Gout is a type of arthritis caused by uric acid crystals forming in your joints

Gout happens when a substance called uric acid builds up in your blood and forms sharp, needle-like crystals in your joints. Your body produces uric acid when it breaks down purines — compounds found naturally in foods like red meat, organ meats, and certain seafood, and also made by your body itself. When you have too much uric acid, or your kidneys cannot filter it out fast enough, crystals can collect in a joint and trigger a sudden, severe attack of pain, swelling, and redness.

The big toe is the most common place for gout to strike, though it can affect ankles, knees, wrists, and other joints. An attack usually comes on without warning — often at night — and can last days or weeks if untreated. Between attacks, you may feel fine and have no symptoms at all.

Key Takeaways

  • Gout occurs when uric acid crystals form in a joint, causing sudden pain, swelling, and redness that usually lasts several days to weeks.
  • Your body makes uric acid naturally, and you also get it from foods like red meat, organ meats, and certain seafood; your kidneys normally filter it out.
  • Men are more likely to develop gout than women, and your risk increases if you have a family history, are overweight, drink alcohol regularly, or take certain medications.
  • A doctor can diagnose gout by examining the joint, testing your blood uric acid level, or analyzing fluid from the joint under a microscope.
  • Gout is treatable with medication to stop acute attacks and lower uric acid levels over time, plus lifestyle changes that reduce your risk of future attacks.

How uric acid builds up in your body

Your body produces uric acid as a byproduct of normal metabolism — the chemical processes that keep you alive. Purines, which break down into uric acid, come from two sources: foods you eat and your own cells. Normally, your kidneys filter uric acid out of your blood and you excrete it in urine.

Gout develops when one of two things happens: either you produce too much uric acid, or your kidneys do not filter it out efficiently enough. In most people with gout, the problem is the second one — their kidneys simply cannot keep up. This can run in families, meaning if your parents or siblings had gout, your risk is higher. Other factors that slow uric acid removal include chronic kidney disease, dehydration, and certain medications like diuretics (water pills) used to treat high blood pressure.

Who is most likely to develop gout

Gout is far more common in men than in women, especially before age 60. Women's risk rises after menopause, when estrogen levels drop. Your chances of developing gout increase if you are overweight, drink alcohol regularly (especially beer), eat a diet high in red meat and organ meats, or have a family history of the condition.

Certain medical conditions also raise your risk: high blood pressure, type 2 diabetes, chronic kidney disease, and heart disease all make gout more likely. Some medications increase uric acid levels too, including diuretics, low-dose aspirin, and certain cancer treatments. If you take any of these medications and are concerned about gout, talk with your doctor — do not stop taking them on your own, but your doctor may be able to adjust your treatment.

What happens during a gout attack

A gout attack begins when uric acid crystals trigger inflammation in a joint. Your immune system reacts to the crystals as if they were a threat, flooding the area with white blood cells and inflammatory chemicals. This causes the sudden onset of intense pain — often described as feeling like the joint is on fire — along with swelling, warmth, and redness.

Attacks typically peak within 24 to 48 hours and then gradually improve over several days to a week, even without treatment. However, treatment can speed up recovery and reduce pain. Some people have just one attack in their lifetime, while others have repeated attacks. If you have multiple attacks or high uric acid levels, your doctor may recommend long-term medication to prevent future episodes.

How doctors identify gout

Your doctor will start by asking about your symptoms, when the pain started, which joint is affected, and whether you have had similar episodes before. They will examine the joint for swelling, warmth, and redness. Because gout can resemble other conditions like infection or rheumatoid arthritis, your doctor will likely order tests to confirm the diagnosis.

The most definitive test is joint aspiration — your doctor uses a thin needle to draw a small sample of fluid from the affected joint and examines it under a microscope to look for uric acid crystals. A blood test measuring your uric acid level is also common, though a normal result during an acute attack does not rule out gout. X-rays may be taken if the diagnosis is unclear or if you have had gout for a long time.

Treatment during an acute attack

The goal of acute treatment is to reduce pain and inflammation quickly. Nonsteroidal anti-inflammatory drugs (NSAIDs) like indomethacin, naproxen, or ibuprofen are often the first choice — they work best when started early in an attack. If NSAIDs do not work or you cannot take them, your doctor may prescribe colchicine, a medication that reduces inflammation, or a corticosteroid injection directly into the joint.

Rest, ice, and elevation of the affected joint also help. Most attacks resolve within a few days to a week with treatment. Your doctor will not usually start long-term uric acid-lowering medication during an acute attack, because lowering uric acid too quickly can actually trigger more attacks. Once the acute attack has settled, your doctor will discuss whether you need long-term treatment to prevent future episodes.

Long-term management and prevention

If you have had multiple gout attacks, your doctor may recommend long-term medication to keep your uric acid level low. The most common choice is allopurinol, which reduces the amount of uric acid your body makes. Another option is febuxostat, which works similarly. If your kidneys do not filter uric acid well, your doctor might prescribe probenecid, which helps your kidneys remove more uric acid.

Lifestyle changes also matter. Losing weight if you are overweight, limiting alcohol (especially beer), reducing red meat and organ meats, staying well-hydrated, and managing conditions like high blood pressure and diabetes all lower your gout risk. Some people find that avoiding or limiting foods high in purines — such as anchovies, sardines, liver, and kidney — helps prevent attacks, though the effect varies from person to person.

Frequently Asked Questions

Can gout go away on its own?

An individual gout attack usually resolves within days to a week, even without treatment, though medication speeds recovery and reduces pain. However, if you have had multiple attacks, the condition itself does not go away — you will likely have future attacks unless you take long-term medication to lower your uric acid level.

Is gout caused by diet alone?

Diet plays a role but is not the only cause. Genetics, kidney function, age, sex, weight, alcohol use, and certain medications all contribute. Some people with a high-purine diet never develop gout, while others develop it despite eating well. If you have gout, dietary changes help, but medication is often needed too.

Can I take gout medication during an attack?

NSAIDs and colchicine can be started during an acute attack to reduce pain and inflammation. However, do not start uric acid-lowering medications like allopurinol during an attack — wait until the acute symptoms have settled, usually a few weeks later. Starting these too soon can make the attack worse.

Does gout cause permanent joint damage?

If gout is treated promptly and your uric acid is kept at a healthy level, permanent damage is unlikely. However, if attacks are frequent and untreated over many years, uric acid crystals can accumulate and cause lasting joint damage and disability. This is another reason why long-term treatment matters if you have recurrent attacks.

Can women get gout?

Yes, though it is much less common in women before menopause. After menopause, when estrogen levels drop, women's risk rises significantly. Women can develop gout at any age if they have risk factors like kidney disease, obesity, high blood pressure, or a family history of gout.