Gout

Gout is a type of inflammatory [arthritis](/condition/arthritis) caused by a buildup of uric acid in the blood. When uric acid levels get too high, crystals form in joints, causing sudden, intense pain, swelling, and redness — most commonly in the big toe. **Key Facts:** - **Classic location:** Big toe (podagra) — but can affect any joint - **Onset:** Sudden, often at night - **Cause:** High uric acid → crystal formation in joints - **Risk factors:** Diet, alcohol, [obesity](/condition/obesity), genetics - **Treatable:** Lifestyle changes + medications very effective **How It Differs from Other [Arthritis](/condition/arthritis):** - **Gout:** Sudden attacks, specific joints, caused by crystals - **[Osteoarthritis](/condition/arthritis):** Gradual wear-and-tear, affects many joints - **[Rheumatoid arthritis](/condition/rheumatoid-arthritis):** Autoimmune, symmetric, affects small joints - See our [gout vs arthritis comparison](/compare/gout-vs-arthritis) **Related Conditions:** - [Arthritis](/condition/arthritis) — gout is a type of arthritis - [Kidney stones](/condition/kidney-stones) — uric acid stones can form - [High blood pressure](/condition/high-blood-pressure) — commonly occurs with gout - [Type 2 diabetes](/condition/type-2-diabetes) — metabolic connection - [Obesity](/condition/obesity) — major risk factor - [Heart disease](/condition/heart-disease) — associated with gout **Warning:** Untreated gout can lead to permanent joint damage and kidney problems.

**How Gout Develops:** **1. Uric Acid Production:** Your body produces uric acid when it breaks down purines — substances found naturally in your body and in certain foods (red meat, organ meats, some seafood). **2. Uric Acid Buildup:** Normally, uric acid dissolves in blood, passes through kidneys, and leaves in urine. If your body makes too much OR your kidneys excrete too little, uric acid builds up. **3. Crystal Formation:** When blood uric acid levels stay high, needle-sharp urate crystals form and accumulate in joints and surrounding tissue. **4. Inflammatory Response:** Your immune system attacks the crystals, causing sudden, intense inflammation — the classic gout attack. **Why the Big Toe?** - Lower body temperature promotes crystal formation - Gravity concentrates uric acid - Small joint with limited blood flow **Risk Factors:** - **Diet:** Red meat, organ meats, shellfish, alcohol (beer), sugary drinks - **[Obesity](/condition/obesity):** Higher uric acid production and lower excretion - **Medical conditions:** [High blood pressure](/condition/high-blood-pressure), [diabetes](/condition/type-2-diabetes), kidney disease - **Medications:** Diuretics ("water pills"), low-dose aspirin - **Genetics:** Family history increases risk - **Gender:** Men more affected (until women reach menopause)

**Acute Gout Attack Treatment:** **First Line:** - **NSAIDs:** Indomethacin, naproxen — start high dose, taper - **Colchicine:** Most effective within 12-24 hours of attack - **Corticosteroids:** Prednisone or injection if NSAIDs/colchicine not suitable **Supportive Care:** - Rest affected joint - Ice application - Elevation - Hydration **Long-Term Uric Acid Lowering (Prevention):** **When to Start:** - 2+ gout attacks per year - Tophi present - [Kidney stones](/condition/kidney-stones) history - Chronic kidney disease with gout **Medications:** - **Allopurinol:** First-line; start low (100mg), increase slowly - **Febuxostat:** Alternative to allopurinol - **Probenecid:** Increases uric acid excretion **Target:** Uric acid level < 6 mg/dL **Important Points:** - Continue uric acid-lowering medication indefinitely - Attacks may increase initially when starting therapy (take colchicine prophylaxis) - Lifestyle changes complement medication **Lifestyle Modifications:** - Weight loss if overweight - Limit purine-rich foods - Limit alcohol (especially beer) - Stay well hydrated - Avoid fructose-sweetened beverages **Related Information:** - [Arthritis](/condition/arthritis) management - [Kidney stones](/condition/kidney-stones) prevention