A consultant rheumatologist explains what gout is.
A consultant rheumatologist explains what gout is.
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Gout is the most common cause of inflamed joints, and affects about 1.4% of people in the UK. People get gout because they have too much of a substance called uric acid in their blood. We all have uric acid in our blood, it's just that people with gout have more uric acid than other people and what happens is that, as uric acid levels rise and saturate body tissues with uric acid, then little crystals, tiny crystals of uric acid, form in and around joints which leads to symptoms of gout.
Gout is an intensely painful form of arthritis. The word ‘arthritis’ simply means inflammation or pain in a joint. Gout is one of the common types of arthritis, affecting between 2-3 adults in every 100 people the UK [Kuo et al., 2015].
Ben was amazed when he found out that gout is a form of arthritis.
Ben was amazed when he found out that gout is a form of arthritis.
Age at interview: 34
Sex: Male
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And what about other people who you told when you found out you'd got gout, what were their reactions like?
They all think it's this rich man's kind of thing. So it was all, you know, they jumped to the same conclusion like, "Oh, you've been drinking the red wine or port or, you know, whatever that is." And that's everyone's assumption of it. I didn't actually know until looking into it it's a - and I think this is right, that it's a form of arthritis. Yeah. Which, which amazed me. I didn't - I didn't know that at all.
People commonly think that gout is self-inflicted and caused by eating rich foods or drinking too much alcohol – lifestyles that were often associated with rich people or kings in past centuries like Henry VIII. While diet can play a part in making attacks of gout more likely, for most people gout is caused by their genetic makeup, their other health conditions, or the tablets they take (for more information see ‘
Causes of gout’).
A consultant rheumatologist explains who can get gout and what the most common causes are.
A consultant rheumatologist explains who can get gout and what the most common causes are.
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Anyone can get gout - it's one of the commonest reasons for inflamed joints. About one in 100 people in the UK have gout. We know gout affects more men than women, and it's unusual in women before they have their menopause. People with gout often have other health conditions, like being overweight, or having kidney disease or diabetes. But people often think that gout is self-inflicted and caused by eating the wrong types of food or drinking too much alcohol, whereas in fact for most people, their gout is caused by a combination of their genetic makeup, or their other health conditions, or the tablets they take.
Gout can affect men of any age, whereas women are more likely to develop gout after the menopause. More men than women are affected by gout. Attacks of gout usually happen suddenly and cause excruciating pain in the joints – often the big toe joint. The joint will typically be swollen, red and very tender. There are no definite answers about why gout is most common in the big toe joint, but there are several possible reasons relating to temperature, injury and osteoarthritis.
A consultant rheumatologist talks about current theories explaining why gout is most common in the big toe.
A consultant rheumatologist talks about current theories explaining why gout is most common in the big toe.
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Well we don’t know for sure why gout most commonly affects the big toe, although there are a number of theories. So the first possible explanation is that the foot is cooler than other parts of the body, and crystals of uric acid find it more easy to form at lower temperatures.
The second theory relates to the fact that people quite commonly stub their toe or knock their foot, and that this can commonly lead to an attack of gout.
The third possible explanation relates to other types of arthritis, and the big toe is a joint that is very commonly affected by osteoarthritis, and it's thought that uric acid crystals form more easily inside joints where the cartilage is affected by arthritis. In truth, we don’t know which of these reasons is the cause, and it's possible that all three reasons are playing together to explain why gout commonly affects the big toe.
Attacks usually reach their most painful stage within 12-24 hours. They last between a few days and a few weeks and will start to get better even without treatment. An attack typically gets better with time. It is thought that this happens because the cells of the immune system stop reacting to the uric acid crystals, which means that the inflammation gets better*. Most people find that they need short-term treatment to reduce the pain and inflammation caused by attacks (see ‘
Treating the pain and inflammation of attacks’). Over time, people may also develop white lumps called tophi under their skin – often around the elbows, feet or ears (for more information see ‘
First symptoms and attacks’ and ‘
Tests and diagnosis’).
*Mechanisms of inflammation in gout
. Dalbeth N, Haskard DO. Rheumatology (Oxford). 2005 Sep;44(9):1090-6.
Last reviewed December 2016
Last updated December 2016
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