Gout

What gout is

Everyone has some urate (uric acid) in their blood. Most of it is made by the body itself, and about a quarter comes from food and drink. If levels get too high, sharp crystals can form in and around the joints. When the immune system reacts to these crystals, the joint becomes suddenly inflamed and very painful.

Gout is about four times more common in men than women. Women rarely get it before the menopause. It becomes more common with age. Things that raise the risk include:

• Being overweight
• Drinking alcohol, especially beer and spirits
• Kidney problems
• High blood pressure
• Diabetes
• High cholesterol
• Water tablets (diuretics) and some other medicines
• A family history

Gout is not your fault, and it isn't caused only by diet. Your genes and how well your kidneys clear urate play a big part.

Forms of gout

Attacks and how gout progresses

Gout attacks, also called flares, often start at night. The joint becomes extremely painful, so even a bed sheet touching it can hurt. The skin over it is hot, swollen and red. The big toe is most common, but feet, ankles, knees, hands, wrists and elbows can be affected.

1. Hours

   Attack starts

   Pain comes on quickly, often overnight. Start your flare treatment as soon as you can.

2. 12 to 24 hours

   Peak

   Pain and swelling are usually at their worst in the first day.

3. 5 to 7 days, up to 2 weeks untreated

   Settling

   The attack slowly eases. The skin may peel or itch as the swelling goes down.

4. Weeks to years

   Between attacks

   You may feel normal. But without treatment, crystals keep building and attacks tend to return.

Attacks can be triggered by drinking a lot of alcohol, a big meal, not drinking enough water, an illness with a fever, an injury to the joint, or a change in medicines.

When to get urgent help

A hot, swollen joint can sometimes be a joint infection (septic arthritis). This can damage the joint quickly and needs treatment straight away.

Diagnosis and referral

Your GP will ask about your symptoms and examine the joint. Tests may include:

• A blood test for urate. Urate can fall during an attack, so if the result is normal, NICE says it should be repeated at least 2 weeks after the attack has settled.
• A joint fluid sample taken with a needle, to look for crystals and rule out infection. This is the most certain way to confirm gout.
• Kidney function and other blood tests, as gout is linked with kidney, heart and blood sugar problems.
• Ultrasound, X-ray or a special CT scan, sometimes used by specialists if the diagnosis is unclear.

Most people with gout are treated by their GP. You may be referred to a rheumatologist if the diagnosis is uncertain, if treatment isn't working, if you can't take the usual medicines, or if you have kidney disease or tophi.

Treating an attack

Start treatment as soon as you can after an attack begins. Many people keep a supply at home, agreed with their GP. NICE suggests one of these, chosen to suit your health and other medicines:

Rest the joint, raise it, and keep weight off it. An ice pack wrapped in a towel for up to 20 minutes at a time can help. Keep bedding off a painful toe and drink plenty of water.

Preventing attacks

Treating attacks doesn't stop crystals building up. Urate-lowering therapy (ULT) dissolves the crystals over time, so attacks stop. NICE says your GP should talk to you about it after your first attack, and offer it if you have repeated attacks, tophi, chronic gouty arthritis, kidney disease or take diuretics.

1. Starting urate-lowering medicine

   Usually 2 to 4 weeks after an attack settles

   NICE recommends allopurinol or febuxostat first. Allopurinol is preferred if you have significant heart disease. Both are prescribed by your GP. They are started low and increased gradually.

2. Finding the right dose

   Blood tests about monthly while the dose is adjusted

   NICE recommends a treat-to-target approach. The aim is a urate level below 360 micromol/litre, or below 300 if you have tophi or keep having attacks. Ask your GP what your level is.

3. Protecting against flares while you start

   Often the first months

   Attacks can happen more often in the first few months as crystals start to dissolve. This is a sign the medicine is working. Your GP may prescribe colchicine, or another anti-inflammatory, to take alongside to help prevent this.

4. Long term

   Usually lifelong

   Keep taking it every day, even when you feel well, and during an attack. Stopping lets crystals build up again. Once you reach your target, your urate level is checked about once a year.

Self-help and living well

NICE says there isn't enough evidence that any one diet prevents gout attacks, and diet alone rarely controls gout. But healthy habits help, alongside medicine.

Gout is linked with heart disease, high blood pressure, diabetes and kidney disease. Ask your GP to check these regularly.

Getting the best treatment

Questions to ask

• Should I start urate-lowering treatment?
• What is my urate level, and what is my target?
• How often will my urate be checked while my dose is adjusted?
• Can I have a supply of flare medicine to keep at home?
• Do I need something to prevent flares while I start treatment?
• Could any of my other medicines be raising my urate?
• Should I be referred to a rheumatologist?

A common problem is that urate-lowering medicine isn't increased enough to reach the target. If you are still having attacks, go back and ask for your urate to be checked. You can ask to see another GP or for a referral to a specialist.

Gout and work

Gout can count as a disability under the Equality Act 2010 (the Disability Discrimination Act in Northern Ireland) if it has a substantial, more than minor, effect on your daily life and has lasted, or is likely to last, at least 12 months. Conditions that come and go count, and the law looks at how you would be without treatment. Recurrent or chronic gout may qualify.

If it does, and your employer knows or should know about it, they must make reasonable adjustments. These might include:

• Working from home during an attack
• Seated work instead of standing or walking
• Changes to uniform or safety footwear rules
• A footrest to keep a foot raised
• A parking space near the entrance
• A workspace on the ground floor
• Easy access to drinking water
• Time off for appointments and blood tests
• Flexibility on attack-related absence
• Voice software if hands or wrists are affected

Access to Work is a government grant that can pay for equipment, travel to work and support. For advice on your rights, contact Acas or Citizens Advice.

Benefits

If you can't work during an attack, you may get Statutory Sick Pay from your employer. If gout has a long-term effect on your daily life, you may also be able to get Personal Independence Payment (PIP), or Adult Disability Payment in Scotland, Universal Credit or Employment and Support Allowance. Turn2us and Citizens Advice can help you check.

Support and sources

Last reviewed: October 2026.