🦶 Men's Health

Gout

Excruciating joint pain with a clear dietary trigger, and a simple blood test that diagnoses it.

Gout is a form of inflammatory arthritis caused by uric acid crystals depositing in joints, most classically the big toe. It is the most common cause of acute joint pain in Nigerian men over 40. It is also completely preventable and highly treatable with the right approach.

Signs and Symptoms

✓ Sudden, severe joint pain: most commonly the big toe (podagra), but also ankle, knee, wrist
✓ The joint becomes red, hot, swollen, and exquisitely tender, even a bedsheet touching it causes agony
✓ Onset often overnight or in the early morning
✓ Attack resolves over 7–10 days without treatment, but recurs if uric acid is not controlled
✓ Tophi: chalky white nodules visible under the skin near joints in chronic, long-standing gout
✓ Kidney stones: uric acid crystals can also form in the urinary tract

Risk Factors

  • High purine diet: red meat (beef, goat), organ meat (liver, kidney, intestine, tripe), oily fish (mackerel, sardines, herring)
  • Excessive alcohol: beer is the highest risk, beer contains both purine and alcohol (which impairs uric acid excretion). Palm wine and ogogoro are also high risk
  • Sugary drinks and fructose: Fanta, Malt, fruit juice, fructose is metabolised to uric acid
  • Dehydration: urine uric acid concentration rises with inadequate fluid intake
  • Obesity: adipose tissue increases uric acid production and the kidneys excrete less
  • Hypertension and medications: thiazide diuretics (hydrochlorothiazide) raise uric acid significantly
  • Kidney disease: impaired uric acid excretion: gout and kidney disease perpetuate each other
  • Male sex and age: testosterone promotes uric acid retention; oestrogen in women is protective until menopause
  • Family history: gout has a strong genetic component: URAT1 transporter variants are common in West Africans

When to Seek Help

SoonFirst gout attack: confirm diagnosis with serum uric acid and start treatment; do not assume it is gout without ruling out septic arthritis (infected joint), which requires urgent drainage
SoonRecurrent attacks: start preventive treatment (allopurinol); do not wait for the next attack
RoutineElevated uric acid found on a blood test without symptoms, discuss with your doctor whether preventive treatment is appropriate based on your level and other risk factors

Tests & Diagnosis

🧪 Serum Uric Acid
Blood test measuring uric acid concentration. Normal: men below 420 µmol/L (7 mg/dL). Gout is associated with levels above 480–600 µmol/L. Important: uric acid can be normal during an acute attack (inflammation temporarily lowers it), recheck 2–4 weeks after the attack resolves for an accurate baseline.
🧪 Joint Aspiration (Gold Standard)
Arthrocentesis: a needle is used to aspirate fluid from the inflamed joint. Polarised light microscopy identifies needle-shaped negatively birefringent monosodium urate crystals, the definitive diagnostic finding. Also rules out septic arthritis (bacterial infection of the joint), which looks identical clinically but requires emergency antibiotics and drainage.
🧪 Kidney Function (Urea, Creatinine, eGFR)
Gout and kidney disease are bidirectional: gout damages the kidneys; kidney disease reduces uric acid clearance and worsens gout. Check kidney function at baseline and monitor annually in all gout patients on long-term allopurinol.
🧪 24-Hour Urine Uric Acid
Distinguishes overproducers (kidneys working correctly but too much uric acid produced, dietary or genetic) from underexcretors (kidneys not clearing enough uric acid, most common). Guides choice between allopurinol (blocks production) and uricosurics (increase excretion).

Treatment Options

1
Acute attack: NSAIDs or colchicine for rapid relief
Indometacin, naproxen, or diclofenac (NSAIDs) at full dose are most effective for rapid relief of an acute attack. Colchicine 0.5 mg twice or three times daily is an alternative, especially if NSAIDs are contraindicated (kidney disease, peptic ulcer, on blood thinners). Oral prednisolone is used when both NSAIDs and colchicine are contraindicated.
2
Ice and joint rest during the attack
Apply ice wrapped in a cloth to the affected joint for 20 minutes every 2–3 hours. Rest the joint, weight-bearing on an inflamed gouty toe significantly worsens pain and prolongs the attack. Elevate the limb to reduce swelling.
3
Start allopurinol for prevention after the acute attack resolves
Allopurinol (xanthine oxidase inhibitor) reduces uric acid production and is the cornerstone of long-term gout prevention. Start at 100 mg/day 2–4 weeks after the acute attack resolves (starting during an attack worsens it). Increase by 100 mg monthly until uric acid is below 360 µmol/L (6 mg/dL). Most patients need 300–600 mg/day. Allopurinol is a lifelong medication for recurrent gout.
4
Dietary modification
Reduce: organ meat, red meat, beer, sugary drinks, fructose-containing foods. Increase: water (2.5L/day), low-fat dairy (protective), vegetables (including cherries, potent uricosuric), and complex carbohydrates. A realistic 10–15% uric acid reduction is achievable through diet alone, insufficient to control gout alone but important alongside medication.
5
Avoid diuretics if possible, treat obesity
If thiazide diuretics are causing gout, discuss switching to a different antihypertensive with your doctor (losartan has mild uricosuric properties and is a useful substitute). Weight loss significantly reduces uric acid levels and attack frequency.

Frequently Asked Questions

Why does gout attack at night?
Several physiological factors converge overnight: body temperature drops slightly, which reduces urate solubility; mild dehydration occurs during sleep (no fluid intake); uric acid levels fluctuate with circadian rhythm; and cortisol levels, which suppress inflammation, are lowest in the early hours. This combination makes 2–6 am the most common time for urate crystals to precipitate in a joint and trigger the inflammatory cascade.
Can I drink alcohol with gout?
Ideally no, especially beer. Beer is the highest-risk alcohol for gout: it contains both purine (from yeast) and alcohol (which impairs uric acid excretion by competing for renal clearance). Red wine is lower risk but still raises uric acid. Spirits have moderate risk. If you choose to drink, red wine in moderation (1–2 glasses) with adequate hydration is the least gout-provoking option. During or after a gout attack: no alcohol until the attack resolves completely.
My uric acid level is high but I have no pain, should I treat it?
Asymptomatic hyperuricaemia (high uric acid with no symptoms) is a nuanced area. Current guidelines generally do not recommend starting allopurinol for asymptomatic hyperuricaemia alone. However, treatment is indicated if: uric acid is very high (>600 µmol/L), there is evidence of urate deposits (tophi on imaging), there are kidney stones, or the patient has chronic kidney disease. Dietary modification and increased water intake are appropriate first steps for all asymptomatic individuals with elevated uric acid.
Is gout the same as arthritis?
Gout is one type of arthritis: specifically, crystal-induced inflammatory arthritis. It shares the joint inflammation of arthritis but differs from osteoarthritis (wear-and-tear) and rheumatoid arthritis (autoimmune). Unlike those conditions, gout is caused by an identifiable, measurable, and modifiable factor (uric acid). It is also one of the few forms of arthritis that can be entirely prevented and reversed with appropriate treatment, making early diagnosis and management particularly valuable.

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Last updated 16 October 2026.