The Facts

Gout is a type of arthritis that is characterized by sudden, severe attacks of joint pain with redness, warmth, and swelling in the affected area. It usually attacks only one joint at a time. It most often strikes the joint of the big toe, where it's also known as podagra, but other toes can also be involved.

Gout is typically a condition that occurs in middle age, is ten times more common in men than in women, is unusual in people under the age of 30, and is rarely seen in women before menopause. A first gout attack most commonly occurs around age 47. It's most common in countries with high standards of living, mainly because diet plays a big part in this condition. It affects about 1% of the population.


The pain and swelling of a gout attack are caused by uric acid crystals building up in the joint and leading to inflammation. The body normally forms uric acid when breaking down cells and proteins, releasing it into the bloodstream. The uric acid usually stays dissolved in the blood and ends up being flushed out by the kidneys. If there's too much uric acid in the blood, called hyperuricemia, or if the kidneys can't get rid of it quickly enough, it may begin to form crystals that collect in the joints and even the kidneys, skin, and other soft tissues.

In severe cases, the uric acid deposits are so large that they can extend out to the skin and beyond. These large deposits around the joints and cartilage (such as the outer ear) are called tophi. Gout can also cause severe bursitis.

Although most people with gout have hyperuricemia, about 3 in 10 turn out to have normal uric acid levels during an actual attack. Meanwhile, hyperuricemia by itself doesn't mean that a person will develop gout - less than 1 in 5 people with high uric acid end up with gout.

Certain high-protein foods can make the body produce too much uric acid, triggering gout. Beverages such as tea, coffee, cocoa, and especially alcohol in any form lead to extra water loss from the body, which can cause an attack. Certain medications can hamper the kidneys' ability to clear out uric acid, including acetylsalicylic acid* (ASA) and diuretics or "water pills" commonly given to control high blood pressure. Finally, sudden changes in diet and weight gain or loss can also lead to gout.

Symptoms and Complications

The symptoms of a gout attack are almost unmistakeable. Typically, a person will go to bed feeling fine, then wake up during the night with intense pain in the big toe (three-quarters of gout cases involve this joint). At first it feels like a bucket of cold water has been poured over the joint, but soon there's an agonizing sensation of stretching and tearing, along with pressure and tightness. The affected area also becomes extremely sensitive to touch – even a bed sheet or someone walking in the room makes it hurt more. The swelling often spreads over the whole foot, making it impossible to put on a shoe. Also, low-grade fever may develop.

An attack will usually taper off on its own in 3 to 10 days, but prompt treatment can end it faster. After such an attack, called acute gout or acute gouty arthritis, over half of sufferers will have another episode within the next year. Attacks tend to strike more often, last longer, and affect more joints over time.

In some people, however, the attacks don't go away – instead, they linger on to become chronic gout. The inflammation persists, while the crystals can permanently damage and deform the affected joints. As well, uric acid crystals can build up in tissues other than the joints, forming deposits called tophi that can show up as whitish or yellowish chalky lumps under the skin, typically in the fingers, toes, back of the elbow, behind the heel, and around the outer edge of the ear. The tophi sometimes poke through the skin, leading to ulcerations or sores.

Gout can cause kidney stones, which can cause symptoms such as severe flank or groin pain, and sometimes blood in the urine. It is unclear as to what degree gout can damage the kidneys besides the effects of kidney stones.

Making the Diagnosis

The symptoms and signs of an acute gout attack are so clear that a doctor can usually be quite sure of the diagnosis just from your history and physical exam. Blood tests showing hyperuricemia can support the diagnosis, but aren't necessary for it. To confirm the diagnosis, your doctor may insert a needle into the joint and draw out some fluid to examine under a microscope. If it's gout, needle-shaped uric acid crystals will show up when the fluid is viewed under polarizing light.

Treatment and Prevention

The first priority is to relieve pain and shorten the acute attack. NSAIDs (nonsteroidal anti-inflammatory drugs) such as indomethacin, diclofenac, and naproxen are the mainstay of treatment. These medications help with the swelling and pain. Another medication called colchicine can be prescribed instead of an NSAID at the first sign of an attack but may have side effects such as diarrhea and vomiting that can limit its use in some cases. Corticosteroids, either injected directly into the joint or taken orally, can control the inflammation.

For chronic gout or repeated attacks, daily colchicine therapy can reduce the frequency of attacks, but it can't prevent the joint damage caused by tophi. However, medications that lower the blood levels of uric acid, such as allopurinol and probenecid can be very effective at preventing attacks and joint damage. Among these medications, allopurinol is the most commonly used. Another medication, febuxostat, can be used in place of allopurinol if it has caused side effects or been ineffective.

Prevention is an important part of managing gout. It's crucial to control weight and blood pressure and to be well-hydrated. A healthy diet is very important and can help minimize attacks. This includes:

  • Avoiding organ meats high in purine content (sweetbreads, liver, kidney).
  • Avoiding high fructose corn syrup-sweetened sodas, beverages, or foods.
  • Avoiding alcohol overuse (>2 servings per day for a male or > 1 serving per day for a female.) Avoid any alcohol consumption during periods of frequent attacks or poorly controlled gout.
  • Limiting consumption of beef, lamb, pork, seafood (sardines, shellfish).
  • Limiting consumption of naturally sweet fruit juices, sweetened beverages, and table salt (including sauces and gravies).

With early diagnosis and treatment, it's possible to control gout, prevent joint damage, and live a normal life.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.