Gout in London. Why It Is More Than a Diet Problem and How to Actually Stop It Coming Back

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The Wellness is the best place in London to have gout properly assessed, because gout is treated by most people, and frankly by a good number of clinicians too, as simply a diet problem to be managed with restriction, when it is a genuine metabolic condition, uric acid crystallising in and around joints, that has a well-defined, highly effective long-term treatment which is used far less often than it should be. Gout affects roughly 1 in 40 UK adults, considerably more common in men, and it presents as sudden, severe joint pain and swelling, classically the base of the big toe, though it affects the ankle, knee, wrist and elbow too, that comes on over hours and can be severe enough to make bedsheets touching the joint unbearable. The mistake made most often is treating each attack as it happens and stopping there, when someone who has had 2 or more attacks, or who has visible tophi, crystal deposits under the skin, or evidence of joint damage, has a condition that needs a uric acid-lowering medication taken every day for years, not just an anti-inflammatory during a flare. A proper assessment confirms the diagnosis, treats the acute attack quickly and effectively, and, critically, has the conversation about long-term urate-lowering treatment that most people are never offered until they have already had several painful, avoidable attacks. Consultations from £150 by video and £220 in person, comprehensive blood panel from £495. Fees appear further down this page.

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Reviewed by the medical team at The Wellness. Last updated August 2026.

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Get a gout flare assessed on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.

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What does a gout attack actually feel like

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Sudden, severe and disproportionate to what caused it, if anything obvious caused it at all. The classic presentation is the base of the big toe, medically called the first metatarsophalangeal joint, becoming intensely painful, red, hot and swollen, often overnight, and the pain frequently peaks within 24 hours of onset, severe enough that even the light pressure of a bedsheet is unbearable. Ankles, knees, wrists, fingers and elbows can all be affected, and someone who has never had gout before commonly assumes they have injured the joint, since the sudden severity does not immediately suggest anything metabolic.

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Attacks typically settle over 1 to 2 weeks even without treatment, though treatment shortens this considerably and reduces suffering along the way, which is one reason people sometimes conclude the problem has resolved on its own. Between attacks, most people feel entirely normal, which is precisely the trap, because normal in between is exactly what allows the underlying uric acid problem to continue unaddressed until the next, often worse, attack.

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Why it is more than a diet problem

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Diet genuinely matters and is worth getting right, but it accounts for only a modest proportion of a person's overall uric acid level, and the bigger drivers are usually how efficiently the kidneys excrete uric acid, which is substantially influenced by genetics, certain medications, and body weight. This is precisely why some people with a very disciplined diet still have frequent attacks, and others who eat and drink relatively freely never develop gout at all, and it is why diet advice alone, however diligently followed, so often fails to prevent recurrence.

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Purine-rich foods, red meat, organ meat and some seafood, do raise uric acid, and alcohol, particularly beer, and sugar-sweetened drinks containing fructose, raise it independently and meaningfully. But several very common medications are under-recognised contributors, including some blood pressure medications, particularly certain diuretics, and low-dose aspirin, and reviewing the full medication list is a genuinely useful and frequently skipped step in working out why someone's gout keeps recurring. Obesity, kidney disease, and a family history of gout all raise risk independent of diet entirely, and treating gout as a moral failing of willpower around food misses most of what is actually driving it in a given individual.

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Ask what might be driving your gout on WhatsApp or email team@thewellnesslondon.com.

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How gout is properly diagnosed

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The gold standard is examining fluid drawn from the affected joint under a microscope for the needle-shaped uric acid crystals that confirm the diagnosis definitively, though in practice a confident clinical diagnosis, based on the typical pattern, the joint affected and the response to treatment, is often sufficient without needing joint aspiration for every attack, particularly where the presentation is classic. A blood uric acid level supports the diagnosis but has a genuine limitation worth knowing, it can be entirely normal during an acute attack even in confirmed gout, because uric acid sometimes drops transiently during a flare, so a normal level during an attack does not rule gout out and should be interpreted alongside the clinical picture rather than in isolation.

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Where the diagnosis is uncertain, or where another cause needs excluding, particularly septic arthritis, a joint infection that can look similar and is a genuine emergency if missed, joint aspiration and analysis becomes important rather than optional. Imaging, ultrasound or, in longstanding cases, X-ray, can show the crystal deposits and joint changes characteristic of gout and is useful in less clear-cut presentations or where damage from repeated attacks needs assessing.

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How an acute attack is treated

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Quickly and without delay, because starting treatment early in an attack makes a real difference to how much it hurts and how long it lasts. NSAIDs at an adequate dose are typically first-line where there is no contraindication, colchicine is an effective and specifically targeted alternative, particularly useful where NSAIDs are unsuitable due to kidney disease, certain heart conditions or interacting medications, and a short course of oral steroid is a further effective option, particularly where several joints are affected or where NSAIDs and colchicine are both unsuitable. Ice and rest of the affected joint help alongside medication, and starting urate-lowering therapy during an acute attack is generally avoided, since it can transiently worsen the attack, though continuing it if someone is already established on it is the right approach rather than stopping.

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Why long-term treatment matters more than most people realise

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This is the part most consistently under-delivered in gout care. Someone who has had 2 or more attacks in a year, who has visible tophi, or who has evidence of joint damage or kidney stones related to uric acid, has crossed the threshold at which daily, long-term urate-lowering medication, typically allopurinol as the first choice, is recommended, not merely offered as an option. Treated to a specific target uric acid level and continued indefinitely, it genuinely prevents further attacks in the great majority of people and can, over time, dissolve existing crystal deposits, meaningfully changing the course of a condition that otherwise tends to recur and progress.

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The mistake made repeatedly, and one worth naming directly, is treating each attack in isolation, prescribing an anti-inflammatory, waiting for the next flare, and never having the conversation about starting allopurinol or a similar medication after someone has clearly crossed the threshold where it is indicated. Uric acid-lowering treatment is started at a low dose and increased gradually to the target level, with the dose adjusted based on regular blood monitoring, and once established it is genuinely one of the more effective, well-tolerated long-term treatments in general medicine, which makes its under-use particularly avoidable.

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What does gout assessment cost in London

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Consultant rheumatology appointments in the Harley Street district run £250 to £450 for a first consultation before any test, with joint aspiration, imaging and follow-ups charged separately. Comprehensive imaging and executive programmes at the top of the London market exceed £32,000. Below all of it sits a tier defined by its conditions rather than its price, a brief remote consultation that treats the flare and stops there, with no conversation about whether long-term urate-lowering treatment is actually indicated.

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At The Wellness the assessment, the acute treatment and the long-term plan are 1 fee, and all figures are from prices. The Executive Health Programme, the most comprehensive assessment with full biomarker profiling and coordinated imaging, is from £11,995. The Comprehensive Blood Panel, including uric acid, kidney function, glucose and a full lipid profile, with consultation and interpretation, is from £495, and a Targeted Blood Panel from £295. An extended 45-minute consultation for recurrent gout with a full medication review and a long-term urate-lowering plan is from £395. An in-person consultation with joint examination in Marylebone is from £220, a same-day video consultation from £150 and telephone follow-up from £59. A home, hotel or office visit is from £495 daytime and £695 evenings and weekends, useful given how disabling an acute attack can be. Joint aspiration, ultrasound imaging and rheumatology referral to a named consultant are arranged at specialist centres with the appointment booked.

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Same-day appointments 7 days a week in Marylebone, 3 minutes from Baker Street.

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Why The Wellness is the best place in London for gout

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Because acute attacks are treated fast, same-day appointments and a choice of effective treatments chosen to fit your other health conditions and medications rather than a single default option regardless of what else is going on.

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Because the full picture behind your gout is actually reviewed, your medication list checked for the diuretics or aspirin that are under-recognised contributors, your kidney function and weight considered alongside diet, rather than diet advice given in isolation as though willpower around food were the whole story.

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And because the conversation about long-term urate-lowering treatment happens at the point it is actually indicated rather than being skipped attack after attack. If you have had 2 or more flares, tophi, or joint damage, that conversation happens here rather than being left for the next painful attack to eventually prompt it, with regular monitoring to make sure the treatment is working at the level it needs to.

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Book a gout assessment on WhatsApp or call 020 3951 3429.

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Frequently asked questions

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What does a gout attack feel like

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Sudden, severe joint pain, redness, heat and swelling, classically at the base of the big toe, coming on over hours and often peaking within a day, severe enough that even light pressure from bedsheets can be unbearable. Ankles, knees, wrists, fingers and elbows can also be affected.

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Is gout only caused by diet

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No, and this is a common misconception. Diet plays a role, but genetics, how efficiently the kidneys excrete uric acid, certain medications including some diuretics and low-dose aspirin, obesity and kidney function all contribute, often more significantly than diet alone, which is why diet changes alone frequently fail to prevent recurrence.

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Can I have gout with a normal uric acid blood test

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Yes, particularly during an acute attack, when uric acid can transiently drop even in confirmed gout. A normal level during a flare does not rule gout out and should be interpreted alongside the clinical picture, or joint fluid analysis where the diagnosis needs confirming definitively.

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How is an acute gout attack treated

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NSAIDs at an adequate dose are typically first-line where suitable, colchicine is an effective alternative particularly where NSAIDs are unsuitable, and a short course of oral steroid is a further option. Starting early in the attack makes a genuine difference to how severe and how long it lasts.

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When do I need long-term medication rather than just treating attacks

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Generally after 2 or more attacks in a year, or with visible tophi, joint damage or uric acid-related kidney stones. Daily urate-lowering medication, typically allopurinol, treated to a target level and continued indefinitely, prevents further attacks in the great majority of people and can dissolve existing crystal deposits over time.

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Can gout damage my joints permanently if untreated

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Yes. Repeated attacks without adequate long-term treatment can lead to chronic joint damage and visible tophi, crystal deposits under the skin, which is one of the strongest reasons to address the underlying uric acid level with long-term treatment rather than only managing individual flares as they occur.

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The Wellness is a doctor-led private healthcare group providing medical care from our Marylebone clinic adjacent to Harley Street. All doctors are GMC-registered. Blood analysis is performed by accredited laboratories, and joint aspiration, imaging and rheumatology care are arranged at specialist centres and reported by consultants. Severe joint pain with fever or a hot, red joint you cannot move needs urgent assessment to exclude joint infection. This article is general information and not a substitute for medical advice about your own health.

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Enquire now on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.

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References. NICE guideline NG219 on gout, diagnosis and management, including the threshold for starting urate-lowering therapy. NICE Clinical Knowledge Summaries on gout, acute and long-term management. British Society for Rheumatology guideline for the management of gout. Published UK prevalence data on gout by sex and age. Published evidence on medication-induced hyperuricaemia, including diuretics and low-dose aspirin. Published 2026 London private rheumatology market pricing.