Causes and triggers

How urate builds up

NIAMS explains that urate comes from purines, which are in the body’s own tissues and in many foods. Normally urate leaves the body in urine. When the body makes too much, or removes too little, urate builds up and can form needle-shaped crystals in and around a joint. NIAMS also notes that many people with high urate never develop gout. The longer version is on What gout is.

Risks you cannot change

• Genes and family. NIAMS and the Arthritis Foundation both list a family history of gout.
• Sex and age. NIAMS lists being male, menopause, and increasing age. Women tend to develop gout later than men. More on that is on Gout in women.

Health conditions

NIAMS names chronic kidney disease, high blood pressure, overweight or obesity, and metabolic syndrome among conditions that can raise the chance of gout. Kidneys are how most urate leaves the body, so kidney function matters. These are in more depth on Other conditions and Kidney stones and gout.

Food and drink

• Alcohol. NIAMS lists drinking alcohol as a risk factor and suggests fewer alcoholic drinks, including nonalcoholic beer. The Arthritis Foundation singles out beer.
• Sugary drinks. NIAMS names sugar-sweetened drinks such as soda. The Arthritis Foundation names food and drinks sweetened with high-fructose corn syrup.
• Purine-rich meat and seafood. NIAMS names red meat, organ meats, and certain seafood such as shellfish, sardines, and anchovies.

Food is part of the picture, not the whole of it. NIAMS is direct that lifestyle changes alone are not enough when flares are frequent or tophi are present. More is on Food and drink.

What can set off a flare

NIAMS says flares can be triggered by certain foods, alcohol, certain medicines, physical injury, or certain illnesses. Starting a urate-lowering medicine can also be followed by flares early on; that is covered on The first months. A trigger is a clue for you and your clinician. It is not something you have proved, and avoiding every trigger is not a substitute for a treatment plan.

Writing down what came before a flare can help that conversation. The free printable flare tracker has a space for it.

Medicines

NIAMS names some medicines that can raise the chance of gout, including diuretics (water pills), low-dose aspirin, large amounts of niacin, and cyclosporine. The Arthritis Foundation also mentions some blood pressure medicines. These medicines are often prescribed for important reasons. If you take one, ask your clinician whether it matters for your gout. Do not stop or change it on your own.

What this page is not

This page does not rank risk factors, give a number for any of them, or say which one caused your gout. It does not tell you to stop a medicine. Your clinician weighs these with you.