First Gout Attack: What to Do, What to Expect & When to See a GP

Quick Answer

If you think you are having your first gout attack, contact your GP. Gout commonly causes sudden, severe pain, swelling, heat and redness in a joint — particularly the big toe — and it often starts rapidly or overnight. However, a painful, red and swollen joint can have other causes, including a joint infection, so a first attack should not simply be self-diagnosed as gout. nhs.uk

While waiting for medical advice, resting the affected joint and applying a wrapped ice pack may help with the pain. A healthcare professional can advise whether medicines such as an NSAID, colchicine or a corticosteroid are appropriate for you. Nice

What Does a First Gout Attack Feel Like?

For many people, their first experience of gout is difficult to forget.

You may go to bed feeling relatively normal and wake during the night with an extremely painful joint. The pain can develop rapidly and the affected area may become swollen, hot and red.

The joint at the base of the big toe is a classic location, but gout can also affect other joints, including the:

• Ankles
• Midfoot
• Knees
• Hands
• Wrists
• Elbows

NICE recommends suspecting gout when there is rapid onset — often overnight — of severe pain together with redness and swelling in the big-toe joint. Nice

Why Has This Suddenly Happened?

Gout is caused by the formation of monosodium urate crystals in and around joints associated with raised levels of urate in the blood.

These crystals can trigger an intense inflammatory response, producing the characteristic pain and swelling of a gout flare.

It's also important not to blame one particular meal.

Gout is more complicated than simply having eaten the "wrong" food. Genetics, body weight, certain medicines and medical conditions can all contribute to someone's risk. NICE also notes that excessive alcohol consumption and excess body weight can worsen gout symptoms and flares. Nice

Is It Definitely Gout?

Not necessarily.

If this is your first suspected attack, NHS guidance recommends seeing a GP. nhs.uk

This matters because other conditions can cause a painful, hot and swollen joint. One important possibility is septic arthritis, which is an infection inside a joint and requires urgent treatment.

Seek urgent medical advice through your GP or NHS 111 if you have sudden joint pain and swelling and the pain is getting worse, or you have a very high temperature or feel hot, cold or shivery. nhs.uk

How Is Gout Diagnosed?

Your GP will normally consider your symptoms, medical history and examine the affected joint.

A serum urate blood test can also form part of the diagnosis. NICE uses a serum urate level of 360 micromol/L (6 mg/dL) or above to help confirm a clinical diagnosis in someone with symptoms and signs of gout. Nice

However, there's an important catch.

Your urate level can be lower during an acute gout attack.

Therefore, a blood result below 360 micromol/L during a flare does not necessarily rule gout out. NICE recommends repeating the serum urate test at least 2 weeks after the flare has settled if gout is still strongly suspected. Nice

If the diagnosis remains uncertain, further investigation such as joint-fluid analysis or imaging may sometimes be considered.

What Can Help During Your First Gout Attack?

A gout flare can be extremely painful, but treatments are available.

NICE recommends an NSAID, colchicine or a short course of an oral corticosteroid as first-line treatment options for a gout flare. Which is suitable depends on factors including your other health conditions and medicines. Nice

This is one reason it is better to seek medical advice rather than simply taking somebody else's gout medication.

Cold therapy

Applying an ice pack to the affected joint in addition to prescribed treatment may help reduce pain. NICE specifically recommends advising people with gout that cold therapy may help alleviate pain. Nice

Wrap an ice pack or cold pack rather than applying frozen material directly to your skin.

How Long Does a First Gout Attack Last?

It can vary considerably between people.

According to the NHS, an untreated gout attack will usually last around 1 to 2 weeks. Future untreated attacks may last longer. nhs.uk

Getting appropriate treatment can help control the flare and gives you an opportunity to discuss preventing another attack.

Does One Gout Attack Mean I'll Get Another?

A first attack should be taken seriously, but it doesn't mean you should panic.

Once the immediate flare has settled, it is worth discussing your urate level and longer-term risk with your GP.

NICE recommends considering a follow-up appointment after a flare to measure serum urate, review medicines, assess relevant health conditions and lifestyle factors, and discuss the potential benefits and risks of urate-lowering therapy (ULT). Nice

For some people, long-term treatment may be recommended to lower urate levels and reduce future gout attacks.

Should I Completely Change My Diet?

You don't need to panic and throw away everything in your kitchen.

NICE states that there isn't enough evidence to show that any particular diet on its own prevents gout flares or lowers serum urate levels. The recommendation is to follow a healthy, balanced diet. Nice

Diet and lifestyle can still form part of gout management, particularly around maintaining a healthy weight and avoiding excessive alcohol, but gout should not be treated as simply a dietary problem.

What Should I Do After My First Attack?

Once the pain has settled, don't simply forget about it.

Arrange appropriate follow-up and consider asking your healthcare professional about your serum urate level, possible contributing factors and whether you need longer-term treatment.

Understanding why the attack happened — and managing the underlying urate level where appropriate — is much more useful than simply waiting to see whether another attack happens.

The Bottom Line

Your first gout attack can be frightening, particularly when severe pain appears seemingly from nowhere.

The important thing is not to self-diagnose your first episode. Speak to your GP so that gout can be properly assessed and other causes of a painful, swollen joint can be considered.

Once you know what you're dealing with, gout can be treated and managed.

GoutShop is here to help you understand gout, uric acid and the practical steps involved in living with the condition — alongside appropriate advice and treatment from healthcare professionals.

Medical disclaimer: This article provides general information and is not intended to diagnose gout or replace advice from a doctor, pharmacist or other qualified healthcare professional. If you are experiencing your first suspected gout attack, seek medical advice.