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Gout often begins when you feel intense pain in your big toe. If left untreated, it can lead to painful joint issues that limit your mobility and further chronic health conditions. However, as you’ll discover, a care plan from your provider may help limit your symptoms.


Gout is an inflammatory arthritis condition that causes pain one joint at a time, most frequently in the big toe. It is caused by the buildup of high levels of urate in your body. Over time, urate may form needle-shaped crystals in and around various joints in your body.

Symptoms may either grow from tenderness to overwhelming pain, which is known as flares, or go into remission. If you have multiple cases of gout, you may develop gouty arthritis which can grow progressively more painful.1

Areas of your body that may be affected by gout include:2

  • Joints
  • Bursae, cushion-like sacs between your bones and other soft tissues
  • Tendon sheaths, the membranes that surround your tendons
  • Kidneys, which can develop kidney stones
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What Are the Symptoms of Gout?

Most people realize that they have gout when they have their first flare in one of their big toes. These flares often begin in the evening and can be so painful that they wake you up. Some people report that the pain feels crushing, throbbing and even overwhelming, as well as your joint becoming red, warm and swollen. Generally, the pain will improve within two weeks.

Some find that they have frequent flares while others may not have them for years at a time. They may be triggered by alcohol, medications, foods, other illnesses and physical trauma. If left untreated, flares will last longer and happen more often. You may also develop tophi, which is when the needle-shaped crystals that gout produces forms hard lumps under the skin, in and around your joints and even around your body’s organs. While painless at first, tophi eventually become painful and can cause misshapen joints as well as bone and soft tissue damage.

In other cases, untreated gout can lead to heart and kidney conditions, such as:

  • Chronic kidney disease
  • Congestive heart failure
  • Diabetes
  • Heart attack
  • High blood pressure
  • Kidney stones
  • Obesity

What Are the Four Stages of Gout?

There are different stages of gout:3

Stage 1: Asymptomatic Gout: As your body breaks down purines, it leaves behind uric acid. This waste product usually dissolves in your blood, is filtered through your kidneys, and is passed out of your body in urine. If your body produces too much uric acid or your kidneys aren’t effectively eliminating it, it reaches elevated levels in your blood. This is called hyperuricemia and for some, there are no symptoms. For others, it leads to the next stage of gout.

Stage 2: Acute gout: As uric acid levels increase, they may move to form crystals around your body’s joints, which leads to the intense pain and swelling of a flare. This first attack may be the first time you learn that you have gout.

Your provider will create a care plan that will lower your pain and inflammation as well as managing the levels of uric acid in your body. This will prevent future flares. They may also discuss dietary changes and medications which will help you to reduce the number of flares you have.

Stage 3: Intercritical or Interval Gout: After your first gout flare, you will go without symptoms for a period of time which may last days, weeks, months or even years. However, even without a gout flare, your body may be building up high levels of uric acid.

Your provider may recommend that you take uric acid-lowering medications.

Stage 4: Chronic Tophaceous Gout: If you are unable to control your uric acid levels, your gout will move on to the final and most painful stage. Urate crystals will now become tophi, which are bumps that appear under the skin as well as around bones, cartilage and even organs. They can also form around your fingers, restricting movement and changing the shape of your hands.

Luckily, most people never move to this final stage, as gout treatment is often very effective. For patients who do suffer at this stage, uric acid-lowering drugs can reduce the risk and may eliminate visible tophi.

How Long Does a Gout Attack Last?

The most intense period of gout flares is within the first 24 hours. The pain, swelling and redness will decrease and disappear within two weeks. However, if your gout goes unmanaged, flares will happen more frequently and increase in severity.

How Do You Manage Gout?

Self-management is often the best way to improve your quality of life if you develop gout. Here are some changes to make in your daily habits:

mature woman eating salad

Change your diet: Avoid foods that may trigger a gout flare, which includes foods like red meat, processed foods, organ meat and seafood. You should also limit drinking high fructose corn syrup and sugar-rich drinks, beer and hard liquor.

Increase your movement: A physical activity program may help reduce pain while improving your mood. Experts recommend that adults be moderately physically active for 150 minutes per week using exercise such as walking, swimming, or biking 30 minutes a day for five days a week. Be sure to speak with your provider before beginning any new exercise regime.

Talk to your provider: Be active about controlling your gout by attending regular appointments with your health care provider and following their recommended treatment plan.

Lose weight: If you are overweight or obese, losing weight may reduce pressure on weight-bearing joints like the hips and knees.

Protect your joints: When working out, choose low-impact activities with a low risk of injury that do not twist or put too much stress on the joints such as walking and swimming.

What Causes Gout?

Gout is caused by a condition called hyperuricemia which is when too much uric acid is in the body. Normally, uric acid is used to break down purines in the foods that you eat. When you have too much of it in your body, uric acid builds up in your fluids and tissues while forming needle-shaped crystals in your joints. This leads to pain, swelling and redness as well as limiting movement and use of the affected joint.

Not everyone with high urate levels develops gout. Researchers are currently learning how your genetics and environmental factors contribute to developing gout. These factors may increase your risk:2

  • Being male.
  • A diet rich in purines such as red meat, wild game and seafood
  • Having high urate levels
  • Drinking alcohol of or high fructose corn syrup and sugar-sweetened beverages
  • Family history of gout
  • Getting older
  • Menopause

Some health conditions may increase your risk of developing gout:2

  • Being overweight or obese
  • Chronic kidney disease
  • High blood pressure
  • Metabolic syndrome, a group of conditions that includes high blood pressure, high sugar levels, abnormal cholesterol levels and excess body fat around your waist
  • Psoriasis
  • Some cancers
  • Rare genetic conditions (Kelley-Seegmiller or Lesch-Nyhan syndromes)

Some medications can increase your risk of developing gout:2

  • Cyclosporine
  • Diuretics
  • Low-dose aspirin
  • Niacin

Gout can be extremely painful and limit the things you want to do in life. The faster that you speak with your provider and start a care plan, the less damage that it can do to your body and lifestyle.

If you think that you’re having a gout flare, your neighborhood MedExpress can help. A provider will examine you for gout and get you a prescription to help, if needed. We can also help you take the next step in your care with your primary care physician (PCP) or a specialist.



  1. CDC. Gout. Last updated June 12, 2023. Accessed April 15, 2024.
  2. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Gout. Last updated December 2, 2023. Accessed April 15, 2024.


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