What Causes Gout?

Nancy LeBrun
·5 min read
1

Medically reviewed by Stella Bard, MD

Gout is a form of arthritis in which a substance in the body called uric acid builds up in the joints. Gout can flare up suddenly, causing severe pain. It occurs most often in the big toe, but it can also affect other toes, ankles, knees, and fingers, as well as other joints.

This article discusses what causes gout, factors that may put you at higher risk for it, what can trigger a flare, and treatments and lifestyle changes to help prevent flares and address pain and swelling.

What Is the Main Cause of Gout?

Gout is caused by high levels of uric acid in the blood. Uric acid is a waste product that usually washes out of the body when you urinate, but if there is too much of it, it can form crystals with sharp edges that inflame joints and cause intense pain. Gout often flares up in places farther from the heart, where the body is coolest, such as the toes.

Gout is inflammatory, but it is not an autoimmune disease, which are conditions in which the immune system mistakenly attacks its own tissues. Research has shown that gout has a genetic component involving genes that regulate uric acid levels in the body.

What Foods Cause Gout?

Some foods contain high amounts of purines, a very common chemical compound. As you digest purines, uric acid is created as a byproduct. If you eat more purine than the body can handle, or if you don't excrete enough uric acid when you urinate, gout can result.

Foods high in purines include:

  • Meats, including turkey, veal, venison, and bacon

  • Organ meats like liver

  • Seafood, including trout, cod, and sardines

  • Scallops

  • Alcohol in any form, but especially beer, including nonalcoholic beer

  • Beverages and foods containing high fructose corn syrup

What Else Causes Gout Flare-Ups?

Certain physical and mental health conditions can lead to higher uric acid levels, including:

  • Stress

  • Fatigue

  • Dehydration

  • Surgery

  • Joint injury

  • Extreme hot or cold temperatures

Low-dose aspirin, certain diuretics (water pills), and niacin may also be associated with a higher risk of developing gout.

Risk Factors for Gout

You may be more likely to develop gout if you have these risk factors:

Gout usually appears in middle age. It is diagnosed 2 to 6 times more often in men than women. The terms for sex or gender from the cited source are used.

How Gout Is Treated

Gout is treated with medication, lifestyle changes, and sometimes surgery. Without treatment, gout can eventually lead to gouty arthritis.

When you have a gout attack, you want relief quickly. The following medications may help:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), including over-the-counter (OTC) Motrin or Advil (ibuprofen) and Aleve (naproxen), and the prescription NSAID Indocin (indomethacin)

  • Colcrys (colchicine), a prescription anti-inflammatory medication

  • Corticosteroids (steroids), effective at reducing inflammation quickly

If you have more than one gout attack per year or have tophi (uric acid deposits), a healthcare provider may prescribe medications to lower uric acid levels. These may include:

  • Zyloprim (allopurinol) and Uloric (febuxostat) prevent the production of uric acid by inhibiting the enzyme xanthine oxidase.

  • Benemid, Probalan (probenecid) decreases the reabsorption of uric acid in the kidneys, so more is eliminated in the urine.

  • Krystexxa (pegloticase) converts uric acid into a form that is more easily eliminated.

Other newer approaches to treatment include medications called inhibitors, which lower the activity of certain substances or reactions in the body. These include interleukin-1 inhibitors and other types still being developed.

All medications can have side effects, so talk to your healthcare provider about the pros and cons of medication. In some cases, surgery can address joints damaged by gouty arthritis.

Gout Home Remedies

There are steps you can take to relieve the pain and inflammation of gout. They include:

  • Icing the joint

  • Elevating the joint

  • Staying hydrated to try to flush out excess uric acid

Some people may find a warm bath helps. You can also try topical NSAID pain relievers that you rub into the skin.

There is some preliminary evidence that supplements, including guava leaves, which may help lower uric acid levels, and cherry extract, which may help inflammation, but this has not been confirmed.

How to Prevent Gout

In addition to medications that a healthcare provider may recommend, lifestyle changes can help prevent the recurrence and progression of gout.

These include:

  • Avoiding alcohol (all forms), nonalcoholic beer, drinks with high-fructose corn syrup, and foods with high purine levels

  • Achieving or staying at a healthy weight

  • Adopting the DASH (Dietary Approaches to Stop Hypertension) eating plan

  • Drinking water with lemon (makes your urine more alkaline and neutralizes uric acid)

  • Drinking coffee (may lower uric acid levels)

Summary

Gout is a form of arthritis caused by high uric acid levels in the blood. The acid can form crystals in the joints with sharp edges that inflame the joint, causing severe pain and swelling. People can develop high uric acid levels due to genetic predisposition and eating foods high in purines.

Foods that contain high purines or raise uric acid levels include certain meats, fish, alcoholic beverages, and foods containing high fructose corn syrup. Some medications can help treat or prevent flares. Icing and elevating the joint are two common home remedies. To prevent gout, avoid foods with high purine levels and stay at a healthy weight.