Understanding Gout: What It Is, Why It Happens & How It Can Be Managed

Quick Answer

Gout is a type of inflammatory arthritis caused by crystals of urate forming in and around a joint.

These crystals can trigger sudden episodes of severe pain, swelling, redness and heat known as gout attacks or flares. The big toe is famously associated with gout, but it can affect other joints too.

Gout is linked to having too much urate (uric acid) in the blood over time. The good news is that gout is treatable, and lowering urate to an appropriate level can help prevent future attacks and long-term joint damage.

What Actually Is Gout?

Gout is more than simply having a painful toe.

It's a form of arthritis caused by monosodium urate crystals forming within and around joints.

Urate is produced when the body breaks down substances called purines. Most urate is normally removed from the body through the kidneys and passed in urine.

However, if the amount of urate in your blood remains high enough, crystals can begin to form.

You might have raised urate without experiencing any symptoms. But when the immune system reacts to crystals within a joint, it can cause the intense inflammation associated with a gout attack.

What Does Gout Feel Like?

A gout attack can develop extremely quickly.

Typical symptoms include:

• Sudden, severe joint pain
• Swelling
• Redness
• Heat around the joint
• Extreme tenderness

The pain may be severe enough that even light pressure against the affected joint becomes uncomfortable.

Attacks frequently begin overnight, and the joint at the base of the big toe is one of the most commonly affected areas.

Where Can You Get Gout?

Although gout is strongly associated with the big toe, it isn't exclusively a foot condition.

Gout can affect joints including the toes, ankles, knees, fingers, wrists and elbows.

Some people experience attacks in the same joint repeatedly, while others may experience gout in different joints.

What Is Uric Acid?

You'll frequently hear the terms uric acid and urate when reading about gout.

Uric acid is produced when your body breaks down purines. In the blood, it exists mainly as urate.

Normally, your kidneys filter urate from the blood and your body gets rid of it in urine.

Problems can arise when your body produces more urate than it can remove or when your kidneys aren't removing enough.

Your blood urate concentration can then increase.

This is known as hyperuricaemia.

Does High Uric Acid Always Mean Gout?

No.

You can have an elevated urate level without having gout.

Likewise, measuring urate during an acute gout attack can sometimes be misleading because the level may temporarily be lower.

NICE recommends measuring serum urate when assessing suspected gout. A level of 360 micromol/L (6 mg/dL) or above supports a clinical diagnosis in somebody with symptoms and signs of gout.

If the result is below this during a flare but gout remains strongly suspected, NICE recommends repeating the test at least two weeks after the flare has settled.

This is one reason a home uric-acid result shouldn't be treated as a diagnosis by itself.

Why Do Some People Develop Gout?

There isn't usually one single cause.

Several factors can influence your likelihood of developing gout, including your genetics, urate level, kidney function, certain health conditions and some medicines.

Lifestyle can also play a role.

The NHS identifies factors including being overweight, drinking alcohol and consuming certain foods as things that can increase the likelihood of gout attacks. Some medicines, including certain treatments for high blood pressure, can also increase uric acid levels.

But it's important to understand something:

Gout isn't simply caused by eating badly.

Someone developing gout after a large meal doesn't necessarily mean that meal caused their gout.

The underlying process involving urate and crystal formation is considerably more complicated.

What Happens During a Gout Attack?

Imagine tiny urate crystals sitting within a joint.

Your immune system recognises those crystals and launches an inflammatory response.

The joint can then become swollen, hot, red and extraordinarily painful.

That's the gout flare.

The immediate goal during an attack is therefore usually to control the inflammation and pain.

NICE recommends an NSAID, colchicine or a short course of an oral corticosteroid as first-line options for treating a gout flare, taking into account the person's medical conditions, other medicines and preferences.

These medicines aren't suitable for everybody, so treatment should be discussed with an appropriate healthcare professional.

How Long Does a Gout Attack Last?

Without treatment, an attack will typically last around 1 to 2 weeks, according to the NHS.

Eventually the inflammation settles.

This can create a dangerous misconception:

"The gout has gone."

The painful attack may have ended, but the underlying tendency for urate crystals to form may still be present.

That's why gout management isn't only about dealing with pain whenever an attack occurs.

Can Gout Cause Long-Term Problems?

Yes, particularly when gout remains uncontrolled.

Repeated attacks can become more frequent and may eventually cause joint damage.

Some people with longstanding gout can also develop tophi — deposits of urate crystals that form lumps beneath the skin, often around joints or the ears.

Effective urate-lowering treatment can help prevent these complications.

Can Gout Be Treated?

Yes.

There are really two different sides of gout treatment.

Treating the attack

During a flare, treatment focuses on controlling inflammation and pain.

This can include medicines prescribed or recommended by a healthcare professional alongside measures such as resting the joint and using cold therapy.

Preventing future attacks

Longer-term treatment is about controlling the underlying urate level.

Medicines such as allopurinol and febuxostat can be used as urate-lowering therapies for appropriate patients.

Rather than simply masking pain, these treatments aim to reduce serum urate sufficiently to prevent crystal formation and allow existing crystals to dissolve over time.

NICE recommends aiming for a serum urate level below 360 micromol/L (6 mg/dL) for people receiving urate-lowering therapy, with a lower target below 300 micromol/L (5 mg/dL) considered for some people.

Can Diet Cure Gout?

There isn't currently good evidence that one particular diet can cure gout.

NICE advises people with gout that there isn't enough evidence to show that any specific diet prevents attacks or lowers serum urate levels. Instead, it recommends following a healthy, balanced diet.

That doesn't mean food is irrelevant.

Weight, alcohol consumption and dietary habits can contribute to someone's overall gout risk and general health.

But someone experiencing repeated gout attacks shouldn't assume that changing their diet alone is necessarily enough to control their urate.

Is Gout Curable?

It's more useful to think about gout as a condition that can be very effectively controlled.

By reducing serum urate sufficiently, existing urate crystals can gradually dissolve and future attacks can be prevented.

That means somebody who previously experienced repeated attacks may eventually remain free from gout flares when their condition is properly controlled.

However, urate-lowering treatment is generally a long-term treatment, rather than something stopped as soon as symptoms disappear.

I've Had My First Gout Attack — What Now?

Don't automatically diagnose yourself.

A red, swollen and extremely painful joint can have other causes, including septic arthritis, which requires urgent treatment.

The NHS recommends seeing a GP if you have symptoms of gout for the first time.

Once gout has been diagnosed, understanding your urate level and discussing your risk of future attacks becomes important.

A follow-up after the flare can include measuring serum urate, reviewing medicines and other health conditions, and discussing whether longer-term urate-lowering treatment is appropriate.

Understanding Gout in One Minute

The basic process is:

Purines are broken down → uric acid/urate is produced → blood urate becomes too high → urate crystals can form → crystals accumulate around a joint → the immune system reacts → inflammation produces a gout attack.

Treating the painful attack deals with the immediate inflammation.

Controlling urate addresses the underlying problem.

Understanding that distinction is one of the most important things someone newly diagnosed with gout can learn.

The Bottom Line

Gout isn't simply a sore toe and it isn't simply caused by eating too much rich food.

It's an inflammatory arthritis associated with urate crystals forming in and around joints.

The severe pain experienced during an attack is one part of the condition. Understanding and appropriately managing the underlying urate level is the other.

With proper diagnosis, appropriate treatment and long-term management where required, gout can be effectively controlled.

Continue reading: First Gout Attack → | Gout Pain Relief → | Understanding Uric Acid → | Food & Gout →

Medical disclaimer: This article provides general educational information and should not be used to diagnose or treat a medical condition. If you think you have gout for the first time, contact your GP. Seek urgent medical advice for a painful swollen joint accompanied by fever, chills or feeling generally unwell.