Gout

Get help straight away if

These are uncommon, but they need same-day care — go to an emergency department, do not wait for an appointment.

• A hot, swollen, very painful joint together with fever or feeling generally unwellGo to an emergency department. An infected joint can look exactly like gout and needs treating within hours.

Contact us promptly if

Not an emergency, but worth being seen sooner rather than waiting it out.

• A first attack that has not been confirmed as goutWorth seeing us — the diagnosis changes what happens for years afterwards, so it is worth getting right.
• Attacks becoming more frequent, or affecting more joints
• Chalky lumps under the skin near joints, or in the earThese are urate deposits and usually mean the level has been high for a long time.

What usually happens

Gout is mostly not caused by what you eat. It is largely determined by how your kidneys handle urate, which is inherited — which is why people who have changed their diet completely still get attacks, and why the guilt that usually comes with this diagnosis is misplaced.

Treating an attack and preventing attacks are two entirely different things, and confusing them is the single commonest reason gout goes on for years. The treatment that settles an attack does nothing to stop the next one.

Preventive treatment lowers the urate level so that the crystals dissolve, and that takes months. It continues through the good spells and usually long term — stopping because you feel fine is what brings the attacks back.

Attacks can become more frequent in the first months of preventive treatment, as existing crystals start to dissolve. That is expected and is not a sign it is failing; it is usually covered deliberately for that period.

Gout keeps company with high blood pressure, kidney disease and cardiovascular risk, so it is worth looking at those at the same time rather than treating the toe in isolation.

At your appointment

We will want to be sure it is gout. A urate blood level is useful but is unreliable during an attack — it is often normal exactly when the joint is worst — so timing matters, and sometimes fluid from the joint gives the definitive answer.

We will talk about whether preventive treatment is worth it for you, which depends on how often attacks come, whether there are deposits, and how your kidneys are.

We will review your other medications, because a few in common use raise urate and there may be alternatives.

We will agree what you do at the first twinge of the next attack, so you are not starting from scratch at two in the morning.

Worth asking

• —Is it worth me being on preventive treatment?
• —What exactly should I do at the first sign of an attack?
• —Do any of my other medicines make this worse?
• —What urate level are we aiming for, and when will we recheck it?