Gout is a form of inflammatory arthritis. People often get attacks in their big toe joints but gout can also affect other parts of the foot, the knees, ankles, elbows, wrists and fingers. It is rare for gout to affect the shoulders, hips or spine.
Ivor’s first attack happened on holiday. He could not bear the bed sheet touching his foot.
Attacks of gout usually begin quickly and reach their most painful stage within 12-24 hours, and last for up to two weeks. Many people we spoke to woke up during the night or in the morning with severe pain. People often had their first attack in one of their big toe joints, but some people’s symptoms had begun in other joints. Jonathan’s first major attack was in his right knee while Jeff X’s affected both his big toe joints at the same time.
Joes first attack was in his big toe. It was so tender that he could not bear anything touching it.
Many people felt that the pain was like no other pain they had experienced before. The incredible pain was particularly worrying for some. People were often confused when they first had the sudden pain because they had no idea what had caused it. Ray wondered if his toe was infected and Sam thought that she might have been stung. Jean thought an in-growing toenail might be causing her symptoms. Shirley X thought the pain was from a type of chilblain, because she had previously had chilblains.
Michael’s first attack started when he was driving back from France. The pain was unlike anything he had experienced before and he did not know what had caused it.
Carole thought her symptoms were related to the operations she had previously had on her big toes. Gerald initially thought the twinges of pain he was having and his swollen joints were a result of working hard and being on his feet for long shifts at work. Janette and Shirley Y had both had pain from arthritis since they were young, so initially thought their symptoms were related to that.
John X wondered if the pain he was getting was a side effect from the medication he was taking for his cholesterol. Tony and Jeff X both had their first attacks during walks and wondered if the pain was caused by the shoes they were wearing. Many other people thought that they must have injured themselves without noticing. Several thought they must have stubbed their toe or even broken it.
Naresh thought the pain in his toes was from a physical injury. His toes were swollen, red and very painful.
Jeff X thought his shoes might be causing his symptoms. His big toe joints were tender, red and swollen.
Some people recognised their symptoms as fitting with their knowledge of gout or with the symptoms of other people they knew with gout. Simon realised straightaway that he had gout because of his medical background and the fact that his father had also had gout. Peter X was advised that he might develop gout before he experienced any symptoms, and so knew what the pain was when it started.
Peter X had been for a medical examination through his health insurance. He was advised that he might develop gout because his uric acid levels were high.
Many people had very clear memories of their first attack because the pain had been so intense. Harry could remember his first attack well because it had occurred during the 1966 football World Cup. A number of people knew exactly when their first attack had happened because they were abroad on holiday at the time. Eric was in Eastern Europe and felt alarmed about being so far from home and in pain. He was unsure about what to do but the hotel manager sent him to a local clinic.
Peter Y was abroad on holiday in Turkey and can remember his first attack in detail.
Many people had their gout diagnosed by their GP. Some made an appointment to see their doctor as soon as they experienced symptoms, often because the pain was so bad. Others decided to wait for a while to see if the symptoms went away. The pain Pat had was not severe enough for her to consider visiting her GP straight away, but after a few months, she decided she needed some advice. Janette decided to see her GP when she had three bouts of pain in one month. In some cases, people made the decision to visit their GP because other people believed that it was necessary.
Ian woke up one morning with severe pain in his toe. He made an appointment to see his GP even though he could hardly walk.
Jeff Y thought he had knocked his toe. He eventually decided to see a doctor because it became very painful.
A few people had experienced such intense pain that they had gone to Accident and Emergency (A&E). Jonathan considered going to A&E or ringing for an ambulance, but then waited to see his GP. Most people who had gout in their feet, ankles or knees found walking and driving very difficult because of the pain. Some struggled to get to their GP or hospital by themselves. Sue’s husband came to collect her from the hospital. John Y could not walk very far but managed to drive to his appointment. Janette’s and Kate’s GPs came out to see them at home because they could not walk (for more see ‘Tests and diagnosis of gout‘).