Also called: Gouty arthritis; crystal arthritis
See someone before self-treating
Strength
A sudden, exquisitely painful joint - most classically the big toe - that goes from fine to unbearable within hours. Urate crystals have formed in the joint, and during an attack even a bedsheet is intolerable. Between attacks the joint is entirely normal.
How common: Around 4% of adults; up to 10% of men over 60
What it is
Gout is caused by crystals of uric acid forming in a joint. Uric acid is the end product of purine breakdown, and when blood levels stay high for long enough, crystals deposit in and around joints - usually silently, until something triggers an inflammatory reaction to them.
The attack itself is one of the most painful things in medicine and it is short-lived: severe over hours, peaking within a day, resolving over one to two weeks. Between attacks the joint looks and feels normal, which is precisely why the underlying urate level so often goes untreated and the attacks keep coming.
What causes it
Most people have more than one of these at once, and they feed each other. Read the
list looking for the two or three that sound like your week rather than for the one
true answer — the ones that describe you are the ones worth acting on.
- Persistently high blood urate
- Crystals form when urate exceeds its solubility. The level is set mostly by how much the kidneys excrete rather than by how much is produced, which is why it is largely a kidney handling problem rather than a diet problem.
- Reduced kidney excretion
- Around ninety per cent of people with gout under-excrete urate. Chronic kidney disease, diuretics and some other drugs all reduce excretion further.
- Diuretics and some medications
- Thiazide and loop diuretics raise urate substantially and are a very common contributor in older adults. Low-dose aspirin does the same. Worth reviewing rather than accepting.
- Alcohol, especially beer
- Alcohol raises urate production and reduces excretion. Beer additionally contains purines. It is one of the most consistently identified triggers.
- Fructose and sugary drinks
- Fructose metabolism generates urate directly. Sugar-sweetened drinks are associated with gout risk about as strongly as beer is, which surprises people.
- Purine-rich foods
- Red meat, offal and some seafood raise urate. The dietary contribution is real but modest compared with genetics and kidney handling, which is why diet alone rarely controls established gout.
- Genetics
- Variants in the kidney's urate transporters are the largest single determinant of blood urate level. Gout runs strongly in families and is not a consequence of self-indulgence.
- Obesity and metabolic syndrome
- Both raise urate and both are strongly associated with gout. Weight loss lowers urate measurably.
- Dehydration and sudden changes
- Dehydration concentrates urate; so can starting urate-lowering treatment, which can paradoxically trigger an attack as deposits mobilise. This is expected and managed rather than a reason to stop.
- Trauma, surgery and illness
- Any acute physiological stress can precipitate an attack, which is why gout so often appears a day or two after an operation or an illness.
What actually helps
The short version: Urate crystals in a joint causing sudden intense inflammation, most classically the big toe. Between attacks the joint is normal; during one it is exquisitely painful
Strength work: BETWEEN attacks: Full Body and weight management reduce attack frequency. DURING an attack: nothing
Stretching: Not during an attack
Massage: NEVER massage an acutely gouty joint - it is intensely painful and massage does nothing for crystal inflammation
Also worth doing: Urate-lowering medication is the actual treatment; reduce alcohol and high-purine intake; treat the metabolic syndrome that usually accompanies it
What the evidence says: Listed as a caution entry. Exercise and weight management reduce attack frequency, but nothing in this app should be recommended during a flare, and a hot single joint always needs a diagnosis first.
The names above are the Targets qFIT tracks —
the Muscle Guide explains what each one does, and
Quick Add switches on the Exercises you
already have.
No ready-made routine for this one yet
249 of the 267 problems here have a routine already built, and this is not
one of them — usually because the work that helps is covered by a general routine
rather than needing its own. What actually helps above names the muscles and the
work involved, which is enough to put it together yourself.
Get it checked if…
A hot swollen single joint could be SEPTIC ARTHRITIS rather than gout, which is a surgical emergency. Never assume gout; a first presentation needs medical assessment
And whatever the body part: chest pain or unusual breathlessness on
exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and
unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or
one calf that is swollen, warm and painful. Any of those, stop and get assessed.
How it usually goes
Acute attacks settle in one to two weeks with treatment and much faster if treated early. The condition itself is highly controllable: urate-lowering therapy taken consistently prevents attacks and dissolves existing deposits over years, yet adherence is famously poor because the joint feels fine between episodes. Exercise and weight loss help but do not replace the medication. A hot swollen joint with fever should always be assessed urgently - septic arthritis looks identical and destroys a joint in days.
Prevalence basis: Rheumatology epidemiology
This is general information, not a diagnosis, and it cannot examine you.
If it matches you, use it to ask better questions of a clinician rather than to replace one.