Gout does not develop overnight. There is a latent period of about seven years
during which the concentration of uric acid in the bloodstream gradually increases.
This latent period is referred to as 'asymptomatic hyperuricaemia', which simply
means high uric acid levels without symptoms. It is important to point out that
most of the people who develop this condition will not go on to develop gout.
The first symptom of gout is usually extreme pain in the big toe. The joint
at the base of the big toe becomes swollen and the overlying skin becomes shiny
and purple. The toe becomes very tender and sufferers find that they are unable
to wear a shoe on the affected foot or even tolerate the weight of bed sheets
The first attack of gout will usually subside after about a week and about
10% of people will never again experience gout. The remainder may experience
attacks with increasing frequency and each subsequent attack can be of longer
duration. Repeated attacks of gout over several years can cause arthritic damage
to the joint.
While gout most often affects the big toe it can also attack other joints.
The knee can sometimes be affected.
If gout is left untreated, the sodium urate crystals will eventually collect
under the surface of the skin and will manifest themselves as small bumps near
the joints, or more commonly on the outer side of the ear. These bumps are known
as Tophi and occasionally they rupture and discharge a yellowish, chalky material.
How is it diagnosed?
Gout is usually diagnosed on the basis of the history of the attack and the
physical signs. In order to rule out other rheumatic conditions, your GP will
probably take a blood sample to measure the concentration of uric acid in the
How is it treated?
Gout is usually treated with non-steroidal anti-inflammatory drugs. Painkillers
that lack anti-inflammatory activity will not give adequate relief since the
joint inflammation is the actual trigger factor for the pain. Most attacks of
gout will subside within a week. Once the inflammation has disappeared the medication
can be discontinued.
If a person suffers from frequent recurrences of gout they may need long term
medication in order to keep the levels of uric acid within normal limits. They
may also need to modify their lifestyle. These measures might include:
- avoiding foods which experience has taught may trigger an attack of gout.
Generally these foods are high in protein and contain chemicals known as purines.
The list includes anchovies, sardines and any foods based on offal such as
kidneys and liver.
- weight reduction if you are overweight.
- reducing alcohol consumption.
- drinking lots of water in order to wash out the urinary system. Excessive
levels of uric acid in the kidneys can lead to the formation of 'calculi'
or kidney stones.