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Read articleGout is a form of arthritis caused by uric acid crystals settling in a joint, producing sudden intense pain most often in the big toe. Attacks settle within days but return, and repeated attacks damage the joint permanently.
Symptoms
Not everyone gets every symptom, and the pattern can differ in older people, in people with diabetes and in children. These are the ones most often reported.
- Sudden severe pain in one joint, often starting at night
- The base of the big toe most commonly affected, then ankle, knee or wrist
- Redness, warmth and marked swelling over the joint
- Pain so severe that even a bedsheet touching the joint is unbearable
- Attacks lasting several days and then settling completely
- Hard lumps of crystal deposit around joints and ears in long-standing disease
When to see a doctor
Do not wait these out
If any of the following applies, arrange to be seen the same day. For anything sudden or severe, call 9281862028 or come straight to the emergency department at SIMS — it is open 24 hours and does not need an appointment.
- A hot, swollen, extremely painful joint — infection must be excluded first
- Fever with a swollen joint, which needs same-day assessment
- Repeated attacks, which need preventive treatment rather than only painkillers
- Gout with kidney stones, kidney disease or high blood pressure
Tests that may be advised
Your consultant will order only the investigations that change the plan. Most of the following are available on the SIMS campus, so results usually come back the same visit.
- Serum uric acid, though it can be normal during an acute attack
- Joint fluid aspiration and examination where the diagnosis is unclear
- Kidney function tests
- Blood sugar, lipid profile and blood pressure assessment
- X-ray of the affected joint in long-standing disease
How it is treated
Treatment is decided case by case — by how advanced the problem is, what else you are being treated for, and what you can realistically sustain. Broadly, it involves the following.
- Anti-inflammatory medication to settle the acute attack
- Uric acid lowering treatment started once the attack has settled, for those with repeated attacks
- Reducing alcohol, especially beer, and sugary drinks
- Moderating red meat, organ meat and seafood; maintaining generous fluid intake
- Weight reduction and control of associated blood pressure and diabetes
This page is general information, not a diagnosis
Gout can look like several other conditions, and the reverse is equally true. Nothing here can replace an examination, your test results and the judgement of the doctor treating you — and no medicine mentioned by name to a friend or relative should be started on the strength of this page. If you recognise yourself in it, book a consultation with the General Medicine department. If a symptom is sudden or severe, call 9281862028.
