Gout Explained

Released April 28, 2026 

PODCAST OPEN: Thank you for tuning in to the Live Yes! With Arthritis podcast, produced as a public service by the Arthritis Foundation. You may have arthritis, but arthritis doesn’t have you. Here, you’ll get information, insights and tips you can trust — featuring volunteer hosts and guest experts who live with arthritis every day and have experience with the challenges it can bring. Their unique perspectives may help you — wherever you are in your arthritis journey. The Arthritis Foundation is committed to helping you live your best life through our wide-ranging programs, resources and services. Our podcast is made possible in part by the generous financial contributions of people like you. Now let’s listen in. (MUSIC BRIDGE) This episode of the Live Yes! With Arthritis podcast is brought to you in part by Amgen. 

Cristina Schaefer: Hi, welcome to the Live Yes! With Arthritis podcast. I'm Christina Schaefer, your host for this episode. I was diagnosed with rheumatoid arthritis over 20 years ago and have been living with the highs and lows of this disease ever since. In today's episode, we are talking about gout. Gout is a type of arthritis. In fact, it's one of more than 100 different types of arthritis, which all told affect nearly 60 million people in the United States. You may not hear about it often, but gout is actually one of the most common types of inflammatory arthritis. 

Today, we're going to explore and explain gout. What causes it? How does it affect the joints and other parts of the body? How is it treated? What can you do to help manage it? And more. To help us, I'm joined by Brian Mandell, MD, PhD. Dr. Mandell is professor and chairman of academic medicine and a senior staff physician in Rheumatology and Immunologic Diseases, Center for Vasculitis Care and Research, at the Cleveland Clinic. He is editor-in-chief of the Cleveland Clinic Journal of Medicine. He's also a Master of the American College of Rheumatology, a Master of the American College of Physicians and is on the board of directors of the Gout Education Society. Dr. Mandell, welcome to the podcast. 

Dr. Brian Mandell: Hi, certainly very happy to be here and doing this with you. 

Cristina Schaefer: Tell us a little bit about yourself and your experiences with gout. 

Dr. Brian Mandell: My history with gout actually goes back to college. And it was just a fortuitous turn of events that the first research project that I ever was involved with in college related to how urate crystals cause inflammation when injected into rabbit joints, which is really rabbit gout. And ever since that time, I've been very intrigued by how inflammatory those crystals are. And fast-forward through my PhD, through medical school, and then training in internal medicine and rheumatology, now taking care of patients who actually have gout. So, it goes back from the basic science at the bench to the clinic office where I sit across from patients and discuss the management, treatment and, if I dare say, cure of their gout. 

Cristina Schaefer: So, what is gout exactly? 

Dr. Brian Mandell: So, gout to patients who have it, is a sudden, acute, very dramatic, red, hot, swollen, painful joint that they can't touch. If it's a foot they can't walk on, it's very impressive. The gout to the clinician, to the rheumatologist, that's a symptom — the red, hot, swollen joint. But the real disease is the deposition of uric acid in and around the joint structures. And people say, "Well, what's uric acid?" Uric acid is a normal chemical that we all have in our bodies that we just don't get rid of very efficiently. 

It builds up and deposits the same way that if you put too much sugar in a glass of iced tea, it settles out in the bottom of the glass. There's too much uric acid in your blood. It settles out in and around joints. And the difference between sugar in the bottom of the glass of tea is that that sugar tastes OK. Uric acid is not OK because those deposits break down, release crystals, which the body's immune system attacks. So, the disease itself is the deposition. The symptom is the acute sudden flare of gout. 

Cristina Schaefer: I understand that gout is the most common type of inflammatory arthritis, but exactly how common is it? 

Dr. Brian Mandell: It really is the most common type of inflammatory arthritis, more common than rheumatoid arthritis. In the United States, maybe four or five out of every 100 people will have it, but it's not equally distributed amongst everybody. It's more common as we get older. And if you think about it, the older we get, if our levels of uric acid are high, it has more time to make those deposits form. It's more common in men than in women. Post-menopausally, women start to catch up, but men have a headstart, in part because we have higher levels of uric acid than women do. But there's probably differences in the biology, the way that males and females deal with this as well. Maybe 9 or 10 million people in the United States will have this. 

Cristina Schaefer: And what causes gout? 

Dr. Brian Mandell: The ultimate cause is having a level of urate in your blood that's too high. Now, we get rid of uric acid, because it's a normal chemical that we all have. It comes from the breakdown of DNA and RNA in our cells. So, we all have it, and we get rid of it, but with various degrees of efficiency. The kidney gets rid of two-thirds or more of it. The rest comes out through the intestines in our bowel movements. And how efficiently we do that is in large part genetically determined. So, those folks who don't get rid of it very efficiently from their kidneys, even though their kidneys may work perfectly fine in every other way, they'll have higher levels of uric acid, which makes it more likely to deposit in and around the joints. 

Cristina Schaefer: How exactly does gout affect the body, your joints and the other organs? 

Dr. Brian Mandell: That can be a complicated question, which means it can be a complicated answer. From the arthritis part of it — those flares, those red, hot, swollen joints, that's the easiest to understand — that those deposits, once they're formed, will release crystals. The body's immune system recognizes those crystals as foreign invaders, the same way that your immune system would recognize a splinter with bacteria on it in your finger as a foreign invader and attacks it. And if you think about what an infected finger splinter looks like, that's very similar to what a swollen, inflamed, gouty-flare joint looks like. How other parts of the body are affected by gout is actually far more complicated and not completely understood. It's not just that the uric acid deposits in different places, which it does, but it probably relates also to the biochemistry of the uric acid circulating levels being higher and how the cells respond to it. 

For instance, the higher levels of urate can influence how your pancreas makes insulin and how insulin affects your sugar. There's an association between having gout and diabetes. In animal models, it's been shown that having higher levels of urate will cause the kidney and adrenal gland to release certain hormones that raise your blood pressure. So, there's an association between hyperuricemia, which means higher levels of urate, and diabetes, chronic kidney disease, high blood pressure, sleep apnea. The associations are very strong between having gout-elevated levels of urate and all these other conditions affecting other parts of the body. 

Cristina Schaefer: And how is gout diagnosed? 

Dr. Brian Mandell: The most definitive way is to find the urate crystals in the fluid of those inflamed joints. So, if you have a red, hot, swollen, tender joint, it's hard to imagine that that's a good feeling, to have a needle put in and fluid taken out. The fact is, with the use of a lot of local anesthetic and then taking the fluid out, the joint actually will feel better afterwards. So, the most definitive way is to take fluid out of an inflamed joint, or even a joint that's not so inflamed, and seeing the urate crystals under a microscope, that's definite gout. There's a lot of people who will have high levels of uric acid in their blood but never have gouty arthritis. So, the way to diagnose gout is not just by finding a level of urate being elevated in a blood test. 

When patients tell me, "Well, I was diagnosed with gout because of a blood test, " I say, "Well, have you had flares of gout? Have you had other issues?" And if the answer is no, then I say, "Well, you don't have gout, you have high levels of urate." There are other ways that we can diagnose gout reliably. One is to see those deposits of uric acid in and around the joints by special techniques, including what's called a dual energy CAT scan or dual energy CT. The software on the computer that does the CAT scanning can be set to recognize urate levels in and around the joint as deposits, and you can demonstrate the presence of those deposits and diagnose the gout that way. And some experienced folks with ultrasound can also demonstrate the presence of those deposits in and around joints. So, those are really the three ways that we diagnose gout. 

Cristina Schaefer: And if you suspect that you might have gout, or you're seeing similar flares, or those deposits that you're mentioning, what type of doctor do you go to, to be diagnosed formally? 

Dr. Brian Mandell: The best way, as I said, is for someone to actually make the diagnosis by pulling the fluid out of a joint. And that's generally going to be done by a rheumatologist. It certainly could be done by a primary care physician or podiatrist or orthopedist who's comfortable taking the fluid out and managing the fluid appropriately by either looking at the fluid for crystals themselves — that’s generally going to be by a rheumatologist — or sending it to the laboratory for analysis. It could be by any of those types of physicians. 

The way that it's frequently going to be diagnosed in real practice is by people, physicians, clinicians, listening to the patient's story carefully and making what we would say is a clinical diagnosis of gout. The history of repetitive episodes of these flares that come on very suddenly may awaken a patient up at night. Many people will be diagnosed clinically, not in the ways that I said are more definitive. And that will be right, many of those times, but not always. So, you always have to be aware that a clinical diagnosis of gout always has to be a little bit wary. 

We have to be a little bit wary about making the diagnosis that way because other things can look like flares of gout but are something else. So, if people then with treatment don't respond as we think they should, and the diagnosis was made just clinically by the history and then the exam, but not with fluid analysis, then you have to reassess that and keep an open mind. I think somewhat with a bias of being a rheumatologist, I would say we are probably the most well-equipped to do that. But certainly, you know, a general internist primary care physician with an interest in crystal diseases of the joint like gout can do that as well. 

PROMO: The Arthritis Foundation’s website offers access to expert resources and strategies for managing arthritis-related pain. Get guidance you can trust and comprehensive information about various pain management techniques and therapies. By using our resources, you’ll expand your understanding of pain relief options and be empowered to improve your quality of life. Visit arthritis.org/pain. 

Cristina Schaefer: What other conditions often accompany gout? 

Dr. Brian Mandell: There's a lot of metabolic syndromes that are associated with high uric acid levels, so thus would be associated. Chronic kidney disease is one of the most common ones. Most people with high levels of urate are inefficient excreters of uric acid, even though the rest of their kidney function may be normal. But patients who have chronic kidney disease where their kidney function is not normal will also have a buildup of uric acid, because they're not getting rid of the uric acid while they're not getting rid of other toxins as well that the kidney tends to deal with. So, chronic kidney disease very commonly is associated with gout. 

High blood pressure, very commonly associated. Patients with heart failure can be very commonly associated, and that gets a little bit complicated, because some of the medications we use to treat the fluid retention of heart failure, and also the fluid retention of kidney disease, we use diuretics to get rid of extra fluid. But those diuretics tend to increase the level of uric acid by the way that they work. So, you could get secondary gout related to the use of those medications as well. 

Cristina Schaefer: You mentioned the removal of fluids earlier. How exactly is gout treated? And is there a cure for gout? 

Dr. Brian Mandell: I would absolutely say that there is a cure of gout. And I don't say cure lightly, and I don't say it with many other diseases that I treat. So, the way to cure gout is really to get rid of those deposits. Once the deposits are completely gone, gout flares will stop. And the flares are what gets patients' attention, obviously. And we do that with medication. There is a little bit of an urban legend that we get high levels of urate, we get gout just from not eating well or eating particularly poorly. And while diet may have some role in the level of urate, the uric acid comes from our own bodies, not from what we eat. So, as carrying that through, the treatment cannot be just by changing your diet. 

A nice healthy diet, heart-healthy, sugar-healthy, salt-healthy, this is all good to do, but probably not good enough to get rid of the urate levels that will lead to the deposit. So, it's going to be with medication. The primary treatment is really to lower the level of urate in your blood with medications and keeping that level really quite low. The lower the level in the blood, the faster the deposits will stay away. And medication is generally for life. 

Cristina Schaefer: To add on to what you just mentioned, sometimes there are different stigmas that come with different diseases. Do you ever find that patients might be worried about the stigmas that come with gout? 

Dr. Brian Mandell: Yeah, that's a good point. There are some folks, because the word on the street is: This is the disease of kings. It's a disease of gluttony. You have to be overweight, if not blatantly fat. You drink too much, you eat too much whatever. But that's clearly not really the case because, you know, most people who get it, it's a good part genetically determined. It's not just what you eat. It's not what you weigh. You can make it worse, just as you can make heart failure worse, just as you can make diabetes worse. That's not the entire issue. It really is managing your urate, most of which comes from inside. 

I don't think that people who have frequent flares of gout should be blaming themselves that they're not able to deal with the disease of their diet and managing it, because, until it's really under control with medication, this can happen to anybody — no matter how religious you are about following an incredibly heart-healthy, weight-healthy diet, you can still have flares of gout. It doesn't mean that you're downing a six-pack every night after work. You can still have flares of gout until those deposits are gone. I tell folks: This is not your fault that you got this, any more than it's your fault that you got pneumonia and need an antibiotic to treat it. The good news is: We actually can treat this, and yes, you should do common sense things that are heart-healthy, gout-healthy, but it's not all your fault. 

Cristina Schaefer: You mentioned the term flare, and that's a term that we often hear in this space. What exactly is a gout flare? 

Dr. Brian Mandell: Well, a gout flare is that red, hot, swollen toe, ankle, knee, wrist joint, that gets your attention. That's the inflammatory response to those deposits. That's a flare. 

Cristina Schaefer: How can gout affect your mental health? 

Dr. Brian Mandell: Well, pain sucks, and I think there's very few people who would argue with that. Gout is said to be one of the most painful, acute conditions that we can get. I've had patients say it hurts more than childbirth without anesthesia. It hurts more than fractures that they've had. So, having intermittent pain to that degree is certainly not good for your mental health. It's also not good not knowing whenever these flares are going to happen. While some patients may say, "If I eat lobster tails or drink three beers and have a steak, I'm going to have a flare." And that may be true for them. But many flares, they're totally unpredictable. They'll just strike in the middle of the night. They'll strike at times that you clearly don't want them to happen. And if that's happening frequently, that's pretty anxiety-provoking — that you just don't know. 

How can you make plans if you don't know suddenly your ankle is going to explode and you're not going to be able to walk? This chronic pain, not knowing when it's going to happen, having it lay you out, really, that you can't do what you want to do for several days. This is not good for anybody's mental health. 

PROMO: Have a great idea for the Live Yes! With Arthritis podcast? Emailing us to suggest topics is a great way to contribute to the conversation. Share your thoughts with us at [email protected]. Your ideas can help shape future episodes and ensure we address the interests and needs of the arthritis community. Play an active role in helping us create arthritis resources. Email us at [email protected]. 

Cristina Schaefer: You mentioned particular triggers that could come from different types of foods. How much of a role does diet play in gout? Are there certain foods that should be avoided or any foods or diets that are good for gout? 

Dr. Brian Mandell: This is not as simple as the question seems to be, and not certainly as simple as many people kind of view it as. So, some foods will raise your urate level, particularly beer, including non-alcoholic beer, shellfish, organ meats, red meat, fructose containing corn syrup. All these things will raise your urate level. And again, the higher the urate level, the more likely you are to have those deposits; the more likely you are to develop gout flares. So, that's one aspect of diet that does play a role: Certain foods will raise your urate levels, but again, most of it's coming from inside of us, so it's not the only problem. 

The other aspect of diet is that there's some foods that, for some people, will trigger their flare. I mentioned that some patients will eat a lobster tail and they know the next day they're going to have a flare, or a steak and a beer. They know they're going to have a flare. This is the concept of an inflammatory diet, which we don't really know how to define. But for some people, they eat certain foods, it kind of revs up their immune system, and they have those deposits. And if their immune system is revved up, they're going to have more likely a flare because their immune system is going to attack those deposits. We have some foods that will increase the urate level, a chronic problem, and will have some foods for some patients that will trigger their immune system to attack the deposits that are already there. 

Those are the major ways that diet can play a role. There's also the comorbidities. If you have heart failure, obviously, a heart-healthy diet includes watching your sodium intake. So, that's important for the comorbidities. If you have coronary disease, atherosclerosis, well, you've got to really have a hearty-healthy diet looking very carefully at cholesterol. The cholesterol intake may not directly affect your gout, but it will affect your heart, it will affect your heart failure, more fluid retention that leads to more diuretic treatment, and more likely to get a flare. So, a lot of these things are very interrelated. 

Cristina Schaefer: Self-care is obviously very important for someone with any kind of chronic condition. What can someone with gout do on their own to help manage their condition? 

Dr. Brian Mandell: I think the main thing you can do on your own is to be aware that gout is a metabolic disease. It's associated with the deposits of urate, and it can be treated and cured. So, the best thing that you can do is to find a physician who's going to work with you to treat the disease. The idea that you're going to be able to treat it yourself with watching your diet, drinking cherry juice, I don't think you're doing yourself a favor with that. They're really very few and far between the patients who are going to be able to treat themselves alone without medication once you've really had established gout. 

Cristina Schaefer: Before each episode, we post a question on social media. For this particular episode, we asked: "What's one thing you really wish you knew about gout when you were first diagnosed?" And Dr. Mandell, we'd love to hear some of your thoughts on a few of these responses. First up, we had Shirley Daley, who said, "I wish I'd been given better explanations as to what was happening to me, my whole body, and what could happen to me if I didn't get the disease under control. The medications were never truly explained, as in why I have to be on two treatments. No one explained one med could help the other work better. I wish I had been told the real side effects of these powerful drugs." 

Dr. Brian Mandell: I wish that I had been the doctor that saw her, and I would have explained that, you know, management of gout, as with many diseases, is a team sport. And the most important thing is for you, as the patient with gout, to understand this almost as well as I do, because we're going to work together to manage this. And the way we're going to do it is understanding that number one, the flares are not your fault. Number two, the flares are a symptom. You've got to address the real disease, which is the deposition. 

The metaphor that I use frequently with patients is: If you have headaches from a brain tumor, yes, it's very important to treat the headaches because, as I said, pain sucks. You want to treat the headache, but you've got to treat the brain tumor. You're going to use medications to treat the flares of gout. We have several that we can choose from that will be best for you that may not be best for the next patient, but that will treat the flares. But we need to treat the disease itself, and that's a different set of medicines that we'll use to lower the urate in your blood and treat the deposits, which is the disease. What she has said here is that if doctors didn't take the time, didn't have the time perhaps, to explain what's going on here. And I think that's critically important. 

I would say my first visit with a patient who we've diagnosed with gout, the overwhelming amount of that time, which will maybe an hour, maybe more, is going to be just talking about what gout is and how we're going to treat it/cure it. And they're going to walk out of my office with a gout 101 lecture that I've printed out for them and say, "We're going to talk about this again the next time you come in, and I want you to always be aware of what your urate level in your blood is, because that's the way we're going to monitor your treatment." 

Cristina Schaefer: Denia Davis said, "At that time, I wish someone would've guided me to a new career path that would adjust with my body. I was young enough to start over with education." 

Dr. Brian Mandell: I don't know that I would direct anybody with needing a change in their career path. Certainly if we started to treat this disease young, my goal is always that we're going to manage the disease, we're going to cure the disease, and the goal is to let you do what you want to do, not let the disease dictate what you do. Now, it is true that some patients who may have had the disease untreated for 20 years, have had so much joint damage happen that may be hard for me to fix. We may need an orthopedist to help us with some surgery, but hopefully that's not going to be the case. And gotten early, this should not impact your life really at all, other than taking one or two pills every day forever to keep the urate level low, but you should be able to do what you want to do. 

Cristina Schaefer: Levi Moore said, "For me, ground turkey makes the inflammation worse." 

Dr. Brian Mandell: That's an easy one. When you have so far untreated gout and your levels are high, the deposits are there, your body's immune system is reacting to those deposits, there may very well be certain foods for you that are going to trigger your immune system to attack the deposits and flares. Once the deposits are gone, there's nothing for your immune system to attack. And my guess would be once we've gotten rid of those deposits, you'll be able to eat ground turkey again. I'm not a ground turkey fan, so that doesn't bother me a bit, but if you like it and want it, have at it. But let's get rid of the deposits first before you start to eat it again. 

Cristina Schaefer: And ground turkey's a staple in our house, so that would be… 

Dr. Brian Mandell: Why? 

Christina Schaefer: …that would definitely affect us. Oh, we love it. (laughs). Alice Ross said, "I really wish I had known that it was a lifetime diagnosis affecting multiple joints and organs." 

Dr. Brian Mandell: And you're right. I wish you would've known that, too. And having listened to this, now you know. But you also know that if we get rid of those deposits, it's not going to affect your multiple joints over time; that once the deposits are gone, unless significant damage has happened, which hopefully will not be the case, because we've gotten it earlier and we've gotten rid of them, your multiple joints are going to be fine. 

Cristina Schaefer: Cynthia Wadsworth said that, “No health professional addresses pain management ever.” That’s something she wished she knew. 

Dr. Brian Mandell: Ah, pain. Again, for the third time, pain sucks. I get it. And pain is very difficult to control. The good thing about gout is we know what causes the pain of gout. Acute flares are painful. We've talked about what happens with that, so we can treat the cause, which means we're going to treat the pain. Once joints happen to be very damaged, that gets harder to treat pain. And in fact, we don't have a lot of great pain medications. 

We can treat the flares that cause pain, and we can treat the pain of that very well. But damaged joints, that's the same way of somebody who may have severe osteoarthritis and painful joints. We don't have great pain medicines. This is a problem. We'll try different things, and it may not be 100% effective because, basically, we just don't have great pain medications. Narcotics, it turns out, don't work very well for inflammatory pain. Anti-inflammatories work far, far better. For damaged joints, anti-inflammatories may not work so well because there's not that much inflammation there. So, it depends on what is causing the pain, where's the pain coming from, what medications may work, and how well they work. 

Cristina Schaefer: Karla Klinas said, "Honestly, everything about the disease. My gout is idiopathic, so there's still so much even the doctors don't know." 

Dr. Brian Mandell: To a certain extent, that is correct. But we do know probably more about gout than we do about any of the other diseases that we treat, because we do know how to cure it. In the overwhelming majority of patients, we can cure the disease. So, we do know enough. You can push the questions far enough to say, "OK, that's where we don't know the answer to." But we do have an understanding of this disease and what causes it to be able to treat it effectively and lead to what really is a functional cure unless joints have been so damaged. And fortunately, that really does take a long time for that to happen. 

PROMO: Arthritis Foundation Connect Groups provide a safe space for people to share their experiences with different forms of arthritis. These virtual and in-person support groups foster connections based on shared interests — allowing participants to support one another in the challenges they face while enhancing their sense of community and understanding. Find your group at connectgroups.arthritis.org. 

Cristina Schaefer: To close each episode, we typically share our top three takeaways from the episode. So, Dr. Mandell, what are your top three takeaways? 

Dr. Brian Mandell: One, to recognize that the gout flares are a symptom, not the disease itself; that the deposits of uric acid in and around joints, that is the disease. Number two is that those deposits can be gotten rid of with appropriate medical approaches, which means that the disease is curable. And I think that's an incredibly important message to have. And number three, that gout is associated with other metabolic-related syndromes, kidney disease, high blood pressure, diabetes, atherosclerosis, fatty liver disease, obstructive sleep apnea. And patients who have gout are at risk for all of those, and they may not all be cured by the same treatment that we use to treat gout flares, but once aware of them, we need to address them. And a common sense approach of patients to management of those problems will also help the management of gout and the overall medical health. 

Cristina Schaefer: As someone who's lived with rheumatoid arthritis for so long, I've always thought about gout to be something very similar to rheumatoid arthritis with the exception of those pictures of the big swollen ankles and stuff that you see. But really, for me, so many takeaways, starting from who gets it, why they get it. But one of the key things that I love that you shared here today is it's manageable and different ways to manage it. So, thank you for those comments. 

Dr. Brian Mandell: Well, you're quite welcome. 

Cristina Schaefer: Well, Dr. Mandell, thank you again for everything you shared with us today. I think this episode will be really helpful to anyone living with gout or somebody that has a loved one living with gout. It'll help really uncover some things they may not have known about the disease. 

Dr. Brian Mandell: I guess one other thing I'd really like to emphasize is that this really is a team sport in management. Patient education about the disease is really critically important, because we can really cure this. And I would look for, as with any form of arthritis or with any medical syndrome, you want reliable sources of information. Certainly the Arthritis Foundation has multiple sources of information. For gout in particular, the Gout Education Society, we have a good amount of literature that's available online. Use reliable sources, you know, when you're making decisions. 

Christina Schaefer: Well, thank you again. For more arthritis resources, including information about gout, please visit the Arthritis Foundation's website at arthritis.org, and send your questions, comments and thoughts to [email protected] We'll see you next time. 

PODCAST CLOSE: Thank you for listening to the Live Yes! With Arthritis podcast, produced as a public service by the Arthritis Foundation. Get show notes and other episode details at arthritis.org/podcast. Review, rate and recommend us wherever you get your podcasts, on Apple, Spotify and other platforms. This podcast and other life-changing Arthritis Foundation programs, resources and services are made possible in part by generous donors like you. Consider making a gift to support our work at arthritis.org/donate. We appreciate you listening. And please join us again!