Everything you need to know about gout

Gout is the most common form of inflammatory arthritis, both in the U.S. and around the world. By some estimates, roughly 4% of Americans have it (Singh, 2019). 

The condition is about three times more common in men than in women, and your risk for gout rises as you age. It’s also more common in African Americans (Singh, 2019). 

While gout was once thought to be driven by lifestyle factors—especially a diet rich in red meat and alcohol—many experts now believe genetic factors play a bigger role than previously thought (Singh, 2020).

If you’ve recently been diagnosed with gout or if you’re concerned that you may have it, here’s everything else you need to know about this inflammatory condition. 

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Gout is a type of arthritis that causes pain, swelling, and redness in your joints. In most cases, these symptoms tend to show up first in a single joint,—the big toe is the most common site for a gout “flare”—but some people experience gout in multiple joints (George, 2021).  

Gout can be intensely and excruciatingly painful. Some people are unable to walk or do much of anything during a flare. The pain can be so great that some people report that the weight of a bedsheet on their big toe is too much to bear.

Gout flares often start during the night and in the early morning hours, and symptoms tend to peak within a few hours from the onset of the pain. They often ebb and flow, and in many cases take 7-10 days to go away completely. A mixture of genetic and lifestyle factors can contribute to the development of gout (Robinson, 2018).

Gout happens when uric acid crystals accumulate in a joint and cause inflammation.

Uric acid, also known as urate, is a chemical substance found throughout the human body, mostly in blood and soft tissue. It comes from the breakdown of certain foods and beverages. Your body also makes some uric acid naturally.

A lot of people—roughly 20–25% of Americans—have elevated levels of uric acid in their blood. This is known as hyperuricemia. In most of these people, hyperuricemia causes no problems or symptoms (George, 2021). 

In others, if they have too much uric acid, it can build up in their joints and form crystal deposits. These crystals sometimes, but not always, cause inflammation. It’s this inflammation that causes the pain and other symptoms associated with gout (Singh, 2020). 

Cooler temperatures, both inside and outside the body, can contribute to the formation of these crystals (Choi, 2015). This is one reason why gout tends to show up in the lower (and cooler) parts of the body, as well as the ears, elbows, hands, and other joints that are away from your warm trunk region (Engel, 2017). At the same time, if it’s hot and you sweat a lot, dehydration can also provoke a gout flare because uric acid concentrations go up (Choi, 2015). 

Ther are some medical conditions that are associated with elevated gout risks, including (Singh, 2020; Engel, 2017):

• High blood pressure

• Obesity

• Kidney disease

• Heart disease

• High cholesterol

The primary symptom of gout is joint pain, which presents in the form of flares (also called gout attacks). Again, the main joint of the big toe is the most common location for acute gout to show up. After the big toe, other joints in the lower body—such as the ankles or knees—are also typical attack sites (Ragab, 2017).

Other symptoms of a typical gout flare include (Ragab, 2017; George, 2021):

• Swelling in the affected joint

• Joint redness

• Heat at the site of joint pain

• Tenderness

• Loss of function

• Fever

• Headache

• General feeling of illness or fatigue

Some people with gout may experience pain in the ball of their elbow or Achilles tendon, although this is less common (Ragab, 2017). If gout shows up in the upper body, this is usually a sign of more advanced or untreated gout (Dalbeth, 2019).

Healthcare professionals divide the disease into four main phases (Ragab, 2017):

1. Hyperuricemia without symptoms: Before someone experiences their first gout attack, some people have high levels of uric acid in their blood but don’t have any symptoms. 

2. Gout flare: Gout flares typically involve a single joint, most often the big toe. If untreated, flares can start to involve multiple joints at once.

3. Intercritical gout: Healthcare professionals call the time between gout flares an "intercritical" period. If your gout is untreated over a period of several years, the time between gout flares shortens, and gout flares can become more severe, last longer, and include multiple joints.

4. Chronic tophaceous gout: Those with untreated, repeated gout flares for many years can develop something called “tophaceous gout”. This is rare and describes a mass of urate crystals that clump together. This mass is called a tophus, and it can cause permanent bone damage or deformity. Untreated gout can also cause organ damage, including kidney failure (Ragab, 2017).

Healthcare providers can often diagnose gout based solely on a person’s symptoms. For example, if you experience pain, swelling, and redness in your big toe, and these symptoms tend to come and go, this is typically enough for a medical professional to diagnose gout with a high degree of accuracy (Engel, 2017). 

However, if your gout symptoms are less typical—for example, if you don’t have symptoms in your big toe or lower body—other tests or measures may be necessary. In some cases, your healthcare provider may extract fluid from your inflamed joint. If this fluid contains evidence of uric acid crystals, this confirms that you have gout. 

Finally, a healthcare provider may perform blood tests to check for signs of elevated uric acid. This can also help them make a gout diagnosis (Engel, 2017).

Again, many researchers now believe that your DNA—not your diet—is the factor that most determines your risk for gout. However, what you eat or drink may still affect the severity or frequency of your gout flares (Singh, 2020). 

Here are the dietary risk factors connected to gout:

Alcohol

Researchers have consistently found that alcohol use—particularly beer and liquor but not wine—is associated with an increased risk for developing gout or experiencing flares. Basically, the more you drink, the greater your risk (Singh, 2020). 

Healthcare providers often encourage people with gout to limit their consumption of liquor and beer. If you do drink, avoiding alcohol at least three days a week may help (Engel, 2017). 

Drinks with high-fructose corn syrup

Soft drinks or other beverages that contain high-fructose corn syrup are also strongly linked to gout flares. Experts recommend that people with gout, or those at risk for gout, avoid these beverages (Engel, 2017). 

Meat and seafood

Many types of meat and seafood contain purines, which increase the release of uric acid from your kidneys. Avoiding or limiting your intake of these purine-rich foods may reduce your risk for gout or your risk of gout flares. 

In particular, you want to watch out for these foods (Singh, 2020):

• Organ meats (kidney, liver, “sweetbreads”)

• Game meats such as deer (venison)

• Anchovies

• Herring

• Scallops

• Shellfish

Until experts release official diet guidelines for gout, it makes sense to maintain a healthy body weight with a balanced diet. Another thing to keep in mind is hydration. Drink adequate water, and limit your intake of alcohol and sugar-sweetened drinks.

The good news is that gout, unlike some other forms of inflammatory arthritis, is very treatable. Common medications are highly effective, and some lifestyle changes can also help. 

First-line medications

Several drugs may help people with new or acute attacks. These include (Engel, 2017):

• Corticosteroids

• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 

• Colchicine, a drug that affects how your body handles uric acid

Your healthcare provider may start you on one of these medicines. 

Urate-lowering medications

These drugs, of which allopurinol is the mainstay, can effectively lower your body’s levels of uric acid. They are proven to help reduce or even eliminate attacks of gout, and they are the main treatment for people with chronic gout (Qurie, 2021).  

While proven safe, some experts don’t like to begin treatment with allopurinol because it can cause side effects. These side-effects include (Engel, 2017; Qurie, 2021):

• Skin rash

• Nausea

• Stomach pain or discomfort

• Diarrhea

In rare cases, allopurinol can cause more serious complications, such as liver or kidney inflammation. Also, when you first start using it, allopurinol can actually increase your gout flares.

Because of these risks and side effects, your medical provider may recommend other meds or dietary changes as a first-line treatment for your gout (Qurie, 2021).  

Dietary changes

Watching out for the foods and drinks mentioned above can help reduce your risk for gout.

Meanwhile, some research has found that no- or low-fat dairy products may protect you from gout. Some studies have also found that men who drink coffee (but not tea) are at lower risk for this condition (Singh, 2020). 

Medication changes

Some hypertension medications, as well as some diuretics, can increase uric acid levels, and may cause or contribute to gout. Other drug options may help you manage your health conditions without raising your gout risks (Singh, 2020).

Don't wait to see someone if you think you may have gout. This form of arthritis is often easily managed with medication and small lifestyle changes. 

On the other hand, if left untreated, gout attacks can worsen and spread to other parts of your body. In extreme cases, gout can also cause the buildup of crystals into damaging lumps (tophi). It can even cause organ failure (Engel, 2017).

Gout is common and manageable. It’s also not something you want to mess around with. 

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Current version

February 07, 2022

Written by

Health Guide Team

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.