Gout is a common joint disease, especially in men (who are three times more likely to be affected than women). But the stereotypical image of a rotund, jolly old man swilling his glass of port while his big toe throbs is completely misleading - gout can occur any time after puberty (although usually after the menopause in women), even to those who consider themselves reasonably fit. There may be a family history of the problem.

Uric acid crystals form in the joints

Gout is caused by a problem with metabolism that leads to high levels of uric acid in the blood (although occasionally levels are normal). In an acute attack, crystals of uric acid precipitate out, usually into a single joint. The most common joint to be affected is the one at the base of the big toe, but it can affect the knee, ankle, wrist, foot and small joints of the hand.

As I'm sure you could tell us, gout is extremely painful and the joint becomes swollen and red over about 24 to 36 hours. Attacks last a few days and usually improve rapidly if a course of non-steroidal anti-inflammatory drugs (NSAIDs) is started immediately. Sometimes a drug called colchicine or a steroid injection into the joint is needed.

Long-term problems

A few lucky individuals will have only one attack of gout. Most, though, have a second attack six months to two years later.

In some cases, more and more joints become involved. In the worst cases, there may be constant pain from chronic inflammation and destruction of the joint.

There's also a risk that crystals will form in the kidneys leading to kidney stones.

Preventing attacks

It's possible to take steps to prevent further attacks of gout. The aim is to control levels of uric acid in the blood. You can do this by:

• Avoiding food rich in a group of chemicals called purines - this includes offal, oily fish, pulses and poultry
• Avoiding excessive alcohol intake
• Recent research has shown that soft drinks sweetened with sugar (but not artificial sweeteners) or fructose (fruit sugar) taken in any form can significantly increase the risk of gout among men, so try to keep these to a minimum
• Keeping your weight within reasonable levels (overweight people are at higher risk of gout)
• Avoiding aspirin, as this increases blood levels
• Following a drug treatment that inhibits the formation of uric acid (such as allopurinol) or increases its excretion by the kidneys (such as probenecid)
• Check with your doctor if you're on regular medication because a number of medicines (for example, diuretics) can cause raised levels of uric acid in the blood, as can one or two diseases, which should be ruled out

Don't worry too much. Most people with gout lead a completely normal life and manage to keep attacks to a minimum.

This article was last medically reviewed by Dr Trisha Macnair in February 2008