Symptoms of a Gout Attack: Gout attacks typically present with a rapid onset, often overnight, of severe joint pain, accompanied by redness and swelling NICE NG219. While most commonly affecting the first metatarsophalangeal (MTP) joint of the foot, gout can also affect other joints such as the midfoot, ankle, knee, hand, or wrist NICE NG219. In some cases, chronic gouty arthritis may present with chronic inflammatory joint pain NICE NG219.
Causes of Gout: Gout is caused by high levels of urate in the blood, which leads to the formation of urate crystals in the joints NICE NG219,NICE CKS. Risk factors for gout include genetics, excess body weight or obesity, certain medications, and comorbidities such as chronic kidney disease (CKD) and hypertension NICE NG219,NICE CKS. Hyperuricaemia and gout are also independent risk factors for cardiovascular disease NICE CKS.
Prevention of Gout Attacks: While there is insufficient evidence to recommend specific diets for preventing flares or lowering serum urate levels, a healthy, balanced diet is advised NICE NG219. Patients should be advised that excess body weight or obesity, and excessive alcohol consumption, may exacerbate gout flares and symptoms NICE NG219. For individuals with gout, particularly those with multiple or troublesome flares, CKD stages 3-5, diuretic therapy, tophi, or chronic gouty arthritis, urate-lowering therapy (ULT) is recommended using a treat-to-target strategy NICE CKS. ULT is typically a lifelong treatment aimed at eliminating urate crystals and preventing future flares NICE CKS. Lifestyle advice should also be provided, and comorbidities such as cardiovascular risk factors and CKD should be assessed and managed NICE NG219,NICE CKS.