Gout is a painful form of inflammatory arthritis that strikes suddenly, often waking people in the middle of the night with intense joint pain. This condition happens when needle-like crystals of uric acid build up in the joints, causing episodes of severe pain, swelling, and redness that can make even the lightest touch unbearable.
How Common Is Gout and Who Gets It?
Gout affects millions of people worldwide and has become increasingly common in recent decades. In the United States, the overall prevalence of gout approaches 4% of the population, with estimates suggesting there may be as many as five million people suffering from this condition.[1][2] Nearly 10% of adults over 65 years old report having gout, making it particularly prevalent among older individuals.[2]
Gout affects about 1 to 2% of adults in the developed world at some point in their lives.[3] Studies from both the Mayo Clinic and Taiwan have shown significant increases in gout prevalence recently compared to the early 1990s, with rates rising in both younger and older people.[4] This increase is believed to be due to several factors including growing rates of metabolic syndrome, longer life expectancy, and changes in dietary habits.[3]
Men are three times more likely than women to develop gout.[2] The condition typically affects men after age 40, while women usually don’t experience gout until after menopause, when they lose the protective effects of estrogen.[4] Gout is the most common type of inflammatory arthritis overall.[4]
What Causes Gout?
Gout develops when there is too much uric acid (a waste product naturally produced by the body) in the bloodstream. This condition is called hyperuricemia. Your body creates uric acid when it breaks down substances called purines, which are natural chemicals found in your body’s cells and in many foods.[2] Under normal circumstances, your kidneys filter uric acid out of your blood, and it leaves your body when you urinate.[3]
However, sometimes your body makes too much uric acid, or your kidneys don’t remove it from the blood fast enough. When uric acid levels climb too high, the excess can form sharp, needle-shaped crystals that build up in your joints and surrounding tissues.[2] These crystals are what trigger the sudden, intense inflammation that characterizes a gout attack. The sharp crystals clump together and cause sudden episodes of severe pain, swelling, and other symptoms.[2]
It’s important to understand that only about one in three people with high uric acid levels actually develop gout.[3] Many people with hyperuricemia never experience gout symptoms. Having temporarily elevated uric acid doesn’t guarantee you will develop the condition.[2]
Uric acid levels can become elevated for several reasons. About 90% of cases are due to decreased clearance of uric acid by the kidneys, which can happen because of intrinsic kidney disease, heart disease causing decreased blood flow to the kidneys, certain medications, genetic predisposition, or age-related decreases in kidney function.[5] The remaining cases involve increased production of uric acid due to dietary factors, genetic conditions, increased tissue turnover from tumors or blood disorders, or other metabolic processes.[5]
Who Is at Higher Risk for Gout?
While gout can affect anyone, certain groups of people face a higher risk of developing this painful condition. People with specific health conditions are more likely to experience gout, including those who are overweight or obese, and those with congestive heart failure, diabetes, high blood pressure, kidney disease, or blood cancers.[2]
Your family history plays a significant role in gout risk. If you have a biological parent or grandparent who has experienced gout, you are more likely to develop it yourself.[2] This suggests a strong genetic component to the disease, and in some cases, gout runs in families.[3]
Diet and lifestyle choices significantly influence gout risk. People who eat a lot of animal proteins, especially red meat, shellfish, and foods containing organ meats like liver, are more susceptible.[2] Regular alcohol consumption, particularly beer, increases risk because alcohol interferes with the kidneys’ ability to eliminate uric acid, causing it to accumulate in the body.[2] Foods and drinks sweetened with high fructose corn syrup, such as sugary sodas and processed snacks, can also raise uric acid levels.[2]
Certain life circumstances can also trigger gout attacks. Having an illness that causes a high temperature, drinking too much alcohol or eating a very large meal, becoming dehydrated, or injuring a joint can all provoke an attack in susceptible individuals.[3] Being overweight increases the body’s production of uric acid and makes it harder for the kidneys to eliminate it.[4]
What Are the Symptoms of Gout?
Gout symptoms almost always occur suddenly, often striking without warning in the middle of the night. Many people describe being awakened by the sensation that their affected joint is on fire.[1] The pain typically reaches its most severe level within the first four to twelve hours after it begins.[1]
During a gout attack, which is also called a flare, the affected joint becomes intensely painful. The pain can be so severe that even the weight of a bedsheet touching the joint feels intolerable.[1] Along with intense pain, the joint becomes hot, swollen, and tender to even the lightest touch.[2] The skin over the affected joint appears red and discolored, though this redness may be harder to see on black or brown skin.[3] The joint also feels warm, as if it’s radiating heat.[2]
Gout most commonly affects the joint at the base of the big toe, a condition historically called podagra. About half of all gout cases involve this joint.[3] However, gout can strike other joints as well, including the midfoot, ankles, knees, wrists, fingers, and elbows.[2] When gout first develops, it often affects only one joint, but over time it may involve multiple joints.[3]
A typical gout attack usually lasts about one to two weeks without treatment.[3] Some flares last longer than others, and severity can vary. Between attacks, you might not experience any gout symptoms at all. These periods without symptoms are called intercritical periods or remissions.[2] Months or even years can pass between attacks for some people, while others experience more frequent flares.[3]
After the most severe pain subsides, some joint discomfort may linger for a few days to a few weeks. As gout progresses, later attacks are likely to last longer and affect more joints than earlier ones.[1] Over time, if left untreated, gout can lead to limited range of motion, making it difficult to move affected joints normally.[1]
When gout becomes chronic and is left untreated over long periods, hard lumps called tophi (singular: tophus) can form. Tophi are large masses of uric acid crystals that build up under the skin, usually near joints or on the outer ear.[3] They start out painless but can become painful over time and may cause damage to bones and soft tissues, leading to joint deformity.[3]
How Can Gout Be Prevented?
Preventing gout involves a combination of healthy lifestyle choices and, in some cases, medication. Reaching and maintaining a healthy weight is one of the most important prevention strategies. Being overweight increases the body’s production of uric acid, so losing excess weight can lower uric acid levels and reduce the frequency of gout attacks, even without strictly limiting purine intake.[6] However, it’s important to avoid crash diets, as rapid weight loss can temporarily increase uric acid levels.[3]
Making smart dietary choices is crucial for preventing gout flares. Instead of focusing solely on avoiding individual high-purine foods, many doctors now recommend following an overall healthy eating pattern. The DASH diet (Dietary Approaches to Stop Hypertension) and similar plant-based diets have been shown to lower uric acid levels more effectively than other dietary approaches.[7] A healthy diet for gout prevention emphasizes fruits, vegetables, whole grains, and low-fat dairy products, while limiting red meat, organ meats, certain seafood, and sugary foods and drinks.[2]
Specific dietary recommendations include consuming low-fat dairy products, which multiple studies have found are associated with lower uric acid levels.[7] Adding citrus fruits and other foods rich in vitamin C, such as strawberries and peppers, may help lower uric acid levels.[7] Some evidence suggests that eating cherries or drinking cherry juice can reduce gout attacks and improve pain, though findings are not conclusive.[7] Drinking plenty of water is essential, as staying hydrated helps your kidneys function better and flush out uric acid.[3]
Limiting alcohol consumption is particularly important for gout prevention. Alcohol, especially beer and hard liquor, should be limited or avoided entirely. Beer is particularly problematic because it contains high levels of purines.[2] Additionally, alcohol prevents your kidneys from eliminating uric acid, causing it to accumulate in your body.[2] It’s recommended to have some alcohol-free days each week and not drink more than 14 units of alcohol weekly.[3]
Foods and drinks high in sugar or high fructose corn syrup should be avoided or limited. This includes sugary soft drinks, concentrated fruit juices, sweetened cereals, store-bought baked goods, ice cream, candy, and many processed foods.[2] Regular table sugar is half fructose (fruit sugar), which breaks down into uric acid in the body, so any food or drink with high sugar content can trigger gout.[2]
Regular physical activity is beneficial, though intense exercise or activities that put lots of pressure on joints should be avoided during and after a gout attack.[3] The CDC recommends at least 150 minutes per week of moderate-intensity physical activity for people with gout.[2] Exercise can help with weight management and overall health, both of which support gout prevention.
For people who experience frequent gout attacks, taking vitamin C supplements may be helpful, though you should ask your doctor about this first.[3] If you smoke, trying to quit is beneficial for overall health and may help with gout management.[3]
When lifestyle changes alone aren’t enough to prevent gout attacks, medications that lower uric acid levels may be necessary. These are typically recommended for people who have multiple gout attacks per year or who have developed tophi or kidney stones.[5]
How Does Gout Affect the Body?
Gout is fundamentally a disorder of metabolism that causes inflammation in the joints. The process begins at the biochemical level when the body has elevated levels of uric acid in the blood, a condition called hyperuricemia. At high concentrations, uric acid doesn’t remain dissolved in the blood but instead crystallizes into tiny, needle-shaped structures made of monosodium urate.[3]
These sharp uric acid crystals have a tendency to settle in and around joints, particularly in cooler areas of the body like the big toe. When these crystals build up in a joint, they trigger a powerful inflammatory response from the body’s immune system.[4] The immune system recognizes these crystals as foreign invaders and mounts an aggressive attack, sending white blood cells to the area. This immune response is what causes the characteristic symptoms of a gout attack: the intense pain, heat, redness, and swelling.[3]
During an acute gout attack, the inflammation normally goes away on its own within one to two weeks, even without treatment.[3] However, the crystals may remain in the joint even after the inflammation subsides, setting the stage for future attacks. Over time, if gout is not properly managed, the recurring inflammation can cause lasting damage to the affected joints.
When gout becomes chronic, meaning it persists over long periods without adequate treatment, the joints may remain slightly inflamed all the time. The ongoing inflammation and continued crystal deposition can lead to joint deformity and make it progressively harder to move the affected joints.[3] The accumulation of crystals can eventually become visible as tophi, large deposits that appear as hard lumps under the skin, typically near joints or on the ears. These masses can damage surrounding bone and soft tissue.[3]
Gout can also affect organs beyond the joints. High levels of uric acid can lead to the formation of kidney stones, as crystals may build up in the kidneys.[3] In rare cases, untreated chronic gout can cause kidney damage leading to chronic kidney disease.[3] Some people develop chronic arthritis as a complication, though this is uncommon.[3]
The body’s kidneys play a crucial role in the development of gout. Normally, the kidneys filter uric acid from the blood and eliminate it through urine. In many people with gout, the kidneys don’t remove uric acid efficiently enough, leading to its accumulation in the bloodstream.[3] This reduced clearance accounts for about 90% of gout cases.[5] In other cases, the body simply produces too much uric acid for the kidneys to handle, even when kidney function is normal.[2]
