What causes gout?

Urate is produced when the body breaks down purines and is normally cleared mainly through the kidneys. Levels can rise when the kidneys remove too little, the body produces more, or both. Genetics, chronic kidney disease, obesity, dehydration, alcohol, purine-rich foods, sugary drinks, and certain medicines can contribute. Having a risk factor does not by itself establish the diagnosis.

Urate crystals can be present before a joint becomes painful. When the immune system reacts to them, gout can present with abrupt, intense pain, warmth, redness, and swelling, often beginning in one joint. A change in urate balance due to dehydration, illness, fasting, alcohol intake, dietary excess, or starting or stopping some medicines may precipitate a flare. A blood urate result during an attack does not, on its own, confirm or exclude gout.

Arrange an assessment for a first suspected attack or repeated episodes. A clinician may examine the joint, review kidney function and medicines, and sometimes test joint fluid for urate crystals and infection. Do not stop prescribed medicines without advice. Regular hydration, gradual weight management where relevant, and moderation of alcohol and high-purine foods can support care, but recurring gout may still need urate-lowering medicine. Flare treatment and long-term urate control serve different purposes.

Seek urgent assessment for a first episode of a hot, swollen, very painful joint, especially with fever, chills, feeling seriously unwell, broken skin nearby, or recent surgery. A joint infection can look like gout and requires rapid treatment. Prompt care is also appropriate when pain escalates quickly, you cannot bear weight, or redness spreads beyond the joint.

Ask how the diagnosis will be distinguished from infection or another crystal arthritis, whether joint fluid testing is appropriate, and when urate should be checked. Request a review of kidney health and medicines that might raise urate. If attacks recur, discuss the goal of long-term treatment, how flare prevention fits with it, and which lifestyle changes matter most for your circumstances.