What Causes Gout? Triggers, Symptoms and Prevention

Gout is one of the most painful types of arthritis. It often starts suddenly, overnight, with a hot, red, swollen joint, most commonly the big toe. Understanding what causes gout, and what triggers attacks, is the key to preventing them.

This guide explains the cause of gout, who is most at risk, the common triggers, what an attack feels like, and how gout is treated and prevented.

Quick answer

Gout is caused by too much uric acid in the blood, which forms sharp crystals in a joint, most often the big toe. High uric acid usually builds up because the kidneys do not remove enough of it, often linked to genes, weight, kidney disease or medicines. Attacks are commonly triggered by alcohol, sugary drinks, purine-rich foods, dehydration or illness.

What causes gout

Gout is caused by too much uric acid in the blood. Uric acid is a normal waste product made when the body breaks down substances called purines, found in our own cells and in some foods and drinks. It is normally removed by the kidneys. When levels stay high, uric acid can form sharp, needle-like crystals in and around a joint. The immune system reacts to the crystals, causing sudden, intense inflammation.

Most people with gout have high uric acid because their kidneys do not remove enough of it, rather than because they eat too much of the wrong foods.

Who is most at risk

• Men, and women after the menopause
• A family history of gout
• Being overweight
• High blood pressure, heart disease or diabetes
• Kidney disease
• Some medicines, including water tablets (diuretics) and low-dose aspirin
• Psoriasis

Common triggers for a gout attack

• Alcohol, especially beer and spirits
• Sugary drinks sweetened with fructose
• Foods high in purines, such as red meat, offal, game, shellfish and some oily fish
• Dehydration
• Illness, surgery or a joint injury
• Crash dieting or fasting
• Starting or changing some medicines

A trigger does not cause gout on its own. It tips uric acid that is already high into forming crystals, which is why one heavy night or a bout of illness can bring on a first attack. More on spotting an attack is in what gout feels like.

What does gout feel like

• Sudden, severe pain, often starting at night or early in the morning
• A hot, red, swollen joint with shiny skin
• Extreme tenderness, so that even a bedsheet is painful
• Most often the big toe, but also the ankle, knee, wrist, fingers or elbow
• Pain peaks within about 24 hours and usually settles over one to two weeks

How gout is diagnosed

A GP can usually diagnose gout from your symptoms and an examination. A blood test for uric acid helps, but levels can be normal during an attack, so the test is best done around two weeks after an attack has settled. Sometimes fluid is taken from the joint to look for crystals.

How gout is treated

A summary is below. Our guide on how to treat gout covers treatment in more detail.

During an attack

• Anti-inflammatory painkillers, colchicine or a short course of steroids from your GP
• Rest and raise the joint
• Use an ice pack wrapped in a towel for up to 20 minutes
• Drink plenty of water

Preventing future attacks

UK guidance recommends discussing a daily medicine to lower uric acid, such as allopurinol, for people with gout, particularly if attacks keep returning. The aim is to keep uric acid below a target level, which gradually dissolves crystals. Lifestyle changes help alongside medication:

• Cut down on alcohol, especially beer and spirits
• Swap sugary drinks for water
• Eat less red meat, offal and shellfish
• Lose weight gradually if you are overweight, avoiding crash diets
• Stay well hydrated

When to get help

• Same day: a hot, swollen joint with fever or feeling unwell, which can be a joint infection
• Gout attacks keep returning
• You notice hard lumps under the skin, called tophi, often on the ears, fingers or elbows
• You have had kidney stones

Frequently asked questions

Is gout caused by diet?

Diet plays a part, but genes, kidney function, weight and medicines matter more for most people. Diet changes help, but medication is often needed to prevent attacks.

Why did I suddenly get gout?

Uric acid usually builds up slowly over years without symptoms. A first attack often follows something that pushes levels up or changes them quickly, such as heavy drinking, dehydration, an illness or operation, a crash diet, or starting a water tablet. Your GP can check your uric acid level and look for causes such as kidney problems.

Can gout be caused by alcohol?

Alcohol raises uric acid and is one of the most common triggers for an attack, especially beer and spirits. It is rarely the only cause, but cutting down lowers the chance of further attacks.

Can women get gout?

Yes. It is less common before the menopause, when oestrogen helps the kidneys remove uric acid, but becomes more common afterwards.

Does gout go away?

Each attack usually settles within one to two weeks, but without treatment to lower uric acid, attacks tend to return and can damage the joint over time.

Is gout a type of arthritis?

Yes. Gout is an inflammatory type of arthritis caused by uric acid crystals.

Gout support in Chiswick

Omnia Lifestyle offers private blood tests and joint pain support at our clinic at 8 to 9 Bedford Corner, The Avenue, Chiswick W4 1LZ, close to Turnham Green station, on bus routes 94, E3 and 272. Limited parking is available on request when booking. Results can be shared with your GP.

You can book blood tests in Chiswick without a GP referral, and an Omnia practitioner goes through the results with you. Between attacks, a physiotherapy assessment (70 minutes, £99) can help restore movement and strength in a joint that has become stiff after repeated flares. Always see your GP for a suspected attack.

Read more about gout, arthritis and high blood pressure, see what arthritis feels like, explore blood tests, or book an appointment.

This article is general information, not medical advice. If you have any of the warning signs listed above, seek medical attention.