Gout

What gout is

Gout is a form of inflammatory arthritis caused by hyperuricaemia: abnormally high uric acid levels in the blood. When uric acid exceeds its solubility limit (around 6.8 mg/dL), it crystallises into monosodium urate crystals that deposit in joints, tendons and surrounding tissues. An acute gout attack occurs when the immune system reacts to these crystals, causing intense inflammation. The classic presentation is sudden, severe pain in the big toe joint (podagra — about 70% of first attacks), often waking the patient at night, with redness, swelling and warmth.³

Attacks also commonly strike the ankle, knee, wrist, fingers and elbow; visible crystal deposits (tophi) can appear at the elbow and ears in chronic gout. Underexcretion of uric acid — not overproduction — accounts for about 90% of cases.

How gout is usually evaluated

Evaluation centres on uric acid — with one critical caveat about timing:

A normal uric acid during an acute attack does not rule out gout. This is the opposite of what most people assume, and normal results are regularly used to dismiss the diagnosis. The crystals formed months or years ago are already sitting in the joint — an attack is the immune system reacting to them, and it does not require a high blood level at that moment. During an attack urate also shifts out of the blood. Always recheck 2–4 weeks after the attack resolves.² Joint aspiration — examining fluid from the joint for crystals — is the definitive test and also rules out joint infection, which a large hot knee joint can mimic.

Your next steps after a gout attack

Treat the attack, then fix the underlying uric acid. Work through these with your doctor:

1. Get the attack treated promptly. First-line options your doctor may use include NSAIDs, colchicine (very effective when started early) or corticosteroids where NSAIDs or colchicine are unsuitable — for example with kidney disease.¹
2. Recheck uric acid 2–4 weeks after the attack resolves. Testing during the flare can mislead; the post-attack level is the one that guides long-term decisions.
3. Ask about long-term urate-lowering therapy. Diet changes lower uric acid only modestly — most people need ongoing therapy (usually started a few weeks after the attack, targeting below 6.0 mg/dL). A flare while starting it does not mean the drug has failed; early flares are expected as crystals dissolve.
4. Review your medicines. Ask whether a diuretic, low-dose aspirin or ciclosporin is worsening your gout — underexcretion from medicines is common and sometimes modifiable.
5. Adjust diet and weight. Limit red meat, organ meats and shellfish; avoid beer and spirits; drink at least 2 litres of water daily; increase low-fat dairy; avoid high-fructose corn syrup; maintain a healthy weight — obesity doubles gout risk.
6. Know when it is urgent. A first-ever hot, swollen joint needs prompt assessment to rule out septic arthritis — especially with fever. Do not assume every joint pain is gout.

Uric acid levels explained

The numbers that define risk, from the evaluation table above in one place:

Guidelines set the treatment target below the crystallisation point to gradually dissolve existing deposits — which is also why flares can paradoxically occur early in treatment.⁴

Practical notes

Keep a flare diary: the date, which joint was affected, how long it lasted, and anything notable beforehand — a wedding feast, dehydration, a new medicine. Over time this record helps your doctor spot your personal triggers and judge whether preventive treatment is working.

Bring a complete medicine list to every visit — some common medicines, including certain diuretics and low-dose aspirin, can raise uric acid. Also mention kidney stones, high blood pressure and kidney function reports, since these influence treatment choices.

Doctors usually discuss hydration, limiting alcohol (beer in particular), and gradual weight management. Very strict food avoidance lists from the internet are rarely necessary — overall dietary pattern matters more. Discuss any diet changes with your doctor rather than eliminating whole food groups.

Uric acid is checked periodically once preventive treatment starts, against a target your doctor sets. An important practical point: do not stop urate-lowering medicine during a flare or because you feel better — discuss any change with your doctor first, as stopping can trigger flares.

In India

In India, a serum uric acid test typically costs around ₹200–₹500 at private labs, though prices vary by city and lab. If joint fluid analysis is advised during a flare, it is a separate procedure charge at the hospital — ask for an estimate beforehand.

Choose a NABL-accredited lab where possible, and home sample collection is widely available in major cities. Uric acid methods differ between labs, so the reference range printed on your own report is the one that counts.

Frequently asked questions