Which joints does gout affect?
Most often the base of the big toe. But gout can also flare in your ankle, knee, wrist, fingers or elbow. And a hot, swollen joint with a fever may not be gout at all.
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Where does gout show up in the foot and other joints?
Most often in the joint at the base of your big toe. The NHS says gout is usually in the big toe. It can also be in other joints in your feet, ankles, hands, wrists, elbows or knees.
It comes from too much uric acid in your blood. This can form sharp crystals around a joint, which cause the pain.
| Joint | How often | What you may notice |
|---|---|---|
| Big toe (base) | The usual spot | Sudden, severe pain. Hot, swollen, red skin. |
| Other toes and midfoot | Can be affected | The same pain and swelling. Over time, firm lumps can form over the toes. |
| Ankle | Can be affected | The same pain and swelling. Lumps can form at the back of the heel. |
| Knee | Can be affected | Lumps can form at the front. CPP crystals are another cause here. |
| Hand, wrist, fingers | Can be affected | Lumps can form on the backs of the fingers and wrists. |
| Elbow | Can be affected | Lumps often form around the elbow. |
| Shoulder, hip, spine | Not common | Joints near the middle of the body are seldom hit. |
Sources: NHS; NICE NG219; Versus Arthritis
Your thumb and fingers count as hand joints. NICE advises doctors. It says to consider gout in the midfoot, ankle, knee, hand, wrist or elbow when severe pain, redness or swelling comes on fast.
Gout is especially common in the toes and fingers. Versus Arthritis says this may be because they are cooler, and cold makes crystals more likely to form.
Write down which joint flared, when it started and how it looked. It helps your GP.
What does a gout attack feel like?
Fast and fierce. Attacks often start in the early hours and usually feel worst within 12 to 24 hours.
Even a light touch hurts. Versus Arthritis says the weight of a bedsheet or a sock can be unbearable.
The skin often looks shiny and may peel as the attack settles. Redness may be harder to see on black or brown skin.
How a gout attack usually runs
- 1
Starts fast
Often overnight, with severe pain and swelling.
- 2
Peaks
Usually worst within 12 to 24 hours.
- 3
Settles
Usually lasts 1 to 2 weeks if untreated.
- 4
Can come back
In a few months or years. More often without treatment.
Sources: NHS; Versus Arthritis; NICE NG219
Several joints can flare at the same time. Left untreated, attacks can become more common and may spread to new joints.
The NHS says untreated gout may cause lasting damage to joints. So see a GP after a first attack.
Gout in the knee, leg or hand: could it be something else?
Yes. A hot, swollen joint with a fever is how a joint infection can look. It needs help the same day.
NICE tells doctors to check for a joint infection, calcium crystals (CPP) and other kinds of arthritis in any painful, red, swollen joint.
| What it is | Clues | What to do |
|---|---|---|
| Joint infection (septic arthritis) | Sudden, severe pain. Hard to move or put weight on the joint. Often a high temperature. | Urgent GP appointment or NHS 111. |
| CPP crystal arthritis (once called pseudogout) | Most often the knee. Rare under 60. Hits men and women equally. | See a GP. |
| Blood clot in the leg (DVT) | Throbbing pain and swelling in 1 leg, usually the calf or thigh. | Urgent GP or 111. Call 999 if short of breath or with chest pain. |
Sources: NHS: septic arthritis; Versus Arthritis: CPP; NHS: DVT
Pain in your leg rather than a joint? Throbbing pain and swelling in 1 leg, usually the calf or thigh, can be a sign of DVT, a blood clot.
Firm lumps on your fingers, elbows or ears may be tophi, crystals under the skin. The NHS says repeated attacks over a long time without treatment can cause them. Show them to your GP.
For the other blood tests behind a sore joint, see joint pain blood tests.
How do you ease a gout attack?
Six NHS steps for a gout attack
- Take any medicine you’ve been prescribed as soon as possible. It should start to work within 2 days.
- Rest and raise the leg or arm.
- Cool the joint with an ice pack or frozen peas wrapped in a towel, for up to 20 minutes at a time.
- Drink lots of water, unless a GP tells you not to.
- Keep bedclothes off the joint at night.
- Keep pressure off the joint.
Source: NHS: gout
Attacks are usually treated with an anti-inflammatory painkiller, like ibuprofen. If the pain and swelling don’t improve, you may be given steroid tablets or an injection.
Frequent attacks or high uric acid? You may need a uric acid-lowering medicine. The NHS says to take it regularly, even when you have no symptoms.
Water tablets (diuretics) and some blood pressure medicines can raise your chance of gout. Never stop or change a prescribed medicine without your prescriber.
To cut the chance of another attack, lose weight if you’re overweight, but avoid crash diets. Drink plenty of fluids. Have some alcohol-free days and no more than 14 units a week.
NICE says there’s not enough evidence that any one diet prevents flares. Its advice is a healthy, balanced diet.
How is gout confirmed?
Usually with your symptoms and a blood test. Your GP may ask about your diet and drinking, then test your uric acid.
- Below 360 micromol/LIn a flare, this doesn’t rule gout out. NICE: if gout still seems likely, retest 2+ weeks after.
- 360 micromol/L or aboveNICE: with gout symptoms, this confirms it.
Source: NICE NG219
Below 360 during an attack? If gout still seems likely, NICE advises a repeat test at least 2 weeks after the flare settles.
A high level alone isn’t proof. You can have high uric acid and no symptoms.
Still unclear? You may see a joint specialist (rheumatologist). They can take a little fluid from the joint with a thin needle and look for crystals.
If that can’t be done, you may have a scan.
After a flare, NICE suggests a check-up that looks at your kidneys and heart risk too. More on the numbers: uric acid blood test.
When to speak to a GP
- See a GP if you have symptoms of gout for the first time.
- See a GP if you have gout and your usual treatments aren’t helping.
- Ask for an urgent GP appointment or call 111 if you have sudden pain and swelling in a joint and the pain is getting worse, you have a very high temperature (or feel hot, cold or shivery), or you feel sick or can’t eat. These can mean an infection inside the joint.
- Call 999 or go to A&E if leg pain and swelling come with shortness of breath or chest pain.
Swelling around the ankle with no sudden pain? See swollen ankles.