Gout

Overview

Gout is a painful form of arthritis (joint inflammation). Uric acid is a normal waste product made when the body breaks down substances called purines. When there is too much of it in the blood, it can form tiny needle-like crystals in and around a joint. The body reacts to these crystals, and the joint suddenly becomes very painful, hot, swollen and red. The big toe is the most common place, but the foot, ankle, knee, wrist, hand and elbow can also be affected.

Gout comes and goes. A painful episode is called a flare or attack. Without treatment a flare usually settles in one to two weeks, and then there may be months with no symptoms (remission). Over time, if uric acid stays high, flares can become more frequent and last longer, and more joints can be involved.

Gout is more common in men and becomes more common with age. It often runs in families and is linked with being overweight, drinking alcohol, high blood pressure, diabetes and kidney problems. Gout is a long-term condition, but it can be controlled very well. Treatment has two parts: quick relief of pain and swelling during a flare, and, for many people, a daily medicine that lowers uric acid to prevent future flares and joint damage.

Symptoms

• Sudden, severe pain in one joint, often starting at night or early morning, most commonly at the base of the big toe
• Swelling of the affected joint
• Hot, red or shiny skin over the joint (redness can be harder to see on brown or dark skin)
• Tenderness so bad that even a bed sheet touching the joint hurts
• Pain and swelling in other joints such as the ankle, top of the foot, knee, wrist, fingers or elbow
• Symptoms that come in flares lasting days to weeks, with symptom-free periods in between
• Hard, painless or painful lumps under the skin (tophi), often on the ears, fingers or elbows, in long-standing gout

Causes and risk factors

Causes

• Too much uric acid in the blood, either because the body makes too much or because the kidneys do not remove enough of it
• Uric acid crystals forming in and around a joint, which trigger inflammation (the body's reaction causing pain and swelling)
• Inherited tendency: gout often runs in families
• Certain medicines, especially water tablets (diuretics), that raise uric acid levels
• Triggers that can set off a flare: a fever or illness, heavy drinking, a very large meal, not drinking enough fluids (dehydration), a joint injury or recent surgery

What makes it more likely

• Being male, and getting older; in women the risk rises after the menopause
• A family history of gout
• Being overweight or obese
• Drinking alcohol, especially beer and spirits
• A diet high in red meat, organ meat (such as liver and kidney), some seafood, and sugary foods and drinks
• High blood pressure, high cholesterol, diabetes or insulin resistance (the body not responding well to insulin)
• Kidney disease or heart failure
• Taking diuretics or some other blood pressure medicines

Complications

If uric acid stays high for years, gout flares can become more frequent, last longer and spread to more joints. Crystals can build up into hard lumps called tophi under the skin and around joints, most often on the fingers, elbows, toes and ears. Tophi can be painful and can damage the joint and nearby bone, leading to long-lasting joint pain, stiffness and loss of movement (chronic gouty arthritis). High uric acid can also form kidney stones. Gout often occurs alongside heart disease, high blood pressure and kidney disease, so doctors usually check for these as well. Long-term treatment that keeps uric acid low can prevent most of these problems.

Diagnosis

A doctor usually suspects gout from the story and an examination: sudden, severe pain, redness and swelling, especially in the big toe joint, or the presence of tophi. The doctor will ask about diet, alcohol, medicines and other illnesses, and will think about other causes such as a joint infection or a related crystal condition sometimes called pseudogout. A blood test for uric acid (serum urate) supports the diagnosis. The level can drop during a flare, so if gout is still suspected the test may be repeated a few weeks after the flare settles. A high uric acid level on its own does not prove gout.

If the diagnosis is unclear, a small sample of fluid can be taken from the joint with a thin needle and looked at under a microscope for uric acid crystals. This is the surest test and is easiest during a flare. If that is not possible, an X-ray, ultrasound scan or a special CT scan (dual-energy CT) may be used. Unclear cases can be referred to a rheumatologist (joint specialist).

Treatment

1. Treat a flare as early as possible with an anti-inflammatory painkiller (NSAID), colchicine or a short course of steroid tablets; the doctor chooses based on your other illnesses and medicines
2. If you take an NSAID, your doctor may add a stomach-protecting medicine (proton pump inhibitor)
3. If tablets cannot be used or do not work, a steroid injection into the joint or into a muscle may be given; rarely, a specialist may use an interleukin-1 inhibitor
4. Use an ice pack on the joint and rest it alongside the medicines
5. After the flare settles, review uric acid level, weight, alcohol, blood pressure, kidney function and current medicines
6. For frequent or troublesome flares, tophi, joint damage, kidney disease or diuretic use, start a uric acid-lowering medicine such as allopurinol or febuxostat, usually a few weeks after a flare settles; your doctor starts low and adjusts it with monthly blood tests until uric acid is below the target
7. Keep taking the uric acid-lowering medicine every day, even when you have no pain; it is usually lifelong, and colchicine or another medicine may be given for the first months to prevent flares

Medicines in Pakistan

Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.

Also used (not yet in our price list): Colchicine (first-line for flares and for preventing flares when starting uric acid-lowering treatment), Febuxostat (uric acid-lowering medicine, an alternative to allopurinol), Interleukin-1 inhibitors (specialist use only, when other flare treatments cannot be used)

Self-care and prevention

Self-care

• Take your flare medicine as soon as an attack starts; it usually begins to work within about two days
• Rest the joint, raise the limb and avoid putting pressure on it
• Cool the joint with an ice pack or a bag of frozen peas wrapped in a towel, for up to 20 minutes at a time
• Keep bed sheets off the painful joint at night
• Drink plenty of water, unless your doctor has told you to limit fluids
• Keep taking uric acid-lowering medicine every day, even during a flare, unless your doctor says otherwise
• Go for your blood tests so your doctor can check your uric acid level

Prevention

• Lose extra weight slowly and steadily; avoid crash diets
• Eat a healthy, balanced diet and limit red meat, organ meat, some seafood, and sugary foods and drinks
• Avoid alcohol or keep it low, with several alcohol-free days each week
• Stay active with regular moderate exercise, such as brisk walking, while avoiding heavy strain on painful joints
• Keep blood pressure, diabetes and cholesterol under control, and ask your doctor whether any of your medicines raise uric acid
• If your doctor has prescribed uric acid-lowering medicine, take it every day long term

Common questions

Is gout caused by eating too much meat?

Diet plays a part, but it is not the only cause. Genes, weight, kidney function and some medicines matter a lot. Foods such as red meat, organ meat, some seafood, sugary drinks and alcohol can raise uric acid, so cutting down helps, but diet alone rarely controls gout and there is no single proven gout diet.

Do I have gout if my uric acid test is high?

Not necessarily. Many people have high uric acid without ever getting gout. Gout is diagnosed when there are typical joint symptoms, and the test is only one part of the picture. Uric acid can also be normal during a flare, so a doctor may repeat the test later.

Should I stop allopurinol during a gout attack?

No, not unless your doctor tells you to. Stopping and restarting uric acid-lowering medicine can make flares more likely. Treat the flare with the medicine your doctor advised and carry on with your daily tablet.

Will I need medicine for the rest of my life?

Gout is a long-term condition. If you need uric acid-lowering medicine, it is usually taken for life, even when the uric acid level has reached its target and you feel well. Stopping it often lets the crystals come back and flares return.

Why do I get more flares when I start uric acid-lowering medicine?

As uric acid starts to fall, crystals in the joints can shift and set off flares in the first months. This is a sign that treatment is starting to work, not that it is failing. Your doctor may give colchicine or another medicine for a while to reduce these flares.

Sources

1. NICE. Gout: diagnosis and management (NG219) (2022).
2. CDC. Gout | Arthritis | CDC (2024).
3. NHS. Gout (2023).
4. Pakistan Journal of Medicine and Dentistry (Ashiq K et al.). Knowledge, Attitude and Practices Assessment of the Gout Patients Residing in Lahore, Pakistan (2024).
5. Annals of King Edward Medical University (Rathore FA et al.). The Analysis of Published Research on Gout and Hyperuricemia from Pakistan in National Biomedical Literature (2022).

Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.

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