Gout is a complex form of arthritis characterized by sudden, severe attacks of pain, swelling, and tenderness in a single joint, often the big toe. These episodes can come on with startling speed, sometimes waking you from a sound sleep with the feeling that your joint is on fire. It's an inflammatory response to a buildup of urate crystals, which form when you have too much uric acid in your blood. These needle-like crystals settle in the joints, causing the intense agony that defines a gout attack.
Overview
Gout is a metabolic disorder where the body either produces too much uric acid or the kidneys cannot excrete enough of it. Uric acid is a byproduct of the breakdown of purines, which are found naturally in your body and in certain foods. When uric acid levels get too high, it leads to the formation of those painful crystals. A gout attack, also known as a flare, can last for days or even weeks. Left unaddressed, these flares can become more frequent, last longer, and lead to serious, long-term complications.
Symptoms
The signs of a gout attack are often unmistakable and tend to appear suddenly, frequently at night. They can include:
Intense joint pain: This is the hallmark symptom. The pain is most severe in the first 4 to 12 hours after it begins and is often centered in the big toe, but can also affect your ankles, knees, elbows, wrists, and fingers.
Lingering discomfort: After the most severe pain subsides, you'll likely feel a persistent, dull ache that can last for days or even weeks. Future attacks may last even longer.
Inflammation and redness: The affected joint becomes swollen, tender, hot, and red. On darker skin tones, this redness may be harder to see, but the heat and swelling are still very apparent.
Limited range of motion: As the gout attack progresses, you may find it difficult to move the affected joint normally.
When to see a doctor
It is crucial to seek medical attention if you suspect you have gout. Timely intervention can prevent the condition from escalating and causing permanent damage.
Non-urgent:
If you're experiencing symptoms for the very first time.
If you have a known gout diagnosis, but your usual treatments are no longer effective.
Urgent:
You should seek immediate medical care if you have a fever and a hot, inflamed joint. This could be a sign of a joint infection, which requires urgent treatment.
Causes
At its core, gout is caused by hyperuricemia, a condition where there is an excess of uric acid in the blood. When this uric acid doesn't get properly filtered out by the kidneys, it can crystallize. Certain foods and drinks are high in purines, which can contribute to the problem. These include red meat, organ meats, some seafood like anchovies and sardines, and alcohol, particularly beer. Fructose-sweetened beverages are also a major culprit, as they can also increase uric acid levels.
Risk factors
Several factors can increase your likelihood of developing gout:
Diet: A diet rich in purines from red meat and seafood, and drinks sweetened with fructose, can raise uric acid levels.
Obesity: Being overweight increases your body's production of uric acid and makes it harder for your kidneys to excrete it.
Medical conditions: Certain untreated conditions like high blood pressure, diabetes, metabolic syndrome, and kidney and heart diseases can elevate your risk.
Medications: Some drugs, including low-dose aspirin, certain blood pressure medications (like thiazide diuretics), and anti-rejection drugs for transplant patients, can also increase uric acid levels.
Family history: Gout sometimes runs in families.
Age and gender: Gout is more common in men, and for women, the risk increases after menopause.
Complications
Left untreated, the consequences of gout can be severe and life-altering. Untreated gout can lead to:
Recurrent gout: Some people may never have another attack, but others can experience them multiple times a year. Without treatment, these attacks can become more frequent and more intense.
Advanced gout: Over time, urate crystals can form hard, painless lumps called tophi under the skin in areas like your fingers, feet, elbows, and Achilles tendons. While they are not usually painful on their own, they can become tender during a gout attack and can eventually cause permanent joint damage.
Kidney stones: Urate crystals can accumulate in the urinary tract, leading to painful kidney stones.
The good news is that gout is manageable. With the right diet, lifestyle changes, and medication, you can often prevent attacks and avoid the devastating complications. Weight management, staying hydrated, and reducing alcohol and purine-rich foods are key. Your doctor may also prescribe medication to lower uric acid levels and prevent future flares.
FAQs
Will gout go away on its own? While a single gout attack will eventually subside on its own, usually within one to two weeks, the underlying condition of high uric acid levels will not. Without treatment, you are very likely to experience future attacks, which can become more frequent and more severe over time.
Can gout kill you? Gout itself is not typically fatal. However, its complications, such as a severe joint infection or chronic kidney disease from recurrent kidney stones, can be very serious and potentially life-threatening if not properly managed.
Published 30th August 2025
References
National Health Service Gout Available at: https://www.nhs.uk/conditions/gout/
Mayo Clinic Gout Available at: https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897