Causes of gout - symptoms and triggers

This page about the causes of gout was last reviewed, or updated, on 7 April 2011.

Gout is a type of arthritis. Initially it's an inflammation of the joints. The precise causes in all gout cases are still not understood. It is a complicated disease that has defied humankind for over 2,000 years. There is no definitive cure for all cases. 

Do not be alarmed. Many gout sufferers have cured their gout using different remedies. These remedies are described on this website. A great deal is known, and it's important you understand the causes of gout.  So let's begin.


A gout definition is this...Monosodium urate crystals, made of a compound of sodium and monosodium urate from uric acid (MSU) and which are covered by certain types of proteins, are deposited in joints, tendons, kidneys and other places. Usually they are found in joints. 

The favourite (favorite) first location for these gout crystals are the joints of the big toes.(A gout attack in the joints of the feet was historically called podagra). Or they are deposited in joints in the hands, wrists, elbows, ankles, knees and other locations.

Over time these gout crystals can enlarge to form  tophi which are knobbly shaped lumps of crystals. If this is the case,the gout worsens. MSU crystals have usually built up over a long period of time. The long term cause of gout therefore, is linked to the level of uric acid in the body because the MSU crystals are largely made of uric acid.


Uric acid acts as an antioxidant in the body. As an antioxidant it acts to destroy the threat of free radicals which if unchecked destroy cells. So it’s not a devil's substance, unless you have gout or too much of it in your blood.

The body obtains uric acid from two sources. The most important by far is the liver (75-80%). The remainder comes from our diet. The amount produced by the liver is determined by our genetic code and our biochemistry. 

Uric acid from our diet is made from substances called  purines in food and beverages.  Different foods, and different beverages, contain varying levels of purines. Some foods are low purine, others are high in purines. We’ll be looking at purines in detail elsewhere on this website. So both the actions of the liver, and of purines from foods, are one of the causes of gout.

But our intake of uric acid  does not determine our body’s level of uric acid. How much we have in blood and tissues also depends on how much we remove. (Supply-Excretion = Level). Most uric acid (about 70%) is filtered through the kidneys and leaves in the urine. The remainder (30%) is dissolved by bacteria in the intestines.

It only takes a small excess of uric acid (UA) self production plus the amount we make from purine consumption, above our UA excretion.... and the body's amount of uric acid will rise gradually over the years.

Which is more important for our level of uric acid, supply or excretion? Most gout accounts say that the uric acid level is caused more by how much we excrete than by how much we produce or intake. 

In over 2/3 of gout cases the cause of gout is not expelling enough uric acid. It is important to keep this in mind - getting rid of it satisfactorily is more important than self manufacture or obtaining it from purines in foods and beverages. 

If it isn’t expelled it builds up in the blood and tissues. So if uric acid is being efficiently expelled it is likely that supply (liver production and purines from diet) is a cause of gout.

A high level of uric acid in the body is called hyperuricemia. Most people with gout have hyperuricemia (hyperuricaemia) , but here’s a curious fact to keep in mind.  Some people who have gout have normal levels of uric acid, and about 80% of people with high levels of uric acid never get gout.

What we know is that the MSU crystals are partly made of uric acid. The amount of uric acid in the blood that’s considered normal is below 7.0 mg/dL for men, slightly less for women (6.5mg/dL) Above 6.5-7.0 mg/dL most likely means hyperuricemia and therefore it can become a cause of gout. 

Uric acid measurements  mg/dL means milligrams per decilitre (deciliter). A decilitre (deciliter) is 100 millilitres (milliliters) and sometimes when you are reading about gout you will see the amount expressed as mg/100 millitres (milliliters - ml). This is the same as mg/dL. It's a measurement of the concentration of uric acid in a decilitre or 100 milliliters of blood. The higher the mg of uric acid in a dL (100 ml)of blood, the higher the uric acid level. 

The concentration of uric acid in the blood may also be expressed as mmol/L - millimoles per litre (liter). mmol/L is sometimes expressed as µmol/L. mg/dL is a popular measurement in the U.S. In most other countries mmol/L or µmol/L is more commonly used.

Gout flare ups The most common, more detailed, explanation of a gout flare up is that pain, inflammation and all the other nasty symptoms begin when the immune system “thinks” that the MSU crystals are foreign bodies. A type of white blood cell called neutrophils attack the crystals and this is what causes inflammation and pain. The attack subsides when the crystals are coated by types of proteins. Once coated, the neutrophils do not now “regard” the crystals as foreign bodies, the attack is over and the flare up subsides. 

A truce between your immune system and the MSU gout crystals has been declared but the war is not over. Gout attacks can return at any time especially under the conditions that are causes of gout flare ups (the triggering conditions).

John Bavosi
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Related links you might enjoy

What's your likelihood of suffering gout attacks en route to a gout cure? Click here to find out more.

Does fructose (fruit sugar and it's in other sweeteners) cause gout ? Visit our first page about fructose and gout.

Click here if you want to find out just how important is your initial uric acid reading if gout has been diagnosed.  And to find out, if you are prescribed allopurinol or febuxostat, how long you will take these pharmaceuticals before gout attacks may cease. 

This gout cause is unproven, but it does have lessons for gout prevention

Why does gout so often attack a big toe first? And how can you use this knowledge to help stave off a gout flare up? Visit our page about big toe gout.

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