Gouty arthritis is caused by uric acid crystals building up in your joints
Gouty arthritis happens when needle-shaped crystals of uric acid form inside a joint, usually the big toe. Your body produces uric acid when it breaks down purines — substances found in certain foods and drinks, and also made naturally by your cells. When you have too much uric acid in your blood, it can crystallize and settle in joints, triggering sudden, severe pain and swelling. This is different from other types of arthritis because it comes on fast and is often triggered by specific things you eat or drink.
The crystals themselves are what your immune system reacts to. When white blood cells try to break down the crystals, they release chemicals that cause inflammation. That inflammation is what you feel as the sharp pain, redness, and heat of a gout attack. Most attacks last a few days to a week, then fade on their own — but they can come back if the underlying uric acid level stays high.
Key Takeaways
- Gout develops when uric acid crystals form in joints, usually triggered by high uric acid levels in the blood.
- Purine-rich foods like red meat, organ meats, and certain seafood raise uric acid; so do alcohol and sugary drinks.
- Some people's bodies produce too much uric acid, while others cannot get rid of it efficiently through the kidneys.
- Family history, male sex, obesity, high blood pressure, and kidney disease all increase your risk of developing gout.
- Gout attacks are sudden and painful but often stop on their own; preventing future attacks means managing uric acid levels over time.
Foods and drinks that raise uric acid levels
Purines are found in high amounts in red meat, organ meats (liver, kidney), and certain seafood including anchovies, sardines, mussels, and scallops. Beef, lamb, and pork are common triggers. Alcohol — especially beer — raises uric acid both by adding purines and by slowing how your kidneys clear uric acid from your blood. Sugary drinks, including those sweetened with high-fructose corn syrup, also increase uric acid levels.
Not everyone who eats these foods gets gout, and not every gout attack is triggered by diet alone. But if you have had gout attacks, reducing these foods and drinks can lower your uric acid level and reduce how often attacks happen. Moderate amounts of poultry and low-fat dairy do not typically raise uric acid the way red meat does.
How your kidneys and genetics affect uric acid buildup
Your kidneys filter uric acid out of your blood and into urine. If your kidneys do not work efficiently — whether from chronic kidney disease, dehydration, or certain medications — uric acid builds up instead of leaving your body. Some people's bodies also produce more uric acid than average, either because of how their cells naturally break down purines or because of genetic conditions that affect purine metabolism.
Family history matters: if your parents or siblings have had gout, your risk is higher. Men are more likely to develop gout than women, especially before age 65. After menopause, women's risk rises because estrogen helps the kidneys clear uric acid more efficiently.
Medical conditions and medications that increase gout risk
High blood pressure, obesity, and type 2 diabetes all raise uric acid levels. Chronic kidney disease is a major risk factor because damaged kidneys cannot clear uric acid well. Heart failure and metabolic syndrome also increase risk. Certain medications — including diuretics (water pills), low-dose aspirin, and some cancer treatments — can raise uric acid as a side effect.
If you take a medication that might affect uric acid, do not stop taking it without talking to your doctor. Instead, discuss whether the benefit of the medication outweighs the gout risk, or whether an alternative exists. Some people need to take uric acid-lowering medication alongside their other treatments.
Why some gout attacks happen suddenly without an obvious trigger
A gout attack can happen even if you have not eaten purine-rich food recently. Dehydration concentrates uric acid in your blood, so attacks sometimes follow illness, surgery, or even intense exercise. Sudden weight loss — from dieting or illness — can also trigger an attack because your body breaks down tissue and releases purines. Starting or stopping uric acid-lowering medication can cause a flare because crystals in joints shift as uric acid levels change.
This is why gout is unpredictable for many people. The attack itself is caused by crystals and inflammation, but the reason the crystals formed or mobilized may not be obvious. Keeping a straightforward log of what you ate, drank, and did before an attack can help you spot patterns over time.
The difference between acute gout attacks and chronic gout
An acute gout attack is a single episode of sudden pain, swelling, and redness — usually in one joint. It happens because crystals have formed or shifted, triggering inflammation. The attack stops when the inflammation dies down, usually within days. Chronic gout means you have had multiple attacks over time, and uric acid crystals have built up in and around joints. With chronic gout, you may have some pain or stiffness even between attacks, and joints can become permanently damaged if uric acid stays high.
The goal of long-term management is to keep uric acid levels low enough that new crystals do not form and existing ones dissolve. This usually means taking uric acid-lowering medication, not just treating the pain during attacks. Your doctor can measure your uric acid level with a blood test to see whether your current approach is working.
Frequently Asked Questions
Can you get gout if you do not eat meat or drink alcohol?
Yes. Some people develop gout from genetics and kidney function alone, even with a low-purine diet. Certain vegetables like asparagus and mushrooms contain purines, and some people are sensitive to them. If you have a family history of gout or kidney problems, diet alone may not prevent it.
Does drinking water help prevent gout attacks?
Staying hydrated helps your kidneys clear uric acid more efficiently, so it may reduce your risk. Dehydration concentrates uric acid in your blood, which can trigger an attack. Drinking enough water is a straightforward step, but it is not a complete solution if your uric acid level is already high.
Why do gout attacks happen at night?
Uric acid levels naturally rise slightly while you sleep because you are not drinking water and your body is less active. The joint is also cooler at night, which makes it easier for uric acid crystals to form. This is why many gout attacks wake people up in the early morning hours.
Can you have gout in places other than the big toe?
Yes, though the big toe is the most common site. Gout can affect the ankle, knee, wrist, elbow, or other joints. It usually hits one joint at a time. If you have had multiple attacks in different joints, it suggests your uric acid level is high and needs to be managed with medication.
Is gout the same as arthritis?
Gout is a type of arthritis caused by crystal buildup, but it is different from osteoarthritis (wear and tear) and rheumatoid arthritis (autoimmune). Gout attacks are sudden and severe, while other arthritis types develop slowly. The treatment approach is also different — gout focuses on lowering uric acid, while other arthritis types use different medications.