Gout: symptoms, treatment, diet and how long an attack lasts

The NHS says the main symptoms are sudden severe pain in a joint, usually the big toe but also other joints in the feet, ankles, hands, wrists, elbows or knees, with hot, swollen, red skin over the joint.

Arthritis UK says attacks usually come on very quickly, often during the night, and that the joint becomes very painful, tender, red, hot and swollen, with shiny skin that may peel as the attack settles. NICE says gout usually affects the joint at the base of the big toe.

The NHS says attacks of gout are usually treated with an NSAID like ibuprofen. If pain and swelling do not improve you may be given steroids as tablets or an injection. Arthritis UK also lists colchicine, which reduces the inflammation caused by urate crystals, and says that NSAIDs and colchicine work best if taken as soon as you notice an attack coming on.

Treating an attack does not lower urate levels or stop future attacks, according to Arthritis UK. NICE Clinical Knowledge Summaries lists an NSAID, colchicine or a short course of oral corticosteroid for acute attacks.

The NHS says an attack usually lasts 1 to 2 weeks if left untreated and that future attacks may last longer without treatment. Arthritis UK says attacks usually settle after one to two weeks, but can go on for longer, and that if gout is left untreated attacks can become more common and spread to new joints.

The NHS says gout can come back every few months or it may be years, and that it can come back more often if it is not treated. Leaving gout untreated may cause lasting damage to joints.

Arthritis UK explains that urate is created every day when the body breaks down purines, chemicals made naturally in the body and also present in some foods. If the body makes too much urate or the kidneys cannot get rid of enough, levels rise and urate crystals can form. When crystals spill into the joint space they cause an attack. It says about three-quarters of urate comes from purines produced within the body and only about a quarter from food and drink.

The NHS says you might have a higher chance of gout if you are overweight, drink alcohol, have been through the menopause, take medicines such as diuretics or ACE inhibitors, have high cholesterol, high blood pressure, kidney problems, osteoarthritis or diabetes, or have had surgery or an injury.

Arthritis UK says you should not have to remove anything completely from your diet, but suggests avoiding large quantities of certain foods. It recommends a balanced diet low in fats and added sugars and high in vegetables and fibre, and gradual weight loss if overweight. Crash diets and Atkins-type diets are not recommended because they can raise urate levels.

The NHS suggests losing weight if overweight (avoiding crash diets), eating a healthy diet, having some alcohol-free days each week, not drinking more than 14 units a week, drinking plenty of fluids, not having lots of sugary drinks and snacks, and asking a GP about vitamin C supplements.

The NHS says you might get an attack if you have an illness that causes a high temperature, drink too much alcohol or eat a very large meal, get dehydrated, injure a joint, or take certain medicines, and says to get treatment immediately if you feel an attack starting. Arthritis UK adds having an operation, and starting urate-lowering therapy or not taking it regularly.

The NHS says the GP may ask about your diet and alcohol, and may do a test to measure how much uric acid is in your blood. If the test is unclear, you may be referred to a rheumatologist and further tests, which could include taking a sample of fluid from inside the affected joint with a needle, or a scan.

Arthritis UK says blood tests for urate help but are not enough on their own to confirm gout, and that a synovial fluid test is a good way to confirm the diagnosis and rule out other causes. NICE Clinical Knowledge Summaries says a serum urate of 360 micromol/L or more supports the diagnosis.

The NHS says repeated attacks over a long period (chronic gout) without treatment can lead to joint damage, hard lumps called tophi under the skin, usually on the ears, fingers or elbows, kidney stones, and, rarely, chronic arthritis. Arthritis UK says most of the damage and complications can be stopped with medication to lower urate levels and a healthy diet and lifestyle.

The NHS says to see a GP if you have symptoms of gout for the first time or if you have gout and your usual treatments are not helping. Ask for an urgent GP appointment or call NHS 111 if you have sudden pain and swelling in a joint and the pain is getting worse, you have a very high temperature or feel hot, cold or shivery, or you feel sick or cannot eat. These could mean an infection inside the joint that needs urgent medical help.

On the NHS, gout is diagnosed and managed by the GP, with referral to a rheumatologist when the diagnosis is uncertain or treatment is not working. NICE Clinical Knowledge Summaries says that urate-lowering therapy should be offered to people with multiple or troublesome flares and that the option should be discussed with everyone after a first or later flare. Private rheumatology and blood tests are available, but gout is a long-term condition, so ask how monitoring of urate levels will be shared with your GP.