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

Gouty arthritis, usually called gout, happens when a substance called uric acid forms needle-shaped crystals inside a joint. Your body makes uric acid when it breaks down purines, which come from certain foods and drinks and are also made naturally in your cells. Normally your kidneys filter uric acid out through urine. But when your body makes too much uric acid, or your kidneys cannot filter it fast enough, crystals form. These crystals trigger sudden, severe inflammation — the hallmark of a gout attack.

Gout is different from osteoarthritis or rheumatoid arthritis. It comes on suddenly, usually in one joint at a time, and causes intense pain that can last days or weeks. The big toe is the most common site, but gout can strike the ankle, knee, wrist, elbow, or other joints. Between attacks, you may have no symptoms at all.

Key Takeaways

  • Gout attacks happen when uric acid crystals form in a joint, causing sudden severe pain, redness, and swelling that usually peaks within 24 hours.
  • Your risk of gout increases if you eat a lot of red meat, organ meats, certain seafood, or drink alcohol or sugary drinks regularly.
  • Men are more likely to develop gout than women, and your risk rises as you age or if you have high blood pressure, kidney disease, or obesity.
  • A doctor can confirm gout by testing fluid from the joint or measuring uric acid in your blood, and can prescribe medications to stop attacks and prevent future ones.
  • Lowering uric acid through diet changes, weight loss, and medication can reduce how often attacks happen and may prevent them entirely.

How a gout attack starts and what it feels like

A gout attack usually begins at night or early morning with sudden, sharp pain in one joint. The pain can be so severe that even the weight of a bedsheet feels unbearable. Within hours, the joint becomes red, swollen, warm, and tender. Most attacks peak within 24 hours and then gradually improve over days or weeks, even without treatment.

The big toe is affected in about 50 percent of first attacks and remains the most common site throughout life. But gout can move to other joints — the ankle, knee, wrist, or elbow — especially if attacks keep happening. If gout is not treated over many years, crystals can build up in the skin around joints, forming lumps called tophi, and can damage the joints permanently.

Why some people develop gout and others do not

Your risk of gout depends on how much uric acid your body produces and how well your kidneys clear it. Men develop gout more often than women, especially after age 40. Women's risk rises after menopause, when estrogen levels drop. Age itself is a risk factor — gout is rare before age 30 but becomes more common in your 60s and 70s.

Certain health conditions raise your risk. High blood pressure, chronic kidney disease, heart disease, and obesity all make gout more likely. Some medications also increase uric acid — diuretics (water pills) used for blood pressure or heart failure, and low-dose aspirin are common culprits. Family history matters too: if a parent or sibling has gout, your risk is higher.

Diet plays a major role. Red meat, organ meats like liver and kidney, certain seafood (anchovies, sardines, shellfish), and alcohol — especially beer — all raise uric acid levels. Sugary drinks and foods with high-fructose corn syrup do the same. Dehydration also concentrates uric acid in your blood, making an attack more likely.

How a doctor diagnoses gout

Your doctor will ask about your symptoms, when attacks happen, which joints are affected, and what you eat and drink. They will examine the joint for redness, swelling, and warmth. To confirm gout, they may draw fluid from the joint using a needle and look at it under a microscope for uric acid crystals. This is the most reliable test.

Your doctor may also order a blood test to measure uric acid levels. A high level supports the diagnosis, but uric acid can be normal even during an attack, so a normal result does not rule out gout. X-rays or ultrasound may be used if gout has been happening for years and damage is suspected.

Medications that stop attacks and prevent new ones

Two types of medication treat gout. The first stops an active attack. Nonsteroidal anti-inflammatory drugs (NSAIDs) like indomethacin or naproxen reduce pain and swelling quickly. Colchicine, an older drug, also works well if started early in an attack. Corticosteroids by mouth or injection are an option if NSAIDs or colchicine cannot be used.

The second type prevents future attacks by lowering uric acid. Allopurinol and febuxostat are the most common. These drugs work slowly — it takes weeks to months to lower uric acid enough to prevent attacks. Your doctor will check your uric acid level with blood tests and adjust your dose until it reaches a target range. Probenecid is another option that helps your kidneys clear uric acid better.

Starting uric acid-lowering medication can actually trigger an attack in the first few weeks, so your doctor may prescribe a preventive dose of colchicine or an NSAID to take alongside it. Do not stop the uric acid medication if an attack happens — keep taking it and treat the attack separately.

Diet and lifestyle changes that lower uric acid

Limiting foods high in purines can reduce uric acid and lower your attack risk. Cut back on red meat, organ meats, and high-purine seafood. Limit alcohol, especially beer. Avoid sugary drinks and foods with high-fructose corn syrup. Drink plenty of water — staying hydrated helps your kidneys clear uric acid. Low-fat dairy products and plant-based proteins like beans and lentils are safer choices.

Losing weight if you are overweight reduces uric acid levels and attack frequency. Even a 10 percent weight loss can make a difference. Regular physical activity helps with weight loss and overall health. If you take a diuretic for blood pressure or heart disease, talk to your doctor about whether a different medication might work — do not stop taking it on your own.

When to call your doctor and when to seek when ready care

Call your doctor if you have sudden, severe pain and swelling in a joint, especially if it is your first attack. They can confirm the diagnosis and start treatment. If you already know you have gout, call your doctor if attacks are happening more often, affecting new joints, or not improving with your current medication.

Seek when ready care if you have fever along with joint pain and swelling — this could signal an infection rather than gout, which needs different treatment. Also seek care if you cannot move the joint, have severe swelling that spreads up your leg or arm, or have signs of infection like warmth, redness, or pus.

Frequently Asked Questions

Can gout go away on its own?

A single attack will improve on its own over days or weeks, even without treatment. But if the cause — high uric acid — is not addressed, attacks will keep happening. Over time, repeated attacks can damage joints permanently. Medication that lowers uric acid can prevent future attacks and may stop them entirely.

Is gout the same as arthritis?

Gout is a type of arthritis, but it is different from osteoarthritis and rheumatoid arthritis. Gout comes on suddenly in one joint, while osteoarthritis develops slowly over years. Rheumatoid arthritis usually affects multiple joints at once and is an autoimmune disease. Gout is caused by uric acid crystals, not wear-and-tear or immune system attack.

Can I drink alcohol if I have gout?

Alcohol raises uric acid levels and increases attack risk, especially beer. If you have had gout attacks, your doctor will likely recommend limiting or avoiding alcohol. If you choose to drink, do so in moderation and talk to your doctor about what is safe for you.

Will taking uric acid medication stop all my attacks?

Lowering uric acid with medication can prevent most or all attacks, but it takes time. Your uric acid level needs to stay low consistently — usually below 6 mg/dL — for crystals to dissolve and attacks to stop. This may take weeks or months. Your doctor will monitor your uric acid with blood tests and adjust your dose to reach the target.

What should I do during a gout attack?

Rest the joint, explore ice, and elevate it if possible. Take your prescribed medication — NSAIDs, colchicine, or corticosteroids — as soon as the attack starts. Drink plenty of water. Avoid foods high in purines during the attack. If the pain is severe or you cannot manage it, call your doctor or seek care.