Overview
Gout is a form of inflammatory arthritis that develops when there is too much uric acid in the blood (hyperuricaemia). Uric acid is produced when the body breaks down purines — substances found naturally in the body and in many foods. When uric acid levels are too high, it can crystallise and deposit in joints as needle-like monosodium urate crystals, triggering intense inflammation and pain. Gout is more common in men and becomes increasingly common with age. It affects around 2.5% of the UK population.
Why Does Uric Acid Build Up?
Uric acid levels rise either because the body produces too much of it, or the kidneys do not excrete enough. Several factors contribute:
- Diet — high intake of red meat, organ meats, shellfish, alcohol, and sugary drinks
- Obesity
- Kidney disease — reduced kidney function means less uric acid is excreted
- Genetic factors
- Certain medications — diuretics (water tablets), low-dose aspirin, ciclosporin
- Dehydration
Stages of Gout
- Asymptomatic hyperuricaemia — high uric acid but no symptoms yet
- Acute gout — sudden, severe joint attacks
- Intercritical gout — periods between attacks with no symptoms
- Chronic tophaceous gout — persistent gout with visible deposits (tophi) if untreated
Treatment Goals
The two main goals of gout treatment are: (1) treating acute attacks promptly with NSAIDs, colchicine, or corticosteroids, and (2) preventing future attacks and lowering uric acid levels in the long term with medications like allopurinol or febuxostat, combined with lifestyle changes.