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Gout: symptoms, types, causes, treatment

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First published: 13.Sept.2023

Overview: Gout

Gout is a type of arthritis that causes redness, swelling and pain in the lower limbs (ankles, toes, big toe) and is caused by a build up of uric acid crystals within the joint's tissue.
It can be managed with medication and also with simple measures like lifestyle changes: a special diet avoid uric acid promoting purines, losing weight and avoiding alcohol.
This article explains all you need to know about this condition: its symptoms and causes and how it is treated.

In this Article (Index)

foot with red area on the side of the big toe, and inset with detail showing the interior of the toe joint
Gout flare up on the big toe Source

What is Arthritis?

Gout is a type of arthritis, but what is arthritis?

"Arthritis" means "inflamamation of a Joint" and causes swelling, inflammation and tenderness of one or more joints.

Joints are places where two or more bones meet, such as your elbow, knee, backbone, hands and feet.

But it isn't a single disease, the term covers over 100 different types of arthritis, and the three most common in the Western world are gout, osteoarthritis (OA) and rheumatoid arthritis (RA).

In this article we will focus on Gout:

Gout (Metabolic Arthritis)

Gout is caused by the buildup of uric acid crystals in the joints. Uric acid is a byproduct resulting from the body metabolizing purines, a chemical found in proteins, especially meat, offal and alcohol.

It appears as painful eposodes known as flares, located in the big toes or on a lower limb.

Gout... is now the most common type of inflammatory arthropathy in adults.
In the United States alone, its prevalence more than doubled between the 1960s and the 1990s, and it is now estimated at 3.9% of U.S. adults (8.3 million adults — 6.1 million men and 2.2 million women) National Kidney Foundation

What Causes Gout?

The accummulation of uric acid crystals in the joints causes inflammation, redness, tenderness and pain. It comes as an attack or "flare" and typically takes place in the lower limbs, ankles and especially in the big toes.

The uric acid accumulation (hyperuricemia) is caused by an excessive breakdown of purines by the body. However there may be other factors involved as many people with high levels of uric acid never suffer from gout and some patients with normal uric acid levels in their bloodstream suffer from gout.

These additional gout triggers may involve previous joint damage due to Osteoarthritis (OA) is by far the most common type of arthritis and also to the microbiome inside the joints.

Purines and Gout

Purines are a group of molecules made up of carbon and nitrogen that play an important role in biological processes: for instance adenine and guanine form part of the DNA and RNA molecules, and other biomolecules such as coenzyme A, ATP and GTP are also composed of purines.

There are two ways that the body obtains purines: roughly two thirds of the purines it contains are produced inside the body. The other third is incorporated through food.

Uric Acid

The body processes purines converting them into a compound called uric acid. Roughly 10% of the uric acid is discarded by the body in the urine and feces, the rest is reabsorbed.


An excessive quantity of purines in the body can cause a condition called hyperuricemia (from the words "hyper" = "excessive", "uric" = "related to urine", "aemia" = "in the blood"), a build up of uric acid in the blood (serum urate).

The excess of uric acid forms needle-shaped urate crystals, that precipitate in the kidneys forming stones, in the skin, blood capillaries and many other tissues, including the joints where they cause gout. Roughly 20% of the people have hyperuricemia and without showing any signs or symptoms.

Managing Gout

The first step to manage arthriti is to get an accurate diagnosis from your caregiver to identify the type of arthritis that is causing your joint pain. It may not be gout.


People with periodic attacks (flares) or painful symptoms of Gout are treated with medication that lowers uric acid levels such as Allopurinol, Febuxostat, or Pegloticase, but these drugs have side effects and don't address the issue of the excessive production of uric acid.

Gout symptoms like pain and inflammation are usually treated with Over-the-counter (OTC) NSAIDs, like ibuprofen and naproxen. People with stomach ulcers, kidney disease or other conditions shouldn’t take NSAIDs so always talk to your healthcare provider before taking NSAIDs. Corticosteroids are another anti-inflammatory treatment option.

cucumbers, tomatoes and splashing water
A healthy and balanced diet is another way to manage gout

Low-Purine Diet to Control Gout

Medication is often accompanied by a low-purine diet to reduce the intake of food-based purines.

It is not a simple task because not all purine-rich foods have the same risk. Some foods high in purines like red meat, offal or seafood have a high risk for increasing uric adid, while other purine-rich foods like leafy-green vegetables don't carry the same risk.

A gout-management diet should exclude high-purine foods, have a low intake of moderate-purine foods and include plenty of low-purine foods (1):

High-purine foods

These purine-rich foods should be avoided and not eaten on a regular basis:

  • Organs (liver, kidneys, heart) and sweetbreads.
  • Game: venison, rabbit, pheasant.
  • Fish with a high content of oil such as anchovies, herring, sardines, trout.
  • Seafood: mussels, shrimps, crab, shellfish, caviar, fish roe.
  • Meat and yeast extracts.
  • Beer, alcoholic drinks

Some processed foods with high-fructose corn syrup, and sucrose promote (2) (3).

Moderate purine foods

Include them in your diet but eat them in moderation; eat small helpings.

  • Meat: beef, lamb, pork.
  • Poultry: chicken, duck.
  • Pulses: beans, dried peas, legumes.
  • Whole grains, bran.
  • Some vegetables: cauliflower, spinach, asparagus.

Low purine foods

Adopting a mostly plant-based diet with fruit, vegetables, olive oil, whole grains and low purine fish (similar to the Mediterranean Diet), eat with no limitations.

  • Dairy: cheese, yogurt, milk, butter.
  • Eggs
  • Fruits and vegetables
  • Bread, pasta, noodles cerals (non-wholegrain).

Other Measures to Treat Gout

Lose Weight

By losing weight you have two benefits, a lower body weight reduces blood levels of uric acid and also the stress on the weight-bearing joints.

Fasting or adopting a quick-loss diete are not recommended because they can provoke a spike in uric acid levels and trigger a gout attack (4).

It is better to adopt a balanced diet with healthy food, quit alcohol and incorporate regular physical activity to your weight loss program.

Drink more water

Increasing your intake of fluids can help remove uric acid through the kidneys.

If you are taking diuretics or have kidney problems, consult your caregiver before increasing your fluid intake, to check if it is safe for you.

Read More

> > Do I need 8 Glasses of Water a Day?.

The myth of the "8 x 8" rule: learn why it is not true.

Detailed Information on each type of Arthritis

We have written pages for each of the most common types of arthritis with in depth information on their symptoms, causes and treatment. Click below to learn all about them.

References and Further Reading

(1) NHS Great Western Hospitals, Dietary Advice for Gout. Accessed: Sept. 13, 2023

(2) Rho YH, Zhu Y, Choi HK. (2011), The epidemiology of uric acid and fructose. Semin Nephrol. 2011 Sep;31(5):410-9. doi: 10.1016/j.semnephrol.2011.08.004. PMID: 22000647; PMCID: PMC3197219

(3) Solyst JT, Michaelis OE 4th, Reiser S, Ellwood KC, Prather ES. (1980). Effect of dietary sucrose in humans on blood uric acid, phosphorus, fructose, and lactic acid responses to a sucrose load. Nutr Metab. 1980;24(3):182-8. doi: 10.1159/000176340. PMID: 7443098

(4) Philip N. Cheifetz (1965). Uric acid excretion and ketosis in fasting. Metabolism Vol 14:12 p1267-1272, Dec 1965 DOI:

National Kidney Foundation Quick Facts: Gout and Chronic Kidney Disease. Accessed: Sept. 13, 2023

About this Article

Gout, A. Whittall

©2023, 13 Sept. 2023. Update scheduled for 13 Sept. 2025.

Tags: arthritis, gout, osteoarthritis, rheumatoid arthritis, arthritis-osteo, degenerative joint disease, cartilage.

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