Gout Nhs Choices

Gout - information prescription
Introduction
Gout is a type of arthritis where crystals of sodium urate form inside and around joints.
The most common symptom is sudden and severe pain in the joint, along with swelling and redness. The joint of
the big toe is commonly affected, but it can develop in any joint.
Symptoms develop rapidly and are at their worst point in just 6 to 24 hours. Symptoms usually last for 3 to 10 days
(this is sometimes known as a gout attack).
After this time, the joint will start to feel and look normal again, and the pain of the attack should disappear
completely.
Almost everyone with gout will have further attacks in the future.
Read more about the symptoms of gout.
What causes gout?

Gout is caused by a build-up of uric acid in the blood. Uric acid is a waste product made in the body every day
and excreted mainly via the kidneys. It forms when the body breaks down chemicals in the cells known as purines.
If you produce too much uric acid or excrete too little when you urinate, the uric acid builds up and may cause tiny
crystals of sodium urate to form in and around joints.
These hard, needle-shaped crystals build up slowly over several years. You will not know this is happening.
Eventually, when there is a high concentration of crystals in your joints, the crystals may cause two problems:
some may spill over from the joint cartilage and inflame the soft lining of the joint (synovium), causing the
pain and inflammation of an acute attack of gout
some pack together to form hard, slowly expanding lumps of crystals (tophi), which can cause progressive
damage to the joint cartilage and nearby bone; this eventually leads to irreversible joint damage,
NHS Choices puts you in control of your healthcare

NHS Choices has been developed to help you make choices about your health, from lifestyle decisions about
things like smoking, drinking and exercise, through to the practical aspects of finding and using NHS services
when you need them.
www.nhs.uk
which causes pain and stiffness when the joint is being used
Factors that increase your risk of gout include:
age and gender gout is more common when you get older and is three to four times more likely in men
being overweight or obese
having high blood pressure or diabetes
having close relatives with gout (gout often runs in families)
having long-term kidney problems that reduce the elimination of uric acid
a diet rich in purines, such as frequently eating sardines and liver
drinking too much beer or spirits these types of alcoholic drinks contain relatively high levels of purines
Read more about the possible causes of and risk factors for gout.
Treating gout
There are two main goals in treating gout:
relieving symptoms this can be done by using ice packs and taking non-steroidal anti-inflammatory drug
(NSAID) painkillers; in some cases, alternative medications such as colchicine or corticosteroids may also
be needed
preventing future gout attacks through a combination of lifestyle changes, such as losing weight if you are
overweight, and taking a medication such as allopurinol, which lowers uric acid levels
It is important to take any prescribed medication as directed and make any recommended lifestyle changes, such
as losing weight.
Many people are able to reduce their uric acid levels sufficiently to dissolve the crystals that cause gout, resulting
in their gout being "cured" with no further attacks.
Read more about treating gout.
Who is affected?
Gout is more common in men than in women. This is mainly because the female hormone oestrogen, which is
released during the female reproductive cycle, reduces a woman's levels of uric acid by increasing the excretion
of uric acid via the kidneys.

when you need them.
www.nhs.uk
After the menopause, uric acid levels rise in women and they too can become liable to getting gout.
It is estimated that, overall, 1 in 45 people in the UK have gout. However, gout is more common in older adults,
affecting 1 in 7 older men and 1 in 16 older women. This makes it the most common type of arthritis after
osteoarthritis.
Gout symptoms usually occur after the age of 30 in men and after 60 in women.
Complications
Complications of gout are uncommon but can include:
kidney stones high levels of uric acid can also lead to stones (uric acid and calcium stones) developing
inside the kidneys
tophus formation tophi are small to large firm lumps sometimes visible and easily felt under the skin
permanent joint damage caused by ongoing joint inflammation between the acute attacks, and by
formation of tophi within the joint that damage cartilage and bone; this is usually only a risk if gout is left
untreated for many years
Read more about the complications of gout.
Symptoms of gout
The most common symptom of gout is sudden and severe pain in one or more joints, typically your big
toe. Gout is extremely painful.
Symptoms often develop at night, although they can occur at any time. Other symptoms include:
your joint being very tender, to the point of being unable to bear anything touching it
swelling (inflammation) in and around the affected joint
red, shiny skin over the affected joint
peeling, itchy and flaky skin over the affected joint as the inflammation subsides
The intense pain that gout causes can make walking and getting around difficult. Even the light pressure of a bed
cover or blanket can be unbearable.
Which joints are affected?

when you need them.
www.nhs.uk
Seventy per cent of people with gout experience their first attack in the big toe and most people with gout
experience pain in their big toe at some point.
However, 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 and may include:
the midfoot (the area where your shoelaces would sit)

ankles
knees
fingers
wrists
elbows
If gout is left untreated, it is more likely to affect more than one joint as it progresses.
Pattern of symptoms
It is difficult to predict when an attack will occur. Symptoms typically develop rapidly over just a few hours and
usually last for 3 to 10 days. After this time, the joint will start to feel normal again and any pain or discomfort
associated with the attack should eventually disappear completely.
Just over half of all people with gout (62%) experience a repeat attack within a year. You may experience
symptoms every few weeks, months or years, but it is impossible to predict when the condition will recur.
Although some people may experience just a few attacks in their lifetime, the vast majority of people with gout
experience attacks that increase in frequency over time. New joints will often start to be affected.
When to seek medical advice

Always see your GP if you suspect you have gout, particularly if it hasn't been previously diagnosed.
It is important that a diagnosis is confirmed because more serious conditions, such as an infected joint, can
sometimes cause similar symptoms.
You may also require treatment with prescription medication that only your GP (or a specialist) can provide.
When to seek immediate medical advice

when you need them.
www.nhs.uk
Contact your GP immediately or call NHS 111 if you have both:
a high temperature of above 38C (100.4F)

joint pain and swelling that is still getting worse after the first 24 hours
You may have an infection inside the joint (septic arthritis).
Causes of gout
Gout is caused by a build-up of uric acid in the blood. Uric acid is a waste product that forms when the
body breaks down chemicals in the cells known as purines.
Most uric acid is removed from the body through the kidneys. A small amount is removed through the digestive
system.
Sodium urate crystals

Uric acid usually remains dissolved in your blood and passes through your kidneys into your urine so it can be
passed out of your body.
If you produce too much uric acid or excrete too little when you urinate, the uric acid will build up and may cause
microscopic crystals of sodium urate to form, usually in joints or surrounding tissue.
The crystals may spill over from the joint cartilage into the joint space, where they trigger a reaction from the soft
lining (synovium), which produces the intense pain and inflammation associated with a gout attack.
Gout attacks occur most frequently in the joints of the feet and hands, possibly because the temperature in these
joints is often lower than the rest of the body, which increases the likelihood of crystals forming. The knees and
elbows are the next most commonly affected. Joints close to the body, such as shoulders, hips, the neck or back
are very rarely affected.
Risk factors
Some things can increase the amount of uric acid in your blood, making you more likely to develop gout. These
risk factors fall into one of three categories:
medical conditions known to increase levels of uric acid

when you need them.
www.nhs.uk
lifestyle factors such as diet or certain types of medication

genetics certain genes you inherit from your parents may make you more likely to develop gout
These risk factors are discussed in more detail below.

Medical conditions
Medical conditions that can increase your risk of developing gout include:
high blood pressure (hypertension)

diabetes both type 1 diabetes and type 2 diabetes
kidney disease
having high levels of fat and cholesterol levels in your blood
having osteoarthritis in your feet, knees or hands
Medication
Certain types of medication can increase your uric acid levels and your risk of developing gout. These include:
diuretics (water tablets), which are used to treat high blood pressure or an abnormal build-up of fluid in your
body
other drugs used to treat high blood pressure, such as beta-blockers, ACE inhibitors and calcium channel
blockers
low-dose aspirin
niacin, which is used to treat high cholesterol
Gender
Men are more likely to develop gout than women because their uric acid levels rise during puberty and remain
higher than women through adulthood.
During the menopause, women experience a similar, albeit smaller, rise in their uric acid levels. This explains why
symptoms usually start later in women than in men.
Diet
Foods naturally high in purines include:

when you need them.
www.nhs.uk
red meat such as beef, lamb and pork

seafood especially shellfish and oily fish
offal such as liver, kidneys and heart
Alcohol
Alcoholic drinks raise the level of uric acid in the blood by increasing its production in the liver and reducing how
much is passed out in urine.
Beer and spirits do this more than wine, and beer also contains significant quantities of purines. Moderate
consumption of wine one or two glasses a day should not significantly increase your risk of gout.
Sugary drinks
Research has shown a possible link between gout and certain sugary drinks.
Specifically, a study found that men who regularly drank sugar-sweetened soft drinks and drinks with high levels of
fructose (a naturally occurring sugar found in many fruits) had an increased risk of gout.
Diet soft drinks were not found to increase the risk of gout.
Family history
Studies have shown that gout often runs in families. Around one in five people with gout have a close family
member who also has the condition.
Susceptibility
It is still uncertain why some people are more susceptible to crystal formation and gout than others with equally
high blood levels of uric acid. Many people with a high level of uric acid in their blood and tissues never develop
gout.
Diagnosing gout
The most accurate way to diagnose gout is for your doctor to check your joints for the presence of
crystals. However, this test is often not practical to carry out at your local GP practice.

when you need them.
www.nhs.uk
Instead, your GP will first ask about your symptoms and medical history to make a diagnosis.
They will usually ask the following questions:
Which joints are affected?

How quickly did the symptoms appear?
How often do you have symptoms?
Are you taking any medication?
Does anyone in your family have gout?
They will also ask you about your diet, particularly your intake of beer, spirits and foods high in purines, such as
red meat and seafood.
Further tests
Many conditions can cause joint pain, inflammation and swelling. Gout is just one of the more than 200 different
forms of arthritis (any condition that causes pain and problems with the joints).
Your GP may be unable to make a firm diagnosis straight away and you may be referred for further tests. These
will either confirm the diagnosis of gout or rule out other conditions.
Joint fluid
A sample of fluid (synovial fluid) may be taken from the affected joint. This test helps to rule out other crystals
(calcium pyrophosphate) that can cause similar attacks of inflammation, as well as an infection in the joint (septic
arthritis).
The fluid sample is taken using a needle and examined under a microscope. If you have gout, there will nearly
always be crystals of sodium urate in the sample.
Blood test
A type of blood test known as a serum uric acid test may be used to measure the amount of uric acid in your
blood.
This test is carried out four to six weeks after an attack of gout, as the serum uric acid level is often not raised at
the time of the attack.

when you need them.
www.nhs.uk
However, a serum uric acid test is not definitive. Some healthy people without gout have high uric acid levels in
their blood, while others who experience an attack of gout have a normal level.
X-ray
An X-ray is rarely used to diagnose gout because inflammation caused by gout is not usually detectable using this
method.
However, an X-ray is sometimes used to help rule out other conditions that affect the joints, such as
chondrocalcinosis (a build-up of calcium crystals in the joints).
Ultrasound scan
An ultrasound scan of an affected joint is a simple and safe investigation that is increasingly used to detect urate
crystals within the joint cartilage.
It can also detect urate crystals deep in the skin that are not obvious during a physical examination.
Follow-up appointment
About four to six weeks after your gout attack has subsided, your GP may ask you to return for a follow-up
appointment to check your serum uric acid level.
Your GP can also give you an advance prescription of painkilling medication so that you can deal with attacks of
gout promptly.
Read more about treating gout.
Treating gout
If you are diagnosed with gout, your treatment plan will first aim to relieve the symptoms of an attack.
Further treatment aims to prevent attacks by lowering uric acid levels.
Relieving symptoms
Self-care techniques

when you need them.
www.nhs.uk
During a gout attack, it is important to rest, raise your limb and avoid knocking or damaging the affected joint.
Keeping the affected joint cool should also help. Remove surrounding clothing and apply an ice pack to it, such as
a bag of frozen peas or some ice wrapped inside a towel.
Apply the ice pack to your joint for around 20 minutes. Do not apply ice directly to your skin and do not apply it for
more than 20 minutes at a time because this could damage the skin.
Medication
Non-steroidal anti-inflammatory drugs (NSAIDs) are a type of painkiller usually recommended as an initial
treatment for gout. They work by reducing the levels of pain and inflammation.
NSAIDs often used to treat gout include:
naproxen
diclofenac
etoricoxib
If you have been prescribed NSAIDs for gout, it is best to keep them near you at all times so you can use them at
the first sign of a gout attack. Continue to take your medication throughout the attack and for 48 hours after the
attack has finished.
NSAIDs should be prescribed together with a medication called a proton pump inhibitor (PPI), which reduces the
risk of the NSAID causing indigestion, stomach ulcers and bleeding from the stomach.
People who have reduced kidney function, conditions such as stomach ulcers or bleeding, or who are using
certain medications such as warfarin or treatments for blood pressure should avoid using NSAIDs.
Colchicine
If you are unable to take NSAIDs or if NSAIDs are ineffective, colchicine can be used instead.
Colchicine is derived from the Autumn crocus plant. It is not a painkiller, but works by reducing the ability of the
urate crystals to inflame the joint lining (synovium), which reduces some of the inflammation and pain associated
with a gout attack.
It is best to keep them near you at all times so you can use them at the first sign of a gout attack.

when you need them.
www.nhs.uk
Colchicine can be an effective treatment for gout. However, it should be used at low doses as it can cause side
effects, including:
nausea
abdominal pain
diarrhoea
Colchicine can cause major gut problems if taken in too high a dose. It is important to follow the recommended
dose. For most people, this means taking no more than two to four tablets a day.
Corticosteroids
Corticosteroids are a type of steroid sometimes used to treat severe cases of gout in people that:
do not respond to other treatment

are unable to take or cannot tolerate an NSAID or colchicine
A short course of steroid tablets often provides relief, but can't be used long-term in high doses as they cause
side effects, including:
weight gain
thinning of the bones (osteoporosis)
bruising
muscle weakness
thinning of the skin
increased vulnerability to infection
Corticosteroids can also exacerbate diabetes and glaucoma (an eye condition that can cause blindness if left
untreated).
Corticosteroids may not be suitable for you if you have:
impaired kidney function

impaired liver function
heart failure
Corticosteroids can also be given by injection, either into muscle or directly into the affected joint, which can

when you need them.
www.nhs.uk
provide rapid pain relief.
Preventing attacks
Two methods used to try to prevent further attacks of gout are:
medication to reduce uric acid levels

making lifestyle changes to reduce uric acid levels
Medication
Drug treatment is recommended on a long-term basis for:
frequent attacks of gout and signs of tophi under the skin (tophi are small white lumps that can form under
the skin)
evidence of joint damage either in terms of associated symptoms or damage detected by X-ray
a history of kidney stones
reduced kidney function
Around 40% of people meet these criteria when gout is first diagnosed. More than 80% of people develop these
symptoms within five years. Drug treatment is therefore considered and explained to most people before their
gout becomes more severe.
The main treatment for gout is known as urate-lowering therapy (ULT). The goal of ULT is to lower uric acid levels
below the levels required for crystals to form (the saturation point).
This prevents any new crystals forming and also helps to dissolve existing crystals. This eventually leads to the
removal of all the crystals in your body and prevents any further attacks or joint damage. But you normally need to
continue with ULT on a daily basis for the rest of your life to maintain this "cure".
Many people with gout begin ULT as soon as they are diagnosed to reduce the frequency of future attacks and the
risk of developing joint damage. This has to be balanced against possible side effects that can occur with ULT,
although these are rare.
Discuss the potential benefits and disadvantages of ULT with your GP or the doctor in charge of your care. If you
agree to start ULT, allopurinol is usually the medication that is tried first.
Allopurinol

when you need them.
www.nhs.uk
Allopurinol helps to lower uric acid levels by inhibiting the enzyme (xanthine oxidase) responsible for converting
purines into uric acid, which reduces the production of uric acid. However, allopurinol is not a painkiller and will
have no effect during an attack of gout.
Allopurinol is a tablet taken once a day. The dose needs to be adjusted to ensure that the target level of serum
uric acid is achieved. The aim is to maintain the level well below 360 umol/L or 6mg/dl.
The dose is usually increased every three to four weeks, depending on the results of the blood tests for uric acid.
Once this target is achieved, it often takes up to a year or two before all crystals have dissolved and no further
attacks occur. The medication will then usually be taken for the rest of your life.
It can take a while to assess the most effective dose for your circumstances. You may need to have several blood
tests to find the most effective dose.
When you first start taking allopurinol, it can sometimes cause a gout attack, because the rapid reduction of uric
acid levels to below the saturation point causes existing crystals in the joint cartilage to partially dissolve and
become smaller.
The smaller crystals can escape more easily or "shed" from the cartilage into the joint cavity, and then inflame the
joint lining (synovium).
The risk of this happening is reduced by slowly increasing the dose of allopurinol as described above.
You may continue to have gout attacks until all the existing crystals have dissolved, which is perfectly normal.
If this does happen, you shouldn't lose confidence in the effectiveness of ULT. It's important to persevere with
treatment to achieve the maximum benefit.
If you do develop a flare-up of gout while taking allopurinol, continue taking the medication while your doctor
prescribes additional treatment to settle the attack.
Although allopurinol is taken without any side effects in most patients, around 10% do experience problems. A
skin rash is the most common side effect. In most cases, this is mild and soon goes away.
However, in a small number of cases, it can be a sign of an allergic reaction. If you develop a skin rash while
taking allopurinol, stop taking the medication immediately and contact your GP for advice. It may be necessary to
stop taking allopurinol and try an alternative ULT.

when you need them.
www.nhs.uk
Other possible side effects of allopurinol include:
indigestion
headache
diarrhoea
You will probably not be able to take allopurinol for safety reasons if you are currently being treated with
immunosuppressant medications (often used to prevent your body rejecting a donated organ) or a type of
medication called cyclophosphamide (used in the treatment of some cancers).
Patients with kidney problems may be started on a lower dose (50mg daily) and have lower monthly increases
(50mg) of allopurinol.
Allopurinol may also not be suitable if you have severe kidney disease. Those with severe kidney disease may not
even be started on allopurinol, but prescribed an alternative ULT such as febuxostat.
Febuxostat
Febuxostat acts in the same way as allopurinol by inhibiting the enzyme (xanthine oxidase) that produces uric acid
and reducing the body's production of uric acid.
However, unlike allopurinol, it is mainly broken down by the liver rather than the kidney, which is why it can be used
more easily in patients with kidney disease.
Febuxostat may be very effective at lowering the serum uric acid level. As with allopurinol, febuxostat may cause
temporary worsening of your symptoms when you first start taking it.
To try to reduce the frequency and severity of this side effect, your doctor may prescribe you regular daily oral
NSAIDs or colchicine (one to two tablets daily) for up to six months following the start of febuxostat as preventative
treatment (prophylaxis).
Common side effects of febuxostat include:
an increased number of acute gout attacks

diarrhoea
headache
feeling sick

when you need them.
www.nhs.uk
skin rash
If you experience more serious symptoms, such as breathing difficulties or facial swelling, stop taking febuxostat
and contact your GP for advice.
Currently, febuxostat is not considered to be suitable for people with heart problems, especially heart failure.
Less commonly used ULT medications
Less commonly used ULT medications include:
benzbromarone
sulphinpyrazone
probenecid
They work by helping the kidneys to remove uric acid from the body.
Sulphinpyrazone and probenecid are now rarely used as they are not as effective as other types of ULT
medications and are not suitable for people with kidney disease.
Benzbromarone is more effective in removing uric acid and can be used in people with kidney disease.
These types of medication tend to only be used if people are unable to take allopurinol or febuxostat. They need to
be prescribed under the supervision of a specialist.
Lifestyle changes
Food
Some foods are high in purines. Avoiding eating the foods below can help reduce the risk of a gout attack:
offal liver and kidneys, heart and sweetbreads

game rabbit, pheasant and venison
oily fish anchovies, herring, mackerel, sardines, sprats, whitebait and trout
seafood mussels, crab, shrimp and other shellfish, fish roe and caviar
foods or supplements that contain yeast or meat extract Marmite, Bovril, commercial gravy and beer
For more detailed information on foods to eat in moderation and low purine foods, see the following factsheet

when you need them.
www.nhs.uk
on gout and diet (PDF, 711kb) produced by the UK Gout Society.

Weight
If you are overweight, the levels of uric acid in your blood often rise. Losing weight will help reduce your uric acid
levels significantly.
If you need to lose weight, it is important to follow a balanced, calorie-controlled diet. Do not crash diet. A highprotein, low-carbohydrate diet should be avoided, because high-protein foods often contain high levels of purines.
Ensure you get plenty of regular exercise. Not only will this reduce your urate levels and decrease your risk of
developing gout, it will also make you feel more energised and healthier.
If you have a gout attack, keep the joint rested and elevated (raised). Avoid exercise that puts strain on the
affected muscles or joints. Swimming is a good way to stay fit without putting pressure on your joints, as the water
supports your weight.
Read more about losing weight safely and getting fit with exercise.
Water
It is important to drink plenty of water to avoid dehydration. Aim to drink about 1.2 litres (six to eight glasses) a
day, or more if you are exercising or when it is hot.
Keeping yourself well hydrated will reduce the risk of crystals forming in your joints.
Alcohol
Some types of alcoholic drinks are associated with a greater risk of developing gout than others.
Beer and stout, which contain significant quantities of purines, carry a greater risk for the development of gout
than equivalent units of spirits, such as vodka and whiskey.
Studies have shown that, as long as you stick to the maximum recommended levels of alcohol intake, wine is not
associated with an increased risk of developing gout.
However, binge drinking of any kind of alcohol can bring on an attack in people who have previously suffered with
gout. Men should not drink more than three to four units of alcohol a day and women no more than two to three

when you need them.
www.nhs.uk
units a day.
Read more lifestyle advice about alcohol and its potential impact on health.
Vitamin C
There is evidence that people who take regular vitamin C supplements (500mg per day) have a lower risk of
developing gout. This may be because vitamin C increases the amount of uric acid that is passed out through the
kidneys into the urine.
It only has a relatively modest effect in terms of lowering uric acid levels. However, if you are more at risk of gout,
you may want to consider taking a regular daily vitamin C supplement.
Talk to your GP first, as taking vitamin C (or any other dietary supplements) is not suitable or safe for everyone.
Complications of gout
Complications of gout can include small lumps forming under the skin (tophi), joint damage, kidney
stones and pain that could affect your daily life.
Tophi
Crystals of sodium urate often form in tissues both outside and inside the joint. The crystals that build up under the
skin may form small white or yellow lumps known as subcutaneous tophi.
Tophi are usually painless, but they can form in awkward places, such as at the ends of your fingers and around
your toes. It usually takes several years after the first attack of gout for tophi to develop, but some people develop
tophi even before experiencing an acute attack.
They usually form on toes, heels, knees, fingers, forearms and elbows, but can occur anywhere in the body, even
in the spinal canal or vocal chords (though this is rare).
If there are tophi below the skin, there will be more within the cartilage and bone of your joints.
They are usually taken as a sign of severe gout and a reason to start uric acid lowering therapy, such as the
medication allopurinol. Read more about the treatment of gout.

when you need them.
www.nhs.uk
Successful lowering of the uric acid to below the saturation point for urate crystal formation will prevent the tophi
from getting any bigger, and allow them to slowly reduce in size as the crystals dissolve.
Occasionally, tophi can become inflamed and even produce a discharge consisting of a mixture of pus and a
white, toothpaste-like material (urate crystals).
If you have tophi that are large or painful, you may have difficulty doing everyday tasks such as preparing food or
dressing yourself.
Speak to your GP if you have tophi and difficulty performing everyday tasks. Your GP can give advice on how to
make these activities easier. If you have very large or painful tophi, they may have to be surgically removed.
Joint damage
If urate crystals continue to build up and form hard lumps (tophi) within the cartilage and bone of the joints, this
could lead to permanent damage.
If you don't treat gout by reducing uric acid levels to below saturation point, future attacks may become more
frequent and prolonged, and your likelihood of developing permanent joint damage will be increased.
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 formation of uric acid crystals in your urinary tract, resulting in
kidney stones. High uric acid levels can also lead to calcium stones forming.
Around 10-25% of people with gout develop kidney stones. Some kidney stones interfere with the flow of urine,
resulting in pain when you pass urine, and can make you feel that you need to pass urine more often.
Kidney stones can also cause an infection in your urinary system.
Most kidney stones are small and pass through your system naturally, usually within a day or two. Drink plenty of
water as this will help flush the stones naturally.
You may be prescribed medication to make your urine less acidic, which should help dissolve any kidney stones
that may have developed.

when you need them.
www.nhs.uk
Psychological effects
As well as affecting you physically, gout can also affect your mood, work and home life. The severe pain that gout
causes can make it difficult to get around, which can sometimes lead to feelings of depression or anxiety.
Your GP will discuss ways to make your day-to-day life easier during a gout attack. They can also help you deal
with any feelings of depression you may experience.
Read more advice about living with pain.
'I felt like I'd been run over and left for dead'
Doctors were surprised when Gina Beauchamp came to them at the age of 37 showing signs of gout,
as it is rare for younger women to get it. That was more than 20 years ago, and she has now shared her
unusual story.
"I was 37 years old when my fingers started to curl up like claws and my toes felt so painful that I couldn't move. I
just thought I was extremely tired.
"My symptoms showed all the signs of gout, yet the doctors were unconvinced. Gout is rare in women and usually
occurs after the menopause, when oestrogen levels have fallen.
"Eventually, my GP recognised that I had gout, probably a result of the hysterectomy I'd had one year before. It's
thought that oestrogen protects women from gout, and my oestrogen levels had dropped after my ovaries were
removed. My GP prescribed allopurinol, a medication that reduces the levels of uric acid (urate) in the blood and
controls gout attacks. It really worked.
"I still take one tablet of allopurinol a day and I've managed to keep my gout under control for the last 10 years. I
also eat very carefully. I don't have too much protein, like meat and fish, and I drink white wine rather than beer,
which can trigger gout.
"Apparently, cherries are very good at preventing gout attacks, so I have these with porridge for breakfast every
day. I also drink plenty of water and herbal teas to keep hydrated.
"However, I had a bad attack recently. I went to friends' houses for meals and ended up eating beef three nights in
a row and drinking alcohol.
"The following Monday morning, I could hardly move. The gout seemed to affect all my joints, not just my fingers

when you need them.
www.nhs.uk
and toes. I felt like I'd been run over by a car, and my eyes felt as if they'd been punched out.
"For the next few days, I ate only vegetables and drank plenty of water, but I felt dreadful for days. The gout was so
painful I couldn't even bear the bedclothes touching my skin.
"It's made me even more determined to identify what I can and can't eat. But other than my recent attack, the gout
hasn't really affected my lifestyle."
'I still get the occasional attack, but it's gone within a day'
Patrick Hanmer was 32 and living life to the full when he had his first attack of gout. Now in his fifties,
he eats, drinks and exercises and, thanks to effective medication, keeps his gout under control.
"I was a 32-year-old aid worker in Somalia when I experienced my first attack of gout. I woke suddenly in the night
to an unbearable pain, as if someone had stamped on the ball of my foot. An area of my foot was shining red, like
a snooker ball, and was very sensitive and inflamed. I was amazed. I didn't know what it was.
"I think the hot climate triggered the attack, and I was dehydrated and drinking far too much beer. I'm a very active
person and would motorcycle across the desert, not drinking enough water, and then go to lots of parties
afterwards.
"The nurse at the British Embassy looked at my foot and told me that I had gout. I was prescribed a medication
called colchicine, which helps clear the uric acid (urate) from your blood.
"Three years later, I got my second attack. Again, I was drinking too much, overeating and getting dehydrated, and
I was stressed. The urate level in my blood was so high, it felt like my blood was congealing. As the years went by,
I had attacks every two weeks.

when you need them.
www.nhs.uk
"I was still taking colchicine, but it gave me diarrhoea if I took too much. I would take the medication during the
attacks, which would subside after three to five very painful days. During that time, I'd be lying down, unable to
walk. It was very depressing.
"In February 2007, I was walking along a street in London and my foot suddenly seized up. I tripped over the
pavement and nearly fell under a bus. That's when I thought, something's seriously wrong here.
"The doctors told me so many urate crystals had accumulated in my blood that a hard white lump called a tophus
had formed under the skin on my foot. A surgeon removed it and the other white residue in the joints of my big toe.
He said it was one of the worst cases of gout he'd ever seen.
"Six months ago, I started taking a drug called allopurinol, which reduces urate in the blood and helps prevent
further attacks. I hadn't taken it before as it tended to trigger attacks, but I now take two tablets a day. It has
controlled the gout and I feel great. My joints don't creak any more.
"I've lost weight and my quality of life is great. I can do everything I used to do, although I have to avoid extreme
exercise as this produces a lot of metabolites (breakdown products) in my blood, which can trigger an attack.
"I still get gout occasionally, but it's just a quick attack that finishes within one day. Keeping hydrated is the key. I
drink a pint of water every morning before I leave my bedroom. I also eat more sensibly and avoid foods like
kidney and certain types of fish, which increase my blood urate levels."
Additional information
Useful organisations
UK Gout Society

when you need them.
www.nhs.uk
UK Gout Society Secretariat PO Box 527 London WC1V 7YP

Tel :
http://www.ukgoutsociety.org/

when you need them.
www.nhs.uk

Gout Nhs Choices

Hochgeladen von

Dokumentinformationen

Originalbeschreibung:

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Gout Nhs Choices

Hochgeladen von

Copyright:

Verfügbare Formate

Gout - information prescription

What causes gout?

NHS Choices puts you in control of your healthcare

NHS Choices puts you in control of your healthcare

Read more about the complications of gout.

Which joints are affected?

NHS Choices puts you in control of your healthcare

the midfoot (the area where your shoelaces would sit)

When to seek medical advice

When to seek immediate medical advice

NHS Choices puts you in control of your healthcare

Contact your GP immediately or call NHS 111 if you have both:

a high temperature of above 38C (100.4F)

You may have an infection inside the joint (septic arthritis).

Sodium urate crystals

medical conditions known to increase levels of uric acid

NHS Choices puts you in control of your healthcare

lifestyle factors such as diet or certain types of medication

These risk factors are discussed in more detail below.

high blood pressure (hypertension)

NHS Choices puts you in control of your healthcare

red meat such as beef, lamb and pork

NHS Choices puts you in control of your healthcare

Which joints are affected?

NHS Choices puts you in control of your healthcare

NHS Choices puts you in control of your healthcare

NHS Choices puts you in control of your healthcare

do not respond to other treatment

impaired kidney function

NHS Choices puts you in control of your healthcare

provide rapid pain relief.

medication to reduce uric acid levels

NHS Choices puts you in control of your healthcare

NHS Choices puts you in control of your healthcare

Other possible side effects of allopurinol include:

an increased number of acute gout attacks

NHS Choices puts you in control of your healthcare

offal liver and kidneys, heart and sweetbreads

NHS Choices puts you in control of your healthcare

on gout and diet (PDF, 711kb) produced by the UK Gout Society.

NHS Choices puts you in control of your healthcare

NHS Choices puts you in control of your healthcare

NHS Choices puts you in control of your healthcare

NHS Choices puts you in control of your healthcare

NHS Choices puts you in control of your healthcare

NHS Choices puts you in control of your healthcare

UK Gout Society Secretariat PO Box 527 London WC1V 7YP

NHS Choices puts you in control of your healthcare

Das könnte Ihnen auch gefallen