What is Gout?
Gout is a type of inflammatory arthritis caused by high levels of uric acid in the blood. When uric acid builds up, it can form sharp crystals in a joint, causing sudden and severe pain. Gout attacks often strike without warning and are notoriously painful — many sufferers describe them as one of the most intense pains they have ever felt.
Key Symptoms of a Gout Attack
- Intense joint pain — most commonly in the big toe, but also ankle, knee, wrist, and elbow
- The joint is hot, red, and very tender — even the weight of a bed sheet can be unbearable
- Swelling and inflammation around the joint
- Attacks typically begin suddenly, often at night
- Symptoms peak within 12–24 hours
- Lingering discomfort after the acute pain subsides
What Triggers Gout?
- Eating purine-rich foods (red meat, organ meats, shellfish)
- Drinking alcohol — especially beer and spirits
- Sugary drinks containing fructose
- Dehydration
- Certain medications (diuretics, low-dose aspirin)
- Illness, surgery, or physical trauma
Managing Gout Symptoms
- Rest the affected joint and elevate it
- Apply ice to reduce swelling
- NSAIDs (naproxen, ibuprofen) for pain relief
- Colchicine — highly effective for acute gout attacks
- Corticosteroids if NSAIDs are not suitable
- Allopurinol — for long-term prevention by lowering uric acid levels
- Stay well hydrated
- Dietary changes to reduce uric acid
What a first UK attack usually looks like
A first gout attack often wakes someone in the small hours with a red-hot big toe that cannot bear a bedsheet. The joint looks shiny, and walking to the bathroom is miserable. Ankles, knees, wrists and elbows can be hit instead. Attacks typically peak within a day and settle over one to two weeks. Between attacks the joint can look completely normal — which is why people delay seeing a GP until the third or fourth episode.
Symptoms that are not gout
An infected joint (septic arthritis) is a medical emergency: severe pain, fever and inability to move the joint need same-day urgent care, not a wait-and-see gout plan. Cellulitis around the foot can also look red and hot. If this is your first attack, ask for a diagnosis rather than assuming it is gout from a photograph. Joint fluid analysis is the gold standard when the picture is unclear.
After the pain: what your GP should discuss
UK guidance treats gout as a long-term urate problem, not a series of bad nights. After even one confirmed attack, many people benefit from a conversation about urate-lowering treatment (usually allopurinol), a target blood urate, and lifestyle steps that help but do not replace medicine. Recurring attacks, tophi, kidney stones or CKD make long-term treatment more important, not less.