Gout Symptoms: Causes, Treatment, and Pain Relief

Gout is a form of inflammatory arthritis characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in the joints. It affects approximately 4% of American adults, making it one of the most common forms of arthritis. Gout most frequently affects the joint at the base of the big toe, but it can occur in any joint, including ankles, knees, elbows, wrists, and fingers.

The pain from a gout attack can be excruciating, often described as feeling like the affected joint is on fire. Attacks typically come on suddenly, frequently at night, and can wake you from sleep. Without treatment, a gout attack usually lasts 3-10 days, but with proper management, symptoms can be relieved much sooner and future attacks can be prevented.

Gout occurs when uric acid builds up in the blood and forms sharp, needle-like crystals in joints and surrounding tissues. While gout was once known as the "disease of kings" due to its association with rich foods and alcohol, we now understand it's a complex condition influenced by genetics, diet, medications, and other health conditions. The good news is that gout is highly treatable, and with proper management, most people can prevent future attacks and live pain-free.

Common Causes

High Uric Acid Levels (Hyperuricemia)

Gout develops when there's too much uric acid in your blood, a condition called hyperuricemia. Uric acid is a waste product created when your body breaks down purines, substances found naturally in your body and in certain foods. Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. However, when your body produces too much uric acid or your kidneys don't eliminate enough, it can accumulate and form crystals.

Signs high uric acid might be the cause:

• Blood tests show uric acid levels above 6.8 mg/dL
• You have a family history of gout
• You've had kidney stones in the past

Diet High in Purines

Certain foods are high in purines, which break down into uric acid in your body. Red meat, organ meats (liver, kidneys), certain seafood (anchovies, sardines, mussels, scallops, trout, tuna), and alcohol (especially beer) can trigger gout attacks in susceptible individuals.

Signs diet might be the cause:

• Attacks occur after eating red meat, seafood, or drinking alcohol
• You consume these foods regularly
• Symptoms improve when you modify your diet

Obesity and Metabolic Syndrome

Excess body weight increases uric acid production and decreases uric acid elimination through the kidneys. Obesity is also associated with metabolic syndrome, which includes high blood pressure, high cholesterol, and insulin resistance—all of which can contribute to gout.

Signs obesity might be contributing:

• You have a BMI over 30
• You have other conditions like high blood pressure or diabetes
• You've noticed joint pain worsening with weight gain

Medications

Certain medications can increase uric acid levels and trigger gout. These include low-dose aspirin, diuretics (water pills) used for high blood pressure or heart failure, and some immunosuppressant drugs used after organ transplants.

Signs medications might be the cause:

• Gout symptoms started after beginning a new medication
• You take diuretics for blood pressure or heart conditions
• You take low-dose aspirin daily

Kidney Disease

Your kidneys are responsible for filtering uric acid from your blood. When kidney function is impaired, uric acid can build up in the bloodstream. Chronic kidney disease, even in early stages, can contribute to gout development.

Signs kidney problems might be contributing:

• You have a history of kidney disease or kidney stones
• Blood tests show elevated creatinine or reduced kidney function
• You have other symptoms like frequent urination at night

Dehydration

Not drinking enough water can concentrate uric acid in your blood and trigger gout attacks. Dehydration reduces your kidneys' ability to eliminate uric acid effectively.

Signs dehydration might be the cause:

• Attacks occur during hot weather or after exercise
• You don't drink much water throughout the day
• Your urine is dark yellow or amber colored

Other Medical Conditions

Certain health conditions increase gout risk, including high blood pressure, diabetes, metabolic syndrome, heart disease, and psoriasis. These conditions can affect how your body processes uric acid or increase inflammation in your joints.

Signs other conditions might be contributing:

• You have multiple chronic health conditions
• You're taking medications for heart disease or diabetes
• You have a family history of gout and related conditions

When to See a Doctor

Seek medical attention if you experience:

• Sudden, intense joint pain that comes on rapidly, especially at night
• Severe pain in your big toe or other joints that makes it difficult to walk or bear weight
• Joint that's hot, swollen, and extremely tender to even light touch
• Fever along with joint pain (could indicate infection)
• First-time symptoms that might be gout—proper diagnosis is essential
• Frequent gout attacks (more than 2-3 per year)
• Chronic joint pain that doesn't fully resolve between attacks
• Visible lumps (tophi) under the skin near joints
• Kidney stones or signs of kidney problems

Early diagnosis and treatment can prevent joint damage and reduce the frequency and severity of future attacks. Your doctor can confirm gout through blood tests, joint fluid analysis, or imaging studies.

Self-Care and Relief Strategies

Immediate Pain Relief During an Attack

During a gout attack, rest the affected joint and avoid putting weight on it. Elevate the joint above heart level to reduce swelling. Apply ice packs wrapped in a towel for 20 minutes at a time, several times a day. Avoid heat, which can worsen inflammation.

Over-the-Counter Pain Medication

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve) can help reduce pain and inflammation during an attack. Take them as soon as symptoms begin for best results. Avoid aspirin, which can actually raise uric acid levels. Always follow package directions and consult your doctor if you have kidney disease, stomach ulcers, or heart problems.

Stay Hydrated

Drink plenty of water—aim for 8-12 glasses per day. Adequate hydration helps your kidneys flush out uric acid more effectively. Avoid sugary drinks and alcohol, especially beer and liquor, which can raise uric acid levels.

Modify Your Diet

Limit foods high in purines: red meat, organ meats, certain seafood, and alcohol. Focus on low-purine foods like fruits, vegetables, whole grains, low-fat dairy, eggs, and plant-based proteins. Cherries and cherry juice have been shown in some studies to help reduce gout attacks.

Maintain a Healthy Weight

If you're overweight, gradual weight loss can help reduce uric acid levels and decrease the frequency of gout attacks. However, avoid crash diets or fasting, which can temporarily raise uric acid levels and trigger an attack. Aim for slow, steady weight loss of 1-2 pounds per week.

Limit Alcohol Consumption

Alcohol, particularly beer and liquor, can raise uric acid levels and trigger gout attacks. Beer is especially problematic because it's high in purines. If you drink alcohol, do so in moderation—no more than one drink per day for women and two for men—and consider avoiding it entirely during and after attacks.

Consider Prescription Medications

For frequent attacks or chronic gout, your doctor may prescribe medications to lower uric acid levels (like allopurinol or febuxostat) or to prevent attacks (like colchicine). These medications are highly effective when taken as directed and can prevent joint damage from recurring gout.

Frequently Asked Questions

Prevention Tips

Preventing gout attacks involves a combination of lifestyle modifications and, when necessary, medication. Maintain a healthy weight through balanced eating and regular physical activity, but avoid rapid weight loss or fasting. Stay well-hydrated by drinking 8-12 glasses of water daily. Limit or avoid alcohol, especially beer and liquor. Reduce consumption of high-purine foods like red meat, organ meats, and certain seafood, while increasing low-purine options like vegetables, whole grains, and low-fat dairy. Some studies suggest that coffee and vitamin C supplements may help lower uric acid levels, though you should discuss supplements with your doctor. If you have frequent gout attacks, work with your healthcare provider to find the right medication to lower your uric acid levels long-term. Regular monitoring of uric acid levels through blood tests can help you and your doctor adjust your treatment plan as needed. With proper management, most people with gout can prevent attacks and avoid joint damage.

The Bottom Line

Gout is a painful but highly treatable form of arthritis caused by uric acid crystal buildup in the joints. While gout attacks can be excruciating, they typically resolve within days to weeks, and with proper treatment, you can prevent future attacks and protect your joints from permanent damage. The key to managing gout is a combination of lifestyle modifications—including dietary changes, weight management, hydration, and limiting alcohol—along with appropriate medications when needed. If you experience symptoms of gout, especially sudden, severe joint pain in your big toe or other joints, see your doctor for proper diagnosis and treatment. With the right approach, most people with gout can live active, pain-free lives and prevent the long-term complications of this condition.