Gout
Gout
Gout is a form of inflammatory arthritis caused by the formation of urate crystals in and around joints.
It commonly causes sudden attacks of severe joint pain, swelling and redness, but it can also lead to recurrent attacks or more persistent joint problems if urate levels remain high.
Dr Richard Campbell assesses and treats patients with suspected gout, recurrent attacks and established gout requiring longer-term management.
Symptoms of gout
Gout often presents as a sudden, very painful attack affecting a single joint, although more than one joint can sometimes be involved.
- Sudden onset of severe joint pain
- Joint swelling
- Redness and warmth around the joint
- Pain that may be particularly severe overnight
- Recurrent episodes affecting the same or different joints
- Pain affecting the big toe, ankle, knee, foot, wrist or fingers
- Persistent lumps of urate crystals, known as tophi, in more established disease
The big toe is a classic site, but gout can affect many different joints.
Why gout develops
Gout develops when the level of uric acid in the blood is high enough for urate crystals to form.
Some people have persistently raised urate without developing gout, while others experience recurrent inflammatory attacks.
Factors that can contribute include kidney disease, certain medications, genetic predisposition, excess alcohol intake, obesity and dietary factors. In many patients, there is more than one contributing factor.
How gout is diagnosed
Diagnosis is usually based on the pattern of symptoms, examination findings and blood tests. A serum urate level may support the diagnosis, although it can sometimes be normal during an acute attack.
In some cases, joint fluid analysis may be used to look for urate crystals. Ultrasound or other imaging may occasionally be helpful where the diagnosis is uncertain.
A normal urate level during an acute attack does not exclude gout.
Treating a gout attack
Treatment of an acute gout attack aims to reduce inflammation and relieve pain as quickly as possible.
Depending on individual circumstances, treatment may include anti-inflammatory medication, colchicine or corticosteroid treatment.
The most appropriate option depends on factors such as kidney function, other medical conditions and current medication.
Patients with frequent attacks may also need a longer-term strategy to prevent recurrence.
Preventing further gout attacks
For patients with recurrent gout or more established disease, treatment is usually aimed at lowering the serum urate level sufficiently to prevent further crystal formation and gradually dissolve existing urate deposits.
Urate-lowering treatment may include medicines such as allopurinol or febuxostat, depending on clinical circumstances.
Treatment is usually adjusted according to serum urate levels rather than simply using a fixed dose.
The aim of treatment is not simply to reduce the number of attacks, but to lower urate sufficiently to control the underlying disease.
Monitoring and lifestyle
Regular blood testing may be required when urate-lowering treatment is started or adjusted.
Lifestyle measures can also help, particularly where there are contributing factors such as excess alcohol intake, obesity or a diet high in certain purine-rich foods.
However, gout is not simply a dietary condition, and many patients require medication to achieve adequate urate control.
When to seek specialist advice
- Recurrent gout attacks
- Uncertain diagnosis
- Persistent joint swelling between attacks
- Tophi
- Gout affecting several joints
- Difficulty tolerating standard treatment
- Kidney impairment complicating treatment
- Gout despite treatment
- Need for advice on long-term urate-lowering therapy
- A second opinion regarding diagnosis or treatment
Specialist gout care
Dr Campbell has extensive experience in the diagnosis and management of gout in both NHS and private practice.
A specialist consultation can help confirm the diagnosis, review previous treatment and investigations, assess contributing factors and agree an appropriate plan for managing both acute attacks and long-term urate control.
Private consultations are available for patients with newly suspected gout, recurrent attacks, established gout or those seeking a further specialist opinion.
Arrange a consultation
If you are experiencing recurrent episodes of joint pain and swelling, have an uncertain diagnosis, or would like advice about long-term gout treatment, a specialist rheumatology assessment can help determine the appropriate next steps.
Appointments are available at The Sloane Hospital in Beckenham and Chelsfield Park Hospital in Orpington. Self-pay and insured patients are welcome.