Gout
A gout attack can wake you at 3am with a hot, swollen big toe that cannot even bear the weight of a bedsheet. Attacks are painful, but the bigger problem is what happens over years if the urate level stays high. My job is to help you settle the attack, understand your urate, and prevent the next one properly.
What gout is
Gout is caused by tiny urate crystals that build up in and around joints. When they trigger inflammation you get a gout attack, which is a sudden, very painful, hot, red, swollen joint, most often the big toe, ankle or knee. Over the years, if the urate level stays high, crystals keep collecting and can damage the joints and the kidneys.
Symptoms to look out for
Sudden severe pain in a single joint, often at night
Redness, warmth and swelling of the affected joint
Pain so severe that even a bedsheet or sock is uncomfortable
First attacks often in the big toe, but ankles, knees, fingers and elbows can be affected
Attacks that resolve over 7 to 14 days, then return later
Firm lumps under the skin (tophi) over the ears, elbows or fingers in longer standing gout
History of high uric acid, kidney stones or a family history of gout
Why this matters to a rheumatologist
As a rheumatologist, I look beyond the attack. Two things matter to me: settling this attack safely, and lowering your urate level to prevent future attacks and long term damage. Many patients are treated only during flares and never brought to a safe urate target, which is why they keep coming back. I explain the numbers, choose the right urate lowering therapy for you, and monitor it properly.
Signs I would like you to seek care for
For emergency symptoms please seek urgent or emergency care first rather than waiting for a WhatsApp reply.
A hot swollen joint with fever, which may indicate joint infection rather than gout
A first attack, so we can confirm the diagnosis correctly
Repeated attacks, even if each attack settles
Tophi (firm lumps under the skin)
Gout with kidney disease, high blood pressure, or diabetes
Gout that is not responding to your usual treatment
What a specialist review looks like
In clinic I confirm the diagnosis, treat the current attack with the right medication for your kidneys and other conditions, and start you on a long term urate lowering plan such as allopurinol or febuxostat when appropriate. I explain the target urate level, monitor it with blood tests, and cover diet, alcohol, weight and medications that may be raising your urate. My aim is fewer attacks and a joint that stays healthy for the long run.
Questions my patients often ask me
Speak with me
If you have had more than one gout attack, or your urate keeps running high, please seek specialist care. I would like to help you get to target and stop the cycle of attacks.
Other conditions I treat
This page is for general education only and does not replace medical advice. Please consult a qualified healthcare professional for diagnosis and treatment.