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Sudden, severe joint pain caused by uric acid crystals — most often at the base of the big toe. An attack settles within days; keeping uric acid low is what stops the next one.
Uric acid is a normal waste product, made when the body breaks down substances called purines. It usually dissolves in the blood and leaves through the kidneys. When there is more than the body can clear, it can form sharp, needle-like crystals in and around joints.
The immune system reacts to those crystals with sudden, intense inflammation — a gout attack, or flare. Between attacks the joint can feel completely normal, but the crystals are still there. Over years, repeated attacks can damage the joint, and crystals can collect under the skin as lumps called tophi.
High uric acid does not always mean gout. Many people have raised uric acid in a blood test and never have an attack. Treatment is decided by attacks, tophi and joint damage, not by a number on its own.
A red, hot, swollen joint can have more than one cause, and one of them is an emergency. They can look alike, so the joint fluid is often what settles it.
| Gout | Joint infection | Pseudogout | |
|---|---|---|---|
| Typical joint | Big toe, foot, ankle, knee; fingers, wrist and elbow in long-standing gout | Knee or hip most often, but any joint | Knee, wrist |
| How it starts | Often overnight, peaking within a day | Over hours to days, and keeps getting worse | Over a day or two |
| Fever | Sometimes, mild | Common, with feeling generally unwell | Sometimes |
| More likely in | Men from middle age, women after menopause | People with diabetes, a joint replacement or weakened immunity | Adults over 60 |
| Joint fluid shows | Uric acid crystals | Bacteria | Calcium crystals |
A joint infection can destroy a joint within days, and gout and infection can occur together. A hot, swollen joint with fever needs to be seen the same day. A bunion affects the same big toe joint but causes a bony bump and aching, not sudden hot swelling.
Call us on +65 8849 0677. We will see you the same day where we can.
If we are closed, go to an emergency department — we are shut on Sundays and after 1pm on Saturdays. A possible joint infection should not wait.
Call +65 8849 0677Uric acid can read normal during an attack. Levels often fall while a joint is inflamed, so a normal result does not rule gout out. The test is usually repeated a few weeks after the attack settles.
Treatment has two separate jobs: settling the attack you have now, and preventing the next one.
Anti-inflammatory tablets, colchicine, or a steroid — as tablets or an injection into the joint. Treatment works best started early. Rest the joint, raise it, and use a cold pack wrapped in a cloth.
Cutting down on beer, spirits and sugary drinks, eating less red meat and organ meat, keeping well hydrated, and losing excess weight all help. Some medicines that raise uric acid may be reviewed. For people with repeated attacks, diet alone is rarely enough.
Recommended for repeated attacks, tophi, joint damage or kidney stones. Allopurinol is the usual first choice, with febuxostat an alternative. The dose starts low and is raised step by step, with blood tests, until uric acid is below target — usually under 360 µmol/L, and lower where there are tophi.
Rarely needed. Considered for large tophi that cause pain, skin breakdown or infection, or for a joint that gout has badly damaged.
Rest and raise the joint, apply a wrapped cold pack, drink plenty of water, and start the treatment your doctor has advised as early as possible. If you already take uric-acid-lowering medicine, keep taking it. A hot joint with fever needs to be seen the same day.
Yes. Uric acid often falls during an attack, so a normal result does not rule gout out. A joint fluid test, or a repeat blood test a few weeks later, gives a clearer answer.
It helps, but for most people with repeated attacks it is not enough on its own. Diet has a modest effect on uric acid; medicine is usually needed to bring it below target.
Uric-acid-lowering medicine is usually long-term. Stopping it lets uric acid rise again and crystals re-form, and attacks often return.
Both affect the base of the big toe. A bunion is a bony bump with aching that builds slowly. Gout comes on suddenly, with a red, hot, very tender joint.
No. Bring any blood test results, a list of your medicines, and dates of previous attacks if you have them.
Foot pain · Bunions · Ankle pain · Knee pain · Knee osteoarthritis · Hand arthritis
If the joint is hot and swollen now, call rather than book online. Seeing it during an attack helps confirm the cause.
