Gout risk factors: who is more likely to get gout

What gout is

Gout is a type of inflammatory arthritis that causes pain and swelling in the joints, usually as flares that last a week or two and then go away. Flares often begin in the big toe or a lower limb (NIAMS).

Urate (uric acid) comes from purines, which are in the body's tissues and in many foods. Normally urate leaves the body in urine. When too much is made or too little is removed, it builds up in the blood, and needle-shaped crystals can form in the joints (NIAMS). Not everyone with high urate levels develops gout (NIAMS); having too much uric acid in the blood (hyperuricemia) does not cause health problems for everyone (MedlinePlus).

With early diagnosis, treatment and lifestyle changes, gout is one of the most controllable forms of arthritis (NIAMS).

Who gets gout

Gout is more common in men than in women and usually develops in middle age. Women usually do not develop gout before menopause, which is why they tend to get it later than men. Younger people get it less often, but when they do it tends to be more severe (NIAMS).

Risk factors

NIAMS lists these factors that may raise your chances of developing gout (NIAMS):

• High urate levels
• A family history of gout
• Being male, having gone through menopause, and getting older
• Drinking alcohol. The AUDIT-C alcohol check shows where your drinking falls.
• Drinking sugar-sweetened beverages, such as soda. MedlinePlus names foods and drinks with a lot of fructose, a type of sugar (MedlinePlus).
• An unhealthy diet with foods rich in purines, usually from animal sources (NIAMS). MedlinePlus gives red meat, organ meats and certain seafoods as examples (MedlinePlus).

Health conditions that raise the risk

• Overweight or obesity (NIAMS). The BMI calculator shows where your weight falls.
• Metabolic syndrome, a group of conditions that includes high blood pressure, high blood sugar, abnormal cholesterol and extra fat around the waist (NIAMS). See metabolic syndrome criteria.
• Chronic kidney disease (NIAMS). See kidney disease risk factors.
• High blood pressure (NIAMS). See high blood pressure risk factors.
• Heart failure (MedlinePlus).
• Conditions that make cells turn over quickly, such as psoriasis or some cancers (NIAMS).
• Rare genetic conditions (Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome) that raise urate (NIAMS).

Medicines that raise the risk

Some medicines can raise the risk of gout (NIAMS):

• diuretics (water pills)
• low-dose aspirin
• niacin, a vitamin, in large amounts
• cyclosporine, an immunosuppressant used after organ transplants and for some autoimmune diseases

General safety advice: do not stop a prescribed medicine, including daily aspirin, without talking to the doctor who prescribed it.

What a gout flare looks like

The most common symptom is pain in the affected joint, often the big toe. Flares often start suddenly at night, and the pain may be bad enough to wake you up. The joint may feel swollen, red and warm (NIAMS). Flares usually affect one joint and can be triggered by certain foods, alcohol, certain medicines, injury or certain illnesses (NIAMS).

Flares usually get better in a week or two. Left untreated, they may come more often and last longer, and hard lumps of crystals (tophi) can form under the skin and around joints, which can damage bone and soft tissue (NIAMS). Pseudogout (calcium pyrophosphate arthritis) can look similar but is caused by calcium crystals, not uric acid (MedlinePlus).

Gout and other health problems

People with gout may be more likely to have or develop other conditions, especially of the heart and kidneys: high blood pressure, chronic kidney disease, obesity, diabetes, kidney stones, heart attack and heart failure (NIAMS). High uric acid can lead to stones in the kidneys (NIAMS), and gout is on NIDDK's list of conditions that raise kidney stone risk; see kidney stones risk factors.

Common questions

What is the biggest risk factor for gout?

Gout happens when urate builds up over a long time, and NIAMS lists high urate levels first among the factors that raise the chances of gout. Not everyone with high urate gets gout (NIAMS).

Does diet cause gout?

Diet is one factor. An unhealthy diet with purine-rich foods, alcohol and sugar-sweetened drinks can raise the chances of gout, alongside genes, sex, age, weight, health conditions and medicines (NIAMS).

Can women get gout?

Yes. Gout is more common in men, and women usually do not develop it before menopause, so they tend to get it at a later age (NIAMS).