Gout attacks are caused by a sudden deposition of uric acid crystals in the joint. They are excruciatingly painful, typically beginning at night, affecting the big toe, ankle, or knee. Most attacks settle within 7–14 days. Short-term treatment with NSAIDs, colchicine, or prednisolone brings rapid relief. Urate-lowering therapy with allopurinol prevents recurrent attacks and is very effective. Gout is entirely manageable — it is not something that has to be simply endured.

Allopurinol should never be started during an acute gout attack as this can prolong or worsen the flare. It should be started 2–4 weeks after the acute attack has settled, ideally while continuing prophylactic colchicine or NSAID cover for the first 3–6 months. Start at 100mg daily and increase every 4 weeks to achieve a target serum urate below 360 μmol/L. Once on a stable dose, allopurinol is continued indefinitely. Stopping and restarting is a common cause of recurrent attacks.

Joint pain with a hot, red, severely swollen joint and fever is a red flag for septic arthritis — a surgical emergency. This requires same-day joint aspiration and IV antibiotics. Joint pain without these features requires investigation to determine the cause: OA, RA, gout, or reactive arthritis. Getting the right diagnosis quickly matters because RA causes joint erosion within weeks to months of onset, and early DMARD treatment dramatically reduces long-term disability.

OA affects cartilage and causes pain that worsens with use and eases with rest. RA is an autoimmune disease causing symmetrical synovial inflammation, morning stiffness >1 hour, systemic symptoms, and elevated inflammatory markers. RA gets worse without treatment and causes irreversible joint destruction; OA does not have systemic consequences. Getting the right diagnosis early is important because the treatments are completely different. If you have morning stiffness lasting over an hour and symmetrical joint swelling, see a clinician urgently for RA screening.

Most back pain is non-specific — caused by muscle, ligament, or disc strain without any serious underlying cause. The vast majority resolves within 4–6 weeks. Key red flags to watch for: bladder or bowel changes (possible cauda equina syndrome — call 999), fever, unexplained weight loss, or pain that is unrelenting at night regardless of position. If none of these are present, staying active, taking regular analgesia, and seeing a physiotherapist is the most effective approach.

Bed rest is not recommended and actually slows recovery. Staying as active as pain allows — walking, gentle stretching, swimming — helps the back heal faster. Most non-specific back pain improves within 4–6 weeks with movement, NSAIDs, and physiotherapy. Seeing a physiotherapist early produces better outcomes than waiting. If back pain has not improved after 6 weeks, or is worsening, a GP review is warranted to consider imaging and further management.

Sciatica is caused by compression of the sciatic nerve or its nerve roots — most commonly from a disc herniation at L4/5 or L5/S1. Around 80–90% of sciatica resolves within 6–12 weeks with conservative management: staying active, NSAIDs, physiotherapy, and nerve pain medication if needed. Red flags requiring emergency assessment: loss of bladder or bowel control, saddle numbness, or rapidly progressive leg weakness. These could indicate cauda equina syndrome, which is a surgical emergency.

Most rotator cuff problems — tendinopathy, partial tears, and impingement — respond well to physiotherapy. A targeted physiotherapy programme addressing rotator cuff strength and scapular control resolves 70–80% of cases within 3–6 months. Steroid injection provides short-term relief but does not improve long-term outcomes. Full-thickness rotator cuff tears with significant weakness warrant MRI assessment and possible surgical repair, especially in younger or active patients. Frozen shoulder runs a natural history of 1–3 years and usually resolves fully without surgery.