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 crystals inside a joint. Your body makes uric acid when it breaks down purines, which are compounds found in certain foods and drinks. Normally your kidneys filter uric acid out through urine, but sometimes it accumulates instead. When the level gets high enough, crystals form—usually in the big toe, but also in ankles, knees, wrists, and fingers. The crystals trigger sudden, severe inflammation and pain.
Gout is different from other types of arthritis. Osteoarthritis develops slowly over years as cartilage wears down. Rheumatoid arthritis is an autoimmune condition where your body attacks joint tissue. Gout strikes suddenly, often in the middle of the night, and can go away completely between attacks. Some people have one attack and never have another. Others have them repeatedly, sometimes several times a year.
Key Takeaways
- Gout causes sudden, severe pain and swelling, usually starting in the big toe but sometimes in other joints.
- An attack typically lasts three to ten days, even without treatment, though medication can shorten it.
- High uric acid levels in your blood create the crystals that trigger gout, and certain foods, drinks, and medical conditions raise uric acid.
- A doctor can confirm gout by testing fluid from the affected joint or by measuring uric acid in your blood.
- Repeated gout attacks can damage joints permanently, so treatment focuses on stopping attacks and lowering uric acid levels over time.
What happens during a gout attack
A gout attack usually starts without warning. You might go to bed feeling fine and wake up with intense pain, redness, and swelling in one joint—most often the big toe. The pain can be so severe that even the weight of a bedsheet feels unbearable. The joint becomes hot to the touch and may look shiny and red.
The attack peaks within 24 to 48 hours and then gradually improves over the next few days. Most attacks last between three and ten days. Some people have only one attack in their lifetime. Others develop a pattern of attacks that happen weeks, months, or years apart. Over time, if attacks keep happening, the crystals can damage the joint permanently, causing lasting pain and reduced movement even when you are not having an active attack.
Common symptoms of gout
The main symptom is sudden, severe pain in one joint. You might also notice:
- Swelling and redness around the joint
- Warmth and tenderness in the area
- Skin that looks shiny or feels tight over the joint
- Mild fever (sometimes)
- Chills or general feeling of illness
Gout almost always affects just one joint at a time, at least in the early stages. If you have pain in multiple joints at once, your doctor may look for other causes. The pain is usually worst in the first 24 to 48 hours, then gradually gets better even if you do nothing. However, without treatment, the attack still lasts several days, and you are at risk for more attacks in the future.
What causes uric acid to build up
Your body produces uric acid naturally when it breaks down purines. Some purines come from foods—especially red meat, organ meats, certain seafood, and high-fructose corn syrup. Alcohol, particularly beer, raises uric acid levels. Sugary drinks and foods also contribute. Other people's bodies simply produce more uric acid than average, or their kidneys do not filter it out as efficiently.
Several medical conditions and medications can raise your uric acid level. Kidney disease makes it harder to filter uric acid. Conditions like psoriasis, leukemia, and lymphoma cause your body to break down cells faster, producing more uric acid. Diuretics (water pills) used for high blood pressure or heart problems can interfere with uric acid removal. Aspirin at low doses also raises uric acid, though high doses lower it. Being overweight, drinking too much alcohol, and dehydration all increase your risk.
How doctors identify gout
If you have sudden joint pain and swelling, your doctor will ask about your symptoms and medical history. They may order a blood test to measure your uric acid level. However, a blood test alone cannot confirm gout—some people with high uric acid never have an attack, and some people with normal uric acid levels still get gout.
The most reliable way to confirm gout is to test fluid from the affected joint. Your doctor uses a needle to draw out a small sample of fluid and looks at it under a microscope for uric acid crystals. This test is called arthrocentesis or joint aspiration. If crystals are present, the diagnosis is confirmed. Your doctor may also take an X-ray to check for joint damage if you have had repeated attacks.
The difference between an acute attack and chronic gout
An acute attack is a single episode of sudden pain and swelling that lasts days to weeks. During this time, your uric acid level may actually be normal or even low, because the crystals are forming in the joint rather than staying in your blood. This is why a blood test during an attack might not show high uric acid.
When attacks happen repeatedly over months or years, the condition is called chronic gout. Between attacks, you may have no symptoms at all, or you may have mild ongoing pain and stiffness. Over time, repeated crystal formation can cause permanent damage to the joint, cartilage, and surrounding bone. This is why long-term treatment to lower uric acid levels is important—it prevents future attacks and protects your joints.
When to see a doctor
See a doctor if you have sudden, severe pain and swelling in a joint, especially if it is your first time experiencing this. Even if the pain goes away on its own, you should get it checked. A doctor can confirm whether it is gout or another condition that needs different treatment.
If you have already been diagnosed with gout and have another attack, contact your doctor if the pain is severe, if the attack lasts longer than ten days, or if you develop fever or chills. These could signal a different problem, such as an infection. If you have had multiple attacks, your doctor may recommend starting medication to lower your uric acid level and prevent future attacks.
Frequently Asked Questions
Can gout go away on its own?
Yes, a single gout attack usually goes away within three to ten days even without treatment. However, without addressing the underlying high uric acid level, you are likely to have more attacks. Medication can shorten the current attack and prevent future ones.
Is gout the same as arthritis?
Gout is a type of arthritis, but it is different from the most common types. Osteoarthritis develops slowly over years. Rheumatoid arthritis is an autoimmune disease. Gout strikes suddenly when uric acid crystals form in a joint, and it can be completely absent between attacks.
Can I get gout in more than one joint at a time?
Most gout attacks affect only one joint, usually the big toe. However, if you have had gout for a long time or have very high uric acid levels, attacks can involve multiple joints. This is less common in early gout but more likely in chronic cases.
Does gout mean I have kidney disease?
Not necessarily. Some people with gout have normal kidney function. However, kidney disease does raise your risk of gout because your kidneys cannot filter uric acid as well. If you are diagnosed with gout, your doctor may check your kidney function as part of your overall assessment.
What is the difference between high uric acid and gout?
High uric acid in your blood is a condition called hyperuricemia. Gout is what happens when that uric acid forms crystals in a joint and causes pain and inflammation. You can have high uric acid without ever developing gout, but gout cannot happen without high uric acid at some point.