Gout

Bone and Joint Conditions· Also known as: gouty arthritisUpdated Oct 2026

Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026

At a Glance

Gout is the most common type of inflammatory arthritis (joint inflammation). Tiny urate crystals build up in and around a joint, and your body reacts with a sudden attack of severe pain, swelling, redness and warmth. It most often hits the big toe, but it can affect any joint. It is more common in men and older people. Each attack usually settles within a week or two. With the right care, including medicine to bring your urate level down, attacks can be treated early and kept from coming back.

What is it?

Gout is a type of arthritis caused by tiny crystals building up in and around your joints. The crystals are made from urate (also called uric acid), a natural waste product in your blood. When there is too much urate, crystals can form slowly over months or years, usually without any symptoms.

Then your immune system reacts to the crystals, and you get a sudden attack of pain, swelling, redness and warmth. These attacks are called flares. They most often start in the big toe, but gout can affect any joint.

If gout isn't treated, flares can become more frequent and last longer. Over a long time, hard lumps of urate called tophi can form under the skin, and the joints can become damaged.

Who does it affect?

Gout is the most common type of inflammatory arthritis. How many people have it depends on the country. Reported figures range from about 0.9 per cent of people in France to 5.1 per cent in the United States. In New Zealand, it is reported in 3.2 per cent of people of European ancestry and 6.1 per cent of people of Māori ancestry.

It is more common in older people and in men. In the UK, among people aged 65 to 74, about 50 in every 1000 men have gout, compared with about 9 in every 1000 women.

Signs and symptoms

A gout flare usually comes on quickly, often at night. You may get sudden, severe pain and swelling in a joint, with warmth and redness of the skin over it. The joint may be very sore to touch and hard to move. The pain usually peaks within 24 hours.

Gout usually affects one joint at a time. The big toe is the most common spot, but it can also affect other toes, the ankle, knee, hand, wrist or elbow. On black or brown skin, the redness can be harder to see.

A flare usually settles within 1 to 2 weeks. Between flares, you often have no symptoms at all.

What causes it?

Gout starts with too much urate in your blood. When the level gets too high, urate can form crystals, and a flare is your body's reaction to them. Many people with high urate never get gout, so other things play a part.

You are more likely to get gout if you:

are older, or male
have a family history of gout
carry extra weight
drink alcohol or sugar-sweetened drinks such as soft drink
eat a lot of meat and fish, or other foods rich in purines (natural substances that your body turns into urate)
take certain medicines, including diuretics (fluid tablets), low-dose aspirin, high-dose niacin or cyclosporine

Gout often goes along with kidney, heart and metabolic conditions such as diabetes. These are linked to gout, but that doesn't mean gout causes them.

How is it diagnosed?

Your practitioner will ask about the pain: how fast it came on, which joints are affected, whether you have had similar attacks before, and whether you have had a fever. They will look at the joint and at your feet. A sudden, severe, red and swollen big toe joint, especially if you have had this before, points towards gout.

The only way to be certain is to find urate crystals in fluid taken from the joint, or from a tophus. Your doctor does this with a fine needle. It is also done to rule out other causes of a painful joint, including infection, even when gout seems likely.

If crystals can't be found, an ultrasound or a special CT scan (called dual-energy CT) can show signs of urate crystals in the joint. Other conditions, such as rheumatoid arthritis, can look like gout. That is why your doctor needs to be involved, and your podiatrist can refer you to them for crystal testing or scans.

Treatment

Gout can be treated well. The aims are to settle a flare quickly and to bring your urate level down so flares stop coming back.

Looking after it at home

The earlier a flare is treated, the better. Treatment works best when it starts as early as possible, ideally within 12 hours of the first warning signs. Talk to your doctor about a flare plan, so you know what to take and when, and can start straight away.

Take your medicines as prescribed. Don't stop or change any other medicine, such as a diuretic or aspirin, without talking to the doctor who prescribed it.

Treatment from your podiatrist

Your podiatrist can explain what gout is and how to manage it. They can look at the affected joint and your feet, ask about your attacks, and refer you to your doctor for tests or medicines.

Gout can bring shame or worry. A good practitioner will explain it clearly and without blame.

Medicines from your doctor

Three kinds of medicine are used for flares: colchicine, anti-inflammatory tablets (NSAIDs), and corticosteroids (steroids). Your doctor chooses between them based on your other health conditions, how you responded before, and how bad the flare is. Treatment usually continues for the shortest time needed, typically 3 to 5 days. Your doctor sets the medicine and the dose.

Each has downsides. Colchicine can cause diarrhoea and headache, and may not suit people with kidney problems. Anti-inflammatory tablets can upset the stomach and may affect the heart and kidneys. Oral steroids seem to work about as well as anti-inflammatory tablets and may cause fewer short-term side effects. If you have a history of ulcers, or heart or kidney disease, check with your doctor or pharmacist before taking any of them.

Other options

If flares keep coming despite treatment, or your medicines cause side effects, go back to your doctor. They can review your treatment or refer you to a rheumatologist (an arthritis specialist). Medicines called anti-IL-1β antibodies, which calm a chemical signal that drives inflammation, are generally recommended when other drugs have caused side effects or haven't worked. These are started only by a doctor or specialist.

It helps to keep a simple record of flare dates, joints affected and treatments you have tried.

Recovery

Each flare usually settles within a week or two, and you often feel normal in between. Without treatment, though, flares can come more often and last longer, and tophi can develop over time.

Gout is often linked with other health conditions. In one US report, about 74 per cent of people with gout had high blood pressure, 71 per cent had chronic kidney disease (stage 2 or above), 53 per cent had obesity and 26 per cent had diabetes. In New Zealand, adults with gout had more heart and blood vessel problems than those without it. These are links only, and they don't show that gout causes the extra risk. It is why your doctor should check your blood pressure, kidneys, blood sugar and heart risk.

Preventing it

The main way to stop flares coming back is to keep your urate level low. Your doctor may suggest a daily medicine called allopurinol from your first attack. The dose is matched to how well your kidneys work. The goal is a blood uric acid level below 6 mg/dL (360 µmol/L), or below 5 mg/dL (300 µmol/L) if your gout is severe. Keep taking it as prescribed and go to your regular blood test checks.

If your body mass index (BMI) is above 25 kg/m², losing weight is recommended, and doing it gradually is best. Cutting back on alcohol and sugary drinks also lowers your risk.

When to see a podiatrist

Book an appointment if

You have a sudden painful, swollen joint, often the big toe, that hasn't been checked. Or you have had gout and the attacks keep coming back despite treatment, or your medicines are causing side effects.

Seek prompt assessment if

A hot, swollen, painful joint with a fever, feeling sick or unable to eat, or pain and swelling that are getting worse, needs same-day medical assessment. Don't assume it is gout: a joint infection can happen alongside gout, and having gout doesn't rule it out. See a doctor if sudden joint pain doesn't improve with pain relief, or if you have a fever, feel generally unwell or can't manage normally at home.

Frequently asked questions

Is gout my fault?

No. Gout isn't caused by poor hygiene or a lack of willpower. Food and drink can play a part, but diet alone is rarely the whole explanation. Family history, weight, medicines and other health conditions all matter too.

Can I have gout if my uric acid blood test is normal?

Yes. About 4 in 10 people have a normal urate level during an attack. A high level doesn't prove you have gout either, because many people with high urate never get it. Diagnosis rests on your symptoms and, where needed, crystal testing or scans.

Is gout the same as pseudogout?

No. Pseudogout is another crystal arthritis that can also cause a hot, painful joint. It is caused by a different kind of crystal, called calcium pyrophosphate. Like gout, it raises the risk of joint infection, so a painful joint needs to be properly checked.

Can women get gout?

Yes. Gout is less common in women than in men, but it still happens. If you have a sudden, hot, painful joint, don't rule gout out because of your sex. Tell your doctor or podiatrist about it so it can be checked properly.