What Is Gout? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Gout is an inflammatory form of arthritis related to high levels of serum uric acid. High serum uric acid levels can cause crystals to form, which can lead to painful, swollen, or stiff joints. (1) For some people, gout looks like a sudden swelling at the base of the big toe.

Intense Big Toe Pain From Gout: a Classic Symptom of an Attack

While the big toe is the most common place for a gout attack to happen, gout can also affect surrounding joints in the foot, ankle, and knee.

People with gout typically experience flare-ups, or attacks, of symptoms followed by periods with no symptoms. The attacks typically last 3 to 10 days. Some people go months or even years without a gout attack after having one. In other people, attacks may become more frequent over time.

Gout can be difficult to diagnose. Once it’s diagnosed, it can be treated with medication and lifestyle changes.

Pain is the most dramatic, the most common, and the most noticeable symptom of gout. Other symptoms of acute gout, or a gout attack, may include:

• Sudden crushing or throbbing pain in one or a few joints (often in the big toe, knee, or ankle) that may last for a few days
• Sometimes an acute gouty arthritis attack has a sudden onset at nighttime. The big toe joint pain may be so severe that even the weight of bedsheets causes discomfort.
• Joints that appear swollen and inflamed, with reddish-purple skin that may feel warm

Chronic Gout Signs and Symptoms

• Compared with the dramatic nature of acute gout pain, chronic gout pain is more of a soreness or persistent ache.
• Pain that tends to be a more continuous feeling of dull aching or soreness in the joints
• Hard white deposits or lumps of uric acid crystals under the skin, called tophi, found on the elbows, ears, or fingers.

Learn More About Gout Signs and Symptoms

Gout happens when too much uric acid builds up in the body. Uric acid is a normal waste product in the blood resulting from the breakdown of certain foods. (2) Uric acid usually passes through the kidneys and is mostly eliminated from the body in urine. But it can build up in the blood and form painful crystals in your joints. This may happen if the body is making too much uric acid or if the kidneys are having a hard time filtering it out.

Having too much uric acid in the blood is a condition called hyperuricemia. (3) Certain foods, medicines, and lifestyle factors can cause high uric acid levels in the blood, triggering a gout attack.

Your risk of gout goes up when your diet is high in naturally occurring compounds called purines. When purines break down in the body, they cause uric acid to form. Purines are found in certain high-protein foods and some drinks. It used to be thought that gout was caused only by lifestyle and diet, but new research has found that's not true; instead, gout is thought to have a genetic link. Diet, however, does play a role in the disease.

Other risk factors for gout include:

• Male gender
• Being overweight
• Consuming excessive amounts of alcohol regularly
• A family history of gout
• High blood pressure
• Hypothyroidism (an underactive thyroid)
• Chronic kidney disease
• Obstructive sleep apnea
• Type 2 diabetes
• Health conditions that cause rapid turnover of cells (including some cancers, psoriasis, and hemolytic anemia)
• Kelley–Seegmiller syndrome or Lesch–Nyhan syndrome (rare disorders affecting males that cause overproduction of uric acid)

If you’ve been experiencing gout pain and other symptoms, see your primary care doctor. Primary care physicians can often diagnose and treat gout or refer you to a rheumatologist or gout specialist for testing or treatment.

The most reliable way to diagnose gout is during a flare-up, when the affected area is painful, hot, and swollen. The physician will perform a physical exam and X-rays, and run lab tests to look for uric acid crystals in the joint. (­2)

The first gout attacks usually affect only one joint and subside after a few days. Subsequent flare-ups may affect more joints — either at the same time or one after the other. If untreated, these later attacks can last up to three weeks. Attacks then snowball in frequency, occurring several times annually, especially if the condition is not diagnosed and treated appropriately.

As the disease progresses, gout becomes more aggressive in patients who develop symptoms before the age of 30, and whose baseline serum uric acid level is greater than 9.0 milligrams per deciliter (mg/dL). If caught and treated early, people with gout can live a relatively normal life. Some patients do not respond to treatment because they fail to follow physician recommendations, consume excessive amounts of certain forms of alcohol, or are undertreated by physicians. (4)

An attack of acute gout will reach its most aggressive form 12 to 24 hours after the onset of symptoms. Without treatment, full recovery can take one to two weeks. (5) With proper treatment, specific diet changes, and reduction in risk factors such as obesity, high cholesterol, and diabetes, patients will be less likely to experience painful flare-ups, which otherwise may occur several times a year.

As soon as you’ve been diagnosed with gout, your doctor will aim to reduce your pain ASAP. The American College of Rheumatology (ACR) updated its guidelines for gout treatment in 2020 for the first time in eight years. There is more evidence in support of early diagnosis and treatment (especially for people with comorbidities such as kidney disease); treat-to-target (T2T) protocols; and allopurinol (Zyloprim) as a first-line agent. (10)

Medication Options

A number of different drugs can be used to treat gout flare-ups:

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) These medications block the production of prostaglandins, which promote pain and inflammation. Common over-the-counter ones include ibuprofen (Advil), aspirin, and naproxen (Aleve); common prescription ones are celecoxib (Celecoxib), meloxicam (Mobic) and naproxen in prescription form. You must talk to your doctor before you take these.
• Colchicine If you are unable to tolerate NSAIDs, your doctor may prescribe colchicine (Colcrys), but it must be taken daily. There can be side effects such as diarrhea, nausea, vomiting, and abdominal cramps.
• Corticosteroids Taken orally or injected directly into affected joint, the most common corticosteroids used for gout are prednisone (Deltasone), prednisolone (Orapred), and methylprednisolone (Medrol).
• Uric Acid–Lowering Medicine These medications, such as febuxostat (Uloric) or allopurinol, must be taken daily and used long-term. The new gout guidelines recommend taking these with a three- to six-month course of NSAIDS.

Alternative and Complementary Therapies

Many complementary and alternative medicine (CAM) approaches for managing gout focus on diet, weight loss, and exercise.  

Your risk of gout goes up when your diet is high in naturally occurring compounds called purines. When purines break down in the body, they cause uric acid to form. In most cases, people who have gout will still need medication even when they follow a diet for gout. That said, tweaking your diet can be a powerful way to help manage gout and gout symptoms. Some research suggests that food changes alone can lower your uric acid levels by up to 15 percent. (11)

The main principles of a gout diet are basically the same as those of any healthy diet: Reduce calorie consumption if you are overweight; opt for unrefined carbohydrates like fruits, vegetables, and whole grains; and limit your intake of sugar, organ meats (such as kidney, liver, or sweetbreads), and saturated fats.

Avoid Foods That May Trigger Gout

Purines are found in certain high-protein foods, such as certain types of seafood (including mackerel, herring, scallops, anchovies, and sardines), and red meat and organ meat (especially beef kidneys, liver, game meats, and sweetbreads). Avoid drinks that may trigger gout:

• Alcoholic beverages (beer, whiskey, gin, vodka, and rum)
• Sugary drinks (sodas, juices, energy drinks)
• Coffee and other caffeinated beverages. While some studies show that caffeine can actually protect against gout pain, others find that sudden spikes in caffeine intake can trigger an attack.

RELATED: Gout Diet and Eating to Help Prevent Gout

Can You Drop 8 Pounds? Weight Loss Helps Prevent Gout

If you’re overweight, you are likely to have higher-than-normal uric acid levels, a primary risk factor for developing gout. That’s why weight loss is an important part of a gout diet.

Losing weight may help lower uric acid levels and reduce the risk that you will experience future gout attacks. In fact, a weight loss of about eight pounds or more led to long-term reductions in uric acid levels and gout attacks in overweight or obese people. (12)

While some people with gout benefit from cutting back on foods that are high in purines, a chemical that contributes to uric acid formation, it is not clear how much purine intake makes a difference. You don’t have to avoid all high-purine foods. Moderate changes to your eating style may help you feel better and reduce gout risks, and research suggests that purine-rich vegetables don’t trigger gout. High-purine foods such as lentils and beans can be a smart source of lean protein.

Get Appropriate Exercise

Many people with gout avoid exercise because they fear it will make the inflamed joint worse. There are special programs that help people with all kinds of arthritis adapt their exercise needs. The Centers for Disease Control and Prevention has a list of recommended programs that you can find in your local hospital, community center, or YMCA. (13)

Learn More About Gout Treatment

In addition to diet, exercise, and weight loss, avoid these medications that can trigger gout, if you can:

• Diuretics (used to treat high blood pressure or heart disease)
• Salicylate-containing drugs (such as aspirin)
• Niacin (vitamin B3 and nicotinic acid)
• Cyclosporine (Neoral) (an immune-suppressing drug)
• Levodopa (used to treat Parkinson’s disease)

In addition to joint damage, joint deformity, bone loss, and loss of mobility, chronic gout may lead to, or develop into, the following conditions:

• Recurrent Gout (Chronic Gouty Arthritis) People with recurrent gout experience flare-ups, or attacks, several times a year. If these attacks aren’t treated, they can cause permanent joint damage.
• Tophi These are chalky lumps or deposits that form under the skin. They’re often found on the elbows, ears, or fingers. Tophi may swell during a gout attack. If they break through the skin, they can become infected, leading to pain and a loss of function. (6)
• Kidney Stones People with gout are more likely to develop kidney stones as a result of too much uric acid in the kidneys. Medications that increase the amount of uric acid excreted from the kidneys can also lead to kidney stones.
• Chronic Kidney Disease High levels of uric acid in the blood can increase the risk of chronic kidney disease. (7)

Learn More About Gout Complications

Research has found that gout rates in the United States have been climbing steadily over the past 50 years, likely because of increases in obesity and high blood pressure. (8)

Gout is the most common type of inflammatory arthritis among men. It’s more common in men than women. About 6 percent of men in the United States have gout, while only about 2 percent of women have it. Women rarely develop gout before reaching menopause. (1)

Gout is rare in children and young adults.

Other conditions that are sometimes confused with gout include: (9)

• Reactive arthritis (joint pain that is triggered by a bacterial infection somewhere else in the body)
• Infectious arthritis (joint pain caused by a bacterial infection in the joint)
• Psoriatic arthritis (a type of arthritis that occurs in 4 to 6 percent of people with the skin condition psoriasis)
• Rheumatoid arthritis (RA), which occurs when the body releases too many inflammatory chemicals (cytokines). Gout is caused by too much uric acid.
• Osteoarthritis (OA), known as wear-and-tear arthritis.

What Is Pseudogout? And How Does Pseudogout Relate to Gout?

Pseudogout has similar symptoms to gout and is often confused with gout. Pseudogout is also a type of arthritis. (9) Like gout, it is caused when painful crystals form in the joints. Unlike gout (which is caused by a buildup of uric acid), pseudogout happens when there is too much calcium in the body. Pseudogout most commonly affects the knees and wrists.

Gout Myths and Misconceptions and the Facts

Gout was once called the “disease of kings,” because of its propensity to affect overweight, rich men throughout history. Famous gout sufferers have included Alexander the Great, Charlemagne, Henry VIII of England, and Benjamin Franklin.

While gout is no longer thought to be a disease of the wealthy, it is more common in men and people with weight-related health problems including high blood pressure and type 2 diabetes.