The condition
What gout is
Gout is an inflammatory arthritis. Urate crystals form in and around a joint, and the joint becomes inflamed. That episode is a flare. The disease is also the quiet stretch afterward, and the damage that can accumulate if it goes on.
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Crystals and urate
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) describes gout this way: urate can build up in the body over a long time and form needle-shaped crystals in and around a joint. The joint then becomes inflamed. That inflammation is the flare.
Urate comes from purines. Purines are in your body’s own tissues and also in many foods. Most of the time urate leaves the body in urine. Gout happens in people who make more than they clear, or clear less than they make. High urate is not the same thing as gout. NIAMS notes that many people with high urate never develop gout. Risk factors and common triggers are on Causes and triggers.
Nothing on this site is a way to “clear crystals” on your own.
A flare, tophi, and joint damage
People use the word gout for a terrible night, a lump near a joint, and a joint that is no longer the same. Those are related. They are not the same problem.
| Compared | A flare | Tophi | Chronic joint damage |
|---|---|---|---|
| What it is | Inflammation set off by crystals in a joint. | Collections of urate crystals, often felt or seen as lumps in or near a joint, sometimes in other tissue. | Cartilage, bone, and nearby soft tissue harmed over time. |
| How it behaves | Often sudden. The joint is painful, swollen, warm, and frequently red. Many people cannot walk on it. | May be painless at first. Can hurt, swell, get in the way of a shoe, or become inflamed. | Stiffness, and a lasting change in how the joint works. Flares may come more often and last longer. |
| Time | A stretch of days, sometimes longer. Easing is a description, not a promise, and not proof the crystals are gone. | Builds over a longer period, not over one night. | A long story. Not one bad night, and not something a home remedy reverses. |
| Easy to mix up with | A joint infection or another emergency. Those can look the same at the start. | A harmless bump. Some lumps are not tophi. A clinician has to sort that out. | Ordinary aging, or a single flare that never really ended. |
- Flare A sudden hot, painful joint; NIAMS says flares often last a week or two, then settle. The big toe, foot, ankle, and knee are common places. Not the only places.
- Between flares Pain may be gone. NIAMS calls this interval, or intercritical, gout. Feeling fine does not mean the crystals have left.
- The long run If it goes on, flares can come more often and last longer. Tophi can form. Joints and nearby tissue can be damaged.
The long-term goal of care, when a clinician has said it applies, is to bring urate down so new flares and tophi are less likely. That plan is on Staying well. It is not a flush.
Where a flare often shows up
NIAMS says flares often begin in the big toe, or in another joint of the lower limb. They often start suddenly, and often at night. Other common places are the rest of the foot, the ankle, and the knee. That is not a complete list. Wrists, elbows, fingers, and other joints can be involved. A list of common places is not a map of where gout is allowed to occur. Illustrations of these places are in the image library.
A flare is not “a toe that hurts a bit.” People often cannot bear weight. Between flares, many people have no symptoms. That quiet stretch is easy to misread as the end of the problem. It is not.
Why you do not diagnose this yourself
A guess from a painful toe is not a diagnosis. If this is the first time, do not close the question because the story matches something you have read. Plenty of painful joints are not gout.
How a clinician knows
NIAMS and the Arthritis Foundation describe what clinicians use: the story and the exam, a blood test for urate, imaging, and, when it can be done, a sample of fluid from the joint looked at for crystals. Seeing those crystals is how gout is confirmed when a sample is taken. A sample is not always taken.
The blood test does not interpret itself. Urate can be normal during a flare. High urate can be present in someone who does not have gout. High urate can also be tied to kidney stones. Heart disease, high blood pressure, kidney disease, and related conditions show up more often in people with gout. Those are reasons to be in regular care. They are not reasons this site can sort out for you.
When to get care instead of reading
Stop reading and get urgent care if a joint is hot and swollen and you have a fever, if you cannot bear weight, or if this episode is unlike your usual flares. Infection and other joint emergencies need a person, not a page.
See a clinician for a first suspected flare even if it is already easing. See them if flares keep coming back, if you notice lumps near joints, or if you have kidney disease or take several medicines. Do not start, stop, or switch a medicine because of this page.
If someone is with you, they can help by resting and elevating the joint, keeping pressure off a swollen foot, and helping you reach care. They cannot tell a flare from an infection either. Notes on work, sleep, shoes, and what to write down are on Living with gout. What happens in the middle of a flare is on During a flare.
Related: keep a record with the printable flare tracker, see common questions in the FAQ, or compare look-alikes on Pseudogout and gout.
Clinical claims on this page follow the sources.