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

Gout happens when a substance called uric acid accumulates in your blood and forms needle-shaped crystals in and around your joints. Your body produces uric acid when it breaks down purines, which are compounds found in certain foods and drinks, and also made naturally by your cells. Normally your kidneys filter uric acid out through urine. When uric acid levels get too high—a condition called hyperuricemia—crystals form instead, triggering sudden, severe inflammation. The big toe is the most common target, though gout can strike the ankles, knees, wrists, elbows, and fingers.

An acute gout attack comes on fast, usually within hours. The joint becomes red, swollen, hot, and extremely painful—often so painful that even a bedsheet touching it causes discomfort. Attacks typically last days to weeks if untreated. Between attacks, you may have no symptoms at all, which is why some people don't realize they have gout until the second or third flare.

Key Takeaways

  • Gout develops when uric acid crystals form in joints, most often the big toe, causing sudden severe pain and swelling.
  • Your body makes uric acid when breaking down purines from food and from normal cell turnover, and your kidneys normally filter it out.
  • High uric acid levels result from eating purine-rich foods, drinking alcohol (especially beer), being overweight, or having kidneys that don't filter efficiently.
  • Some people are genetically prone to gout, and men are affected far more often than women, particularly after age 40.
  • Gout is different from osteoarthritis or rheumatoid arthritis—it is a metabolic condition, not wear-and-tear or autoimmune damage.

How uric acid builds up in your body

Uric acid comes from two sources: food and your own cells. When you eat foods high in purines—red meat, organ meats, certain seafood like anchovies and sardines, and high-fructose corn syrup—your digestive system breaks them down into uric acid. Your body also produces uric acid constantly as cells die and are replaced. Normally this is not a problem: your kidneys filter out excess uric acid and you excrete it in urine.

Gout develops when one of two things happens. Either you produce more uric acid than your kidneys can handle, or your kidneys don't filter it efficiently. Some people have kidneys that are naturally less effective at clearing uric acid—this is often inherited. Others develop reduced kidney function from chronic kidney disease, high blood pressure, or diabetes. A third group produces excess uric acid because of their diet, weight, or alcohol use. Most people with gout have a combination of these factors.

Foods and drinks that raise uric acid

Certain foods and drinks are known to raise uric acid levels more than others. Beer is the biggest culprit among alcoholic drinks because it contains yeast, which is high in purines. Spirits and wine raise uric acid less dramatically. Red meat, organ meats (liver, kidney, brain), and certain seafood (anchovies, sardines, mussels, scallops, trout) are high in purines. Chicken and fish like salmon are lower in purines and generally safer.

High-fructose foods also trigger gout attacks in some people, even though fructose itself is not a purine. This includes sugary drinks, desserts, and foods sweetened with high-fructose corn syrup. Dehydration makes uric acid more likely to crystallize, so drinking less water can worsen gout. Interestingly, moderate amounts of low-fat dairy products and vitamin C from food may actually lower uric acid levels, though the effect is modest.

Who is most likely to develop gout

Gout is not random. Certain people are at much higher risk. Men develop gout far more often than women—roughly three to four times as often. Men typically develop it after age 40, while women are more likely to develop it after menopause, when estrogen levels drop. Having a family history of gout significantly raises your risk, since the tendency to produce excess uric acid or have inefficient kidneys often runs in families.

Being overweight or obese increases gout risk because excess body weight raises uric acid production. Chronic kidney disease, high blood pressure, and diabetes all reduce your kidneys' ability to filter uric acid. Certain medications also raise uric acid levels, including diuretics (water pills) used for high blood pressure and heart failure, and low-dose aspirin. People who have had an organ transplant or chemotherapy are at higher risk as well, because of the rapid cell turnover involved.

The difference between gout and other types of arthritis

Gout is often confused with other joint conditions, but it is distinct. Osteoarthritis is wear-and-tear damage to cartilage that develops slowly over years, usually in weight-bearing joints. Rheumatoid arthritis is an autoimmune disease where your immune system attacks joint tissue, causing chronic inflammation and damage. Gout is neither. It is a metabolic disorder—a problem with how your body processes uric acid—that causes sudden, severe attacks followed by symptom-free periods.

This distinction matters because treatment is different. Gout attacks respond to anti-inflammatory medications and can be prevented by lowering uric acid levels. Osteoarthritis and rheumatoid arthritis require different long-term management strategies. If you have sudden joint pain that comes and goes in episodes, especially in the big toe, gout is more likely than the other two. A blood test showing high uric acid and imaging showing crystals in the joint confirm the diagnosis.

What happens during a gout attack

When uric acid crystals form in a joint, your immune system recognizes them as foreign and launches an inflammatory response. White blood cells rush to the area, releasing chemicals that cause pain, redness, swelling, and heat. This happens rapidly—often within 12 to 24 hours of the trigger. The pain is typically described as severe and throbbing. Some people report that the pain is so intense they cannot walk or wear shoes.

Attacks usually peak within 24 to 48 hours and then gradually improve over days to weeks, even without treatment. However, the longer an attack goes untreated, the longer it lasts. Repeated attacks can eventually damage the joint permanently, so treating gout early and preventing future attacks is important. Some people have just one attack in their lifetime; others have several per year. The pattern varies widely.

Why some people have recurring gout attacks

If your uric acid level stays high between attacks, crystals remain in the joint. Any trigger—a large meal, alcohol, dehydration, surgery, or even starting a new medication—can cause them to shift and spark another attack. This is why people with gout often have a pattern of flares. Without treatment to lower uric acid levels, attacks tend to become more frequent and may eventually cause permanent joint damage called chronic tophaceous gout, where deposits of uric acid crystals form lumps under the skin.

The good news is that gout is one of the most manageable forms of arthritis. Medications can lower uric acid levels, preventing future attacks. Lifestyle changes—losing weight, limiting purine-rich foods and alcohol, staying hydrated—also help. Many people who take uric acid-lowering medication never have another attack. Understanding what triggers your attacks and working with a doctor to manage your uric acid level can make a major difference in your quality of life.

Frequently Asked Questions

Can you get gout from eating too much fruit?

Fruit itself is not high in purines, but some fruits contain fructose, which may trigger gout in susceptible people. Fruits with added sugar or high-fructose corn syrup are more likely to cause problems than whole fruits. Berries, citrus, and apples are generally considered safer choices.

Is gout contagious?

No. Gout is not contagious. It is a metabolic condition caused by how your body handles uric acid. You cannot catch it from another person or pass it to someone else.

Can you have gout without high uric acid levels?

Rarely. Most people with gout have elevated uric acid in their blood. However, some people with normal or only slightly elevated uric acid can still form crystals and have attacks, usually because their kidneys are less efficient at handling the uric acid they do have.

Does gout always affect the big toe?

The big toe is the most common site, but gout can develop in any joint. The ankles, knees, wrists, elbows, and fingers are all possible targets. Some people experience their first attack in a different joint entirely.

Can you prevent gout if it runs in your family?

You cannot eliminate genetic risk, but you can reduce your chances of developing gout by maintaining a healthy weight, limiting alcohol and purine-rich foods, staying hydrated, and managing conditions like high blood pressure and diabetes. If you do develop gout, medication can prevent future attacks.