Gout

Crystals of uric acid in a joint. Ferociously painful, entirely treatable, and still treated as a joke.

What it is

Gout has an image built in the eighteenth century and it has cost patients dearly ever since. It is not a disease of overindulgence, and telling somebody to lay off the port is neither accurate nor useful.

Uric acid builds up in the blood and forms needle-shaped crystals in a joint. The immune system attacks them, and the resulting inflammation is among the most painful things in general practice. Patients describe not tolerating a bed sheet on the affected toe.

It affects around one in forty people in the UK, and it is commoner in chronic kidney disease, in heart failure and with certain diuretics.

Signs you might notice

Sudden, severe pain in one joint, very often the base of the big toe, frequently starting at night.

The joint red, hot, swollen and exquisitely tender.

Attacks lasting days to a couple of weeks, then settling entirely between them.

Over years, lumps of crystal called tophi under the skin, and permanent joint damage.

How it can affect day-to-day life

The gap between treatment for the attack and treatment for the disease is where most harm happens. People get anti-inflammatories for the flare and nothing to lower uric acid, so the attacks keep coming and the joint quietly erodes.

Gout is also a marker. It travels with high blood pressure, type 2 diabetes and cardiovascular disease, so it is worth treating as a prompt for a broader check.

And an acute hot joint always deserves a second thought: septic arthritis looks similar and is an emergency.

Supporting someone well

Treat the flare early. The sooner treatment starts, the shorter the attack.

Ask about long-term urate-lowering treatment such as allopurinol if there has been more than one attack, or any tophi or joint damage. This is the part routinely missed.

Do not stop urate-lowering treatment during an attack, and do not start it and abandon it because a flare happened. Flares during the first months are expected.

Keep fluids up. Review diuretics with a GP rather than stopping them.

Diet helps a little. It is not the main lever, and pretending otherwise leaves people blaming themselves for a genetic condition.

Where to get help

A GP diagnoses and manages gout, sometimes with a blood test or joint aspiration.

A hot, swollen joint with fever needs urgent assessment to exclude infection.

UK Gout Society have clear patient information written without the moralising.