Gout Explained: Causes, Flares and Long-Term Control

What causes gout

Gout is caused by uric acid, a waste product made when the body breaks down substances called purines, found naturally in our cells and in some foods. Normally uric acid dissolves in the blood and passes out in urine. But if levels stay high for a long time, either because the body makes too much or the kidneys remove too little, the acid can form sharp, needle-like crystals in and around joints. The immune system reacts fiercely to these crystals, causing sudden inflammation. This is a gout flare. High uric acid alone does not always cause symptoms, but it is the underlying problem, which is why long-term treatment focuses on lowering it.

What a flare feels like

A gout flare often strikes suddenly, frequently at night, and can be intensely painful. The classic site is the base of the big toe, which becomes red, hot, swollen and so tender that even the weight of a bedsheet feels unbearable. Other joints can be affected too, including the ankle, knee, midfoot, fingers and wrist. A flare usually peaks within a day and, untreated, may last several days to a couple of weeks before settling. Some people mistake it for an infection because of the redness and heat. Over time, if gout is not controlled, flares can become more frequent and involve more joints, and hard lumps of crystals called tophi can form under the skin.

Who is at risk

Several factors raise the risk of gout, and most relate to uric acid levels. Men are affected more often, and risk rises with age, and in women after the menopause. A family history matters, as the tendency can be inherited. Being overweight, having high blood pressure, diabetes, kidney disease or heart problems all increase risk. Diet plays a part: red meat, offal, seafood, sugary drinks and alcohol, especially beer, can push uric acid higher. Some medicines, including certain water tablets used for blood pressure, can also raise levels. Dehydration can trigger flares. Understanding your personal risk factors helps, because many, such as weight, drinks and hydration, can be improved to reduce attacks.

Treating a flare

The aim during a flare is to calm the inflammation and ease pain quickly. Resting and raising the joint, and applying an ice pack wrapped in a cloth, can help. Anti-inflammatory medicines are commonly used, and there are other options a GP can prescribe if these are unsuitable, so it is worth seeking advice early, as treatment works best when started promptly. A pharmacist can offer initial guidance and pain relief. It is important not to stop any long-term uric-acid-lowering medicine during a flare unless told to. If a joint is very hot and swollen and you feel feverish or unwell, seek urgent medical advice, because a joint infection can look similar and needs different, prompt treatment.

Preventing future attacks

Because gout is driven by high uric acid, the key to preventing flares is lowering it and keeping it low. For people with frequent attacks, tophi, joint damage or kidney stones, GPs offer long-term medicines that reduce uric acid production or help the kidneys clear it, taken daily and usually for life. These are very effective, and over time they can dissolve existing crystals so flares stop altogether. Lifestyle changes support treatment: reaching a healthy weight, cutting back on alcohol and sugary drinks, moderating red meat and seafood, staying well hydrated, and reviewing any medicines that raise uric acid with your GP. With steady treatment, most people with gout can become completely free of attacks.