Gout is most usually diagnosed from a combination of clinical signs, so what the joint looks like, and the symptoms that a patient presents with. To diagnose gout with 100% certainty you can draw fluid from an affected joint and look for crystals – uric acid crystals in the fluid. But it’s often difficult to do that, particularly in joints like the big toe, and GPs often don’t do that, so it’s usually a clinical diagnosis.

We can also do blood tests to measure the level of uric acid in the blood, but sometimes during acute attacks the blood tests can be normal, and so it doesn’t help us. In people who have had gout for a long time, there may be changes on x-rays which are typical of gout, but again if you’ve only had a first attack of gout these may be normal.

Once gout is diagnosed it’s important to check for other conditions that are linked with gout, such as diabetes, high cholesterol, or kidney disease. In terms of keeping an eye on people once they’re on treatment for gout, it’s important to check uric acid regularly, as that gives a marker of how the treatment is working, and we aim as doctors to make the uric acid level quite low, so we monitor this. It’s also important to check kidney tests and these are done usually through blood tests. We know that people who have gout are more likely to have other health conditions, such as heart disease, and so people with gout are often invited for extra health checks, to check things like blood pressure and to screen for things like diabetes.

It sometimes causes confusion that when uric acid levels are measured during an attack of gout, they can come back as low or normal. The reason for this is that, at times when theres a lot of inflammation around in the body such as during an attack of gout the kidneys actually pass more uric acid out into the urine, which means that the level in the blood drops. So the most important message from this is that if somebody is thought to have gout, but they are found to have a low or normal uric acid level during an attack of gout, the blood test should be repeated when the attack has settled down.

So the doctor came to your home. Can you talk me through how he diagnosed it?

Well, he examined me. He examined the foot – and my foot, you know, the swollen big toe and bright red and the questions he asked and what-not. They’re all I’ve always had my feet well looked after. I’m also a diabetic. I’m very peripheral diabetes. I haven’t had a positive test for over ten years, but they do keep looking at your feet [laughs] when you’re a diabetic. And you’re apparently you’re always one if you’ve once been diagnosed. So he knew me and he knew my history. He very quickly said, It’s gout. I think I knew by that time that it was gout. In fact, I’m sure I knew [laughs].

I got a referral to that rheumatologist, via the GP, and then went to see the rheumatologist, who took – so took bloods again. Again, I had, yeah, I had elevated, urate levels. Clinically it sounded like gout. I did ask to, to get an aspirate of my knee, to try and confirm it, you know, get the gold standard diagnosis with crystals – and I had a steroid injection at the same time, to resolve the knee, because it had been grumbling on. And we didn’t actually get, there weren’t any crystals in the sample, and I don’t know, so I’ve never had a, a definitive diagnosis, so, so it was a, a combination of the hyperuricemia and the clinical presentation. So that’s so the GP said, It is gout, and then the rheumatologist confirmed that.

I was diagnosed six years ago, and, so that was the result of I had what I now understand to be a major attack of gout in my right knee, so that, sort of prompted me to eventually go to the GP after a few days suffering at home, not in silence, as my partner would say.

Prior to that, I did have a, well what I now understand to be a couple of minor attacks. So I’ve always had the only attacks I’ve ever had are in my right ankle and my right knee. So a couple of occasions before that I had been to the GP. So when I was playing football I thought I must have twisted something that I’d not noticed, so my ankle had blown up. And he just sent me away and told me to take some ibuprofen or whatever. So I think they were actually gout attacks.

I just could hardly get out of bed. My leg was so swollen and very, very painful, and bright red. And so the wife rang into work, and said I shouldn’t be coming into work. So I, the second house as you turned into this road, but, I couldn’t walk to the doctors which was on that, if you past it, theres like a Co-op, and a few shops there, which is what 300 yards. So, I could, I couldn’t walk that far. So, I just managed to put the car into gear, and drove there. And, I went to the doctor and, he thought I’d got septicaemia. So, he said, Can you get to the hospital? So I said, Yes. So, I managed to get back home again.

My dad took me to the hospital, and I sort of went to the desk, sat down, and I, first I sat down again, they called me through, and they said, they took a sample from me knee, and said that it will be sort of an emergency. Because, they thought it was septicaemia, by the looks of it. So, they took an emergency blood sample, and sort of, to do that, I’d be on the ceiling. So, they come at me with a needle that big, literally, and, but I didn’t feel anything, they’d deadened it. And, they took this gungy, yellowy brown stuff away, and. And about an hour and half later, two hours later, they came back, and said, It isn’t septicaemia, thankfully.

I think it started about two or three years ago. I started getting pains in my feet and inflammation. Every time by the time I could get an appointment with the GP, because it was quite painful, all the inflammation had gone. So he never really saw it when it was at its worst.

Then it really started at the beginning of last year. I started to get a sort of regular flare-up of inflammation in my feet. It went very red and very painful. I had months and months and months of nausea; waking up in the morning and feeling really, really nauseous.

Then it was last autumn I had two really big flare-ups. I had one night when I was just in agony with pain in my feet. I went to the doctor the next morning, and they thought it might’ve been an infection in the bone in my foot. They sent me up to the hospital and I saw a bone an orthopaedic doctor, who said it wasn’t an infection in the bone. He then referred me to the rheumatologist who thought he said that he thought it looked like gout, which I was a bit surprised about. And then they drew some fluid off the front of the foot, and they came back a couple of hours later to say that they’d confirmed it was gout and that there were crystals there.

When it first started it was very painful, and I actually had an appointment with the chiropodist, sort of, a couple of days after. I assumed it was due to the in growing toenail. So I went along to him and I said to him, Was it? and he said, No, it’s not, and he checked it, examined it, and he said, Well, if I didn’t know better, I’d say you had gout, he said, But you can’t have gout because you have artificial toe joints. So I said, Oh, but he said, I’m sure it is. Anyway, when hed finished, he said to me, you know, You really have to go straight to your doctor and have a word and get it sorted, he said, because it was very, very hot.

So I went there and she saw me more or less straightaway, which, I was surprised, and she again said, Gout, she said, But I don’t see how you can have gout with artificial toe joints. So, she did a blood test and the uric acid level was quite high, and she put me on allopurinol, just one a day, and, it was fine, it was fine. And then in June, July, in July, it came back again. So I had to go and I saw a different doctor, who also told me that I couldn’t have gout because I had artificial toe joints [Laughter], but then he just did a blood test for an infection which, of course, came through negative, and they increased the allopurinol. So I’ve been on two a day ever since, and it hasn’t come back [laughter].

It was around February 2011, I’d been to the GP previously, because I’ve had this continuous swelling in my left foot. So I’d been – I’d had blood tests in the past for diabetes, but this particular foot I’d broken years before and I’d also done the ligaments and different things, so we just assumed there was sort of progression of arthritis in the joint.

But – and both my parents have been diagnosed with rheumatoid arthritis, so it started off being, looking at that sort of thing. But then kind of about the – well in the August we went on holidays and I was really ill when we were abroad on holidays. My foot – I was in horrendous pain as if somebody was jabbing me with needles. So when I came home then, I went to the GP and explained all the symptoms. And she sort of said to me then, she said, Well I don’t think you’ve got gout, she said, But I’d better test you for it because your symptoms are sort of connected with that. And she said, Well it’s very unlikely because – female, and your age, and you’re not particularly overweight, or anything, but well test anyway. And my – when it came back I’d had the bloods done the beginning of October and a week later the bloods came back that my uric acid level was high.

First when I experienced this kind of illness I thought it was just a simple you know, muscle pain or joint pain, with my foot. That was a long time ago as well because I – I experienced this when I was single, I wasn’t married yet at the time. By the time that I felt this kind of pain that I suffered was really worse, but the thing is not really stay quite a long time and then there were – there were several attacks that happened to me as well, which I consider it’s really worse because l couldn’t even walk, I couldn’t even go to the toilet, I couldn’t even do anything that I usually do, then. But the thing is, I just only taking those kind of pain relievers because in our place – because back home (Philippines) we don’t really go to the specialist right away, I just only found out that this kind of illness is considered as gout when I was here (UK), since I – since I went to my GP and then the GP told me that that it was suspected that I have gout, so they told me to – give my – to have a blood test and then at the time they found out that my uric acid was really high.

I was first diagnosed with gout when I went to see my GP in – and it was in – roundabout March, April 1966. And the date sticks in my mind because it was the year of the World Cup, and the first severe attack that I had, the first time that it had made me ill and incapable of walking, was in June/July 1966. And that was at the time of the World Cup, and I watched it lying down on a settee, with my feet in the air, and not letting anyone near me at all.

Prior to that I’d always led quite an active, sports, like I used to play badminton for the work’s team, I played squash, I played cricket, I played rugby in the winter, and I used to find that, after the exercise, my toes would go red and they would be quite sore. It didn’t last very long. It would last two or three days and then it would go away and I thought it was just the exercise and that maybe I’d been kicked or whatever, until 1966 when my GP said, “No, you have gout.”