety.org
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.
