What is gout?
Gout occurs when urate, a waste product in the blood, rises high enough to form needle-like crystals in and around joints, triggering sudden attacks of severe pain, swelling and redness. The big toe is the classic site, but ankles, knees, wrists, fingers and elbows are also affected. Untreated, attacks tend to become more frequent, and persistent crystal deposits (tophi) can damage joints.
Gout affects roughly 1 in 40 adults in the UK, more commonly men, with risk rising with age, genetics, kidney function, certain medicines such as diuretics, and dietary factors including alcohol and sugary drinks. Diagnosis is usually clinical, supported by a blood urate level; the definitive test is finding urate crystals in fluid drawn from the joint, and ultrasound can also show characteristic changes.
Common symptoms
- Sudden, severe joint pain, often starting at night
- A hot, swollen, red joint — classically the big toe
- Skin that is exquisitely tender to the lightest touch
- Attacks lasting days to two weeks if untreated
- Firm lumps (tophi) around joints or ears in long-standing gout
- Repeated attacks in the same or different joints
How long will you wait?
Most gout is managed by GPs without referral, but routine NHS rheumatology appointments for difficult or recurrent gout typically take three to six months in many areas.
Privately, you can typically see a consultant rheumatologist within 3–7 days — useful when attacks are frequent or the diagnosis is uncertain.
NHS England median referral-to-treatment wait: 12.4 weeks, with 2.5 million people waiting over 18 weeks (May 2026). Individual waits vary by trust and urgency.
Treatment options
- Acute attack treatment. NSAIDs, colchicine or a short steroid course to settle an attack quickly.
- Urate-lowering therapy. Daily allopurinol or febuxostat to keep urate below target and prevent attacks long term.
- Treat-to-target monitoring. Regular urate blood tests, adjusting medication until levels stay below 360 micromol/L (or 300 in severe gout).
- Lifestyle measures. Reducing alcohol and sugary drinks, maintaining a healthy weight and reviewing contributing medicines.
What does private treatment cost?
As a guide, a private rheumatology consultation costs around £250–£350, with blood tests around £50–£150 and joint aspiration or ultrasound around £200–£400 if needed.
Does health insurance cover gout?
Private medical insurance usually covers assessment of new joint symptoms, including consultations, tests and joint aspiration to confirm gout and exclude infection or other arthritis. Established, recurrent gout is commonly treated as a chronic condition, so long-term urate-lowering medication and routine monitoring generally sit outside cover. Acute severe episodes needing specialist input may still be covered depending on your policy's terms.
Frequently asked questions
Is gout caused by diet and drinking too much?
Only partly, and the stereotype is unfair. Genetics and how efficiently your kidneys clear urate are the biggest factors — many people with impeccable diets get gout, and some heavy drinkers never do. Alcohol, red meat, seafood and sugary drinks can raise urate and trigger attacks, so moderation helps, but diet alone rarely controls gout; medication is usually the decisive treatment.
Do I need lifelong medication?
If you have recurrent attacks, tophi, joint damage or kidney stones, guidelines recommend daily urate-lowering therapy, and it is usually lifelong — stopping typically allows crystals to reform and attacks to return. The good news is that allopurinol is inexpensive, generally well tolerated and, once your urate is at target, most people become essentially attack-free. An annual blood test keeps things on track.
Why did I get an attack after starting allopurinol?
This is common and does not mean the drug is failing. As urate levels fall, existing crystals begin dissolving, which can transiently trigger attacks in the first months of treatment. That is why treatment is started at a low dose, increased gradually, and usually accompanied by a preventive cover of colchicine or an NSAID for the first three to six months. Persevere — it settles.