Gout is a form of inflammatory arthritis. People often get attacks in their big toe joints but gout can also affect other parts of the foot, the knees, ankles, elbows, wrists and fingers. It is rare for gout to affect the shoulders, hips or spine.
Ivor’s first attack happened on holiday. He could not bear the bed sheet touching his foot.
Ivor’s first attack happened on holiday. He could not bear the bed sheet touching his foot.
Age at interview: 69
Sex: Male
SHOW TEXT VERSION
PRINT TRANSCRIPT
The first time I suffered and I didn't even know what it was at the time, not initially anyway. I was overseas, we were on holiday, and I felt a sort of a pain in my big toe which just felt like I'd sprained it initially, but it just got worse and worse and eventually after about four days I was lying in bed and it was in the middle of the night and it was absolutely excruciating pain and I couldn't even put a sheet over my foot, it really was bad. At which point my wife called the doctor. So he came and made a quick assessment and told me it was gout and I immediately rebuffed him, I said, “It can't” - at that age having gout, because I was only what 45 or whatever, 45 years old. So, no 35, sorry, and he was absolutely insistent that it was gout and he gave me some anti-inflammatories which actually took a long time to take effect so - and my foot was really very, very swollen, I couldn't wear shoes, and that situation pertained for about almost four weeks before it eventually subsided that I could walk properly again with a regular pair of shoes. And thereafter I suffered from time to time, I think for about five or six years it happened three or four times a year.
Attacks of gout usually begin quickly and reach their most painful stage within 12-24 hours, and last for up to two weeks. Many people we spoke to woke up during the night or in the morning with severe pain. People often had their first attack in one of their big toe joints, but some people’s symptoms had begun in other joints. Jonathan’s first major attack was in his right knee while Jeff X’s affected both his big toe joints at the same time.
Joe’s first attack was in his big toe. It was so tender that he could not bear anything touching it.
Joe’s first attack was in his big toe. It was so tender that he could not bear anything touching it.
SHOW TEXT VERSION
PRINT TRANSCRIPT
Well the big toe just swelled up and, very tender, you know, if you put a feather on it, it hurt. You try and sleep with your leg out of the bed and all that, you can’t stand the blanket on it or anything. It’s hard to walk, obviously, and for a time, when I first had it, I did work on it and walk, like on the side of my foot, because I’m a bit stupid like that, but I had to stop in the end, because with it being a heavy job and all, I just couldn’t do it, so I was off until it subsided really, a couple of weeks, which you know, it’s very painful, a very drawn out time, where you just, it just takes you off your feet really.
Many people felt that the pain was like no other pain they had experienced before. The incredible pain was particularly worrying for some. People were often confused when they first had the sudden pain because they had no idea what had caused it. Ray wondered if his toe was infected and Sam thought that she might have been stung. Jean thought an in-growing toenail might be causing her symptoms. Shirley X thought the pain was from a type of chilblain, because she had previously had chilblains.
Michael’s first attack started when he was driving back from France. The pain was unlike anything he had experienced before and he did not know what had caused it.
Michael’s first attack started when he was driving back from France. The pain was unlike anything he had experienced before and he did not know what had caused it.
SHOW TEXT VERSION
PRINT TRANSCRIPT
My first gout attack was about 14, 15 years ago and I didn't know what it was. We were coming back from France, been on holidays and basically driving through France and back into England and my left knee started to get very sore as we were driving. As I said, I didn't know what it was, but it was kind of unexplained. I hadn't hurt it or injured it at all. I thought maybe it was tired or stiff.
But anyway, as the journey went on, it got worse and worse to such an extent that by the time we got back to England I wasn't able to drive so my wife had to drive the remainder of the journey. I think that was on a Saturday evening and I was in agony. My left knee was in complete agony. I couldn’t bend it. As I say, it was, it was not like any sort of pain I'd had before. It wasn't particularly swollen. It was a little bit swollen, but it wasn't - there was no obvious signs of injury. It was very debilitating because basically I couldn't move it at all, so I couldn't walk properly and managed to get to bed. Anyway, the next day I couldn't - it was still in, in agony, so basically I sat myself down the stairs to get down the stairs and basically got a taxi to the hospital because my wife had gone to work. So sat in A&E, didn't know what was wrong but at this stage it was excruciating pain and I felt a bit silly really because I didn't know what was wrong with it.
Carole thought her symptoms were related to the operations she had previously had on her big toes. Gerald initially thought the twinges of pain he was having and his swollen joints were a result of working hard and being on his feet for long shifts at work. Janette and Shirley Y had both had pain from arthritis since they were young, so initially thought their symptoms were related to that.
John X wondered if the pain he was getting was a side effect from the medication he was taking for his cholesterol. Tony and Jeff X both had their first attacks during walks and wondered if the pain was caused by the shoes they were wearing. Many other people thought that they must have injured themselves without noticing. Several thought they must have stubbed their toe or even broken it.
Naresh thought the pain in his toes was from a physical injury. His toes were swollen, red and very painful.
Naresh thought the pain in his toes was from a physical injury. His toes were swollen, red and very painful.
Age at interview: 62
Sex: Male
SHOW TEXT VERSION
PRINT TRANSCRIPT
The first time it happened was 1974. Actually I was playing cricket at the time, you know, and I was starting to get some kind of pain in my toes, the right and left, both, you know. So I thought probably, maybe, it was physical things, and then it started gradually, it started beginning – getting worse, you know. So when I come home, it’s just swollen right, so I thought it must be something happened, or twisted. Then after that, I went to an appointment with the doctors, and the doctor looked at it and he, looked at it, it was already red, and very painful. So it was so swollen, you know. So he said that to me, “I think you’ve got gout”.
Jeff X thought his shoes might be causing his symptoms. His big toe joints were tender, red and swollen.
Jeff X thought his shoes might be causing his symptoms. His big toe joints were tender, red and swollen.
Age at interview: 68
Sex: Male
SHOW TEXT VERSION
PRINT TRANSCRIPT
I was walking down to the village, to get shopping and things, and it was, it was quite a steep incline coming back. Well and going down, but I was going down, going down. Coming back it was quite steep, so I thought it was probably the, sort of beachy type shoes I was wearing, that maybe I hadn’t, you know sort of - weren’t comfortable. Causing some sort of, you know, imbalance in my, in my gait, or whatever. But it was, you know, it was quite severe after a day or two.
And can you describe the pain at all?
Well it was, basically, it was just in my, my big toe joints. They were very sore, if they were touched - if one touched the other one. And yet, ibuprofen, it didn’t seem to affect my, I managed to sleep okay, most of the time. It was, how do I describe it? Well, what I imagine arthritis might feel like. That’s the best I can say, really. It was tender to touch, to touch the joints was very tender, and they were a bit red and swollen.
Some people recognised their symptoms as fitting with their knowledge of gout or with the symptoms of other people they knew with gout. Simon realised straightaway that he had gout because of his medical background and the fact that his father had also had gout. Peter X was advised that he might develop gout before he experienced any symptoms, and so knew what the pain was when it started.
Peter X had been for a medical examination through his health insurance. He was advised that he might develop gout because his uric acid levels were high.
Peter X had been for a medical examination through his health insurance. He was advised that he might develop gout because his uric acid levels were high.
Age at interview: 75
Sex: Male
SHOW TEXT VERSION
PRINT TRANSCRIPT
When I was working in 1992, ’93 under my terms of employment I did have private health insurance and we got notification that we could have a medical examination. So I said, “Yes.” And in January ‘93 I went for a medical examination down in [hospital name]. There, it was, it lasted a few hours, and when it was all over I went to the final room and sat down and they talked to you and they said, “Right there’s two things we should tell you about. One, you have a heart murmur, so yes get somebody to check that for you, and two, how long have you had gout?”
I said, “I haven’t got gout.” He says, “Well you will have within two weeks, your uric acid level is very high.” So I said, “Ok, but everything else is alright is it?” “Yes you’re perfect.” So that was the end of the medical examination and we came home and yes, within two weeks, my fingers and toes started aching, and so I knew what it was. But I went to see my local doctor and he said, “Yes you’ve got gout”.
Many people had very clear memories of their first attack because the pain had been so intense. Harry could remember his first attack well because it had occurred during the 1966 football World Cup. A number of people knew exactly when their first attack had happened because they were abroad on holiday at the time. Eric was in Eastern Europe and felt alarmed about being so far from home and in pain. He was unsure about what to do but the hotel manager sent him to a local clinic.
Peter Y was abroad on holiday in Turkey and can remember his first attack in detail.
Peter Y was abroad on holiday in Turkey and can remember his first attack in detail.
Age at interview: 63
Sex: Male
SHOW TEXT VERSION
PRINT TRANSCRIPT
I can remember the first attack very well indeed. We were abroad on holiday with the family and with friends as well, in Turkey. And I noticed that my foot was aching during one day, I think, and I assumed it was, because we’d been walking over rough ground or something like that, and then it became excruciatingly painful during the evening. And my biggest memory of it, which has remained in the, sort of, family lore is, that my daughter, who was about 10 at the time, was up all night making ice packs to place on my toe, and - so it was in my right toe. And we, sort of, arranged the bedding so there was nothing sitting on the foot.
I was a GP at the time. One of my friends we were with was a GP, and I’m not sure whether we diagnosed it as gout, actually. I sort of, in retrospect, I hope we did, but I certainly didn’t have any particular specific gout treatment with me at the time, so I just took ordinary painkillers and drank some, plenty of fluids. And, I, my memory is, it gradually went down over about 48 hours, but I was unable to drive, that was another thing I remembered; that my wife had to drive the car. And I also remember having to, sort of, get a stick, fashion a stick out of a piece of a local tree and use that. And that gradually, then, went down and was better in a few days, I think, but it certainly impacted on a day or two of the holiday. That’s what I remember.
Many people had their gout diagnosed by their GP. Some made an appointment to see their doctor as soon as they experienced symptoms, often because the pain was so bad. Others decided to wait for a while to see if the symptoms went away. The pain Pat had was not severe enough for her to consider visiting her GP straight away, but after a few months, she decided she needed some advice. Janette decided to see her GP when she had three bouts of pain in one month. In some cases, people made the decision to visit their GP because other people believed that it was necessary.
Ian woke up one morning with severe pain in his toe. He made an appointment to see his GP even though he could hardly walk.
Ian woke up one morning with severe pain in his toe. He made an appointment to see his GP even though he could hardly walk.
SHOW TEXT VERSION
PRINT TRANSCRIPT
Well I first - actually got the symptoms of gout in - back in 1996, overnight, I woke up one morning, got a real big pain in my big toe, and I thought that I'd broken my toe and slept funny in the night or something of that nature. But I had a really - I could hardly walk, had a real pain, as though it was - a bit like a fracture almost. So I made an appointment at the doctor, and they took some tests and found out that was gout.
Jeff Y thought he had knocked his toe. He eventually decided to see a doctor because it became very painful.
Jeff Y thought he had knocked his toe. He eventually decided to see a doctor because it became very painful.
SHOW TEXT VERSION
PRINT TRANSCRIPT
I suppose I had had gout a long time before I realised it was gout - and I just thought it was a swollen toe and done nothing about it. It became very painful so I went to the doctor and after a lot of time he said, “Yes, it’s gout.”
So, so when you first had the swollen toe, how long did that go on for before you ended up going to the doctor?
Oh some time. Weeks if not months, I should think.
And what did you think it was?
Just a swollen toe - damaged it, knocked it, something like that, you know. That’s what basically I thought it was.
So why did you decide finally to go to the doctor's then?
Because it became so painful [Laughter].
Okay. And you said when you went to the doctor's - after some time.
Yes
It was diagnosed as gout. Can you tell me what happened?
Well I went, went to the - well we moved house a lot, and we came up to [where we are living now] and went to a new doctor, naturally, and as I say - yes, just said, “Well I think you’ve got gout.”
A few people had experienced such intense pain that they had gone to Accident and Emergency (A&E). Jonathan considered going to A&E or ringing for an ambulance, but then waited to see his GP. Most people who had gout in their feet, ankles or knees found walking and driving very difficult because of the pain. Some struggled to get to their GP or hospital by themselves. Sue’s husband came to collect her from the hospital. John Y could not walk very far but managed to drive to his appointment. Janette’s and Kate’s GPs came out to see them at home because they could not walk (for more see ‘
Tests and diagnosis of gout’).
Last reviewed December 2016
Last updated December 2016
Copyright © 2024 University of Oxford. All rights reserved.
