Think You Know About Gout? Common Myths Explained
MBChB (New Zealand), PGDipObstMedGyn, FRACP (New Zealand), FAMS (Rheumatology)
Gout is often associated with rich food, older men and sudden attacks of severe joint pain. While there is some truth behind these associations, they do not tell the whole story.
Misconceptions about gout can affect how the condition is recognised and managed, particularly when symptoms disappear between attacks. Understanding what actually causes gout and why it can return is an important part of managing it effectively.
Myth #1: Gout Is Caused by Eating Too Much Rich Food
Diet is often blamed for gout, and there is some truth behind the association. Foods such as red meat, organ meats and certain seafood are high in purines, which the body breaks down into uric acid. In people who are susceptible to gout, these foods may raise uric acid levels or contribute to a flare.
However, diet alone does not explain why someone develops gout. Gout occurs when uric acid builds up and forms crystals in and around the joints, and this can be influenced by factors such as:
Genetics
A family history of gout can increase your risk.
Kidney function
Reduced uric acid removal can cause levels to build up in the blood.
Certain medications
Some medicines, including particular diuretics, can raise uric acid levels.
So while changing what you eat may form part of gout management, gout is not simply the result of eating too much “rich food”.
Myth #2: Gout Only Affects Older Men
Gout can affect adults of different ages and both men and women, although it does become more common with age.
The stereotype of gout as an “older man’s condition” has some basis in its usual pattern. Men are more likely to develop gout than women, while the overall risk increases with age. In women, gout is less common before menopause because oestrogen helps the kidneys remove uric acid from the body. As oestrogen levels fall after menopause, uric acid levels can rise and gout becomes more common.
Older men may therefore fit the familiar picture of gout, but being younger or female does not rule it out.
Myth #3: If the Pain Goes Away, the Gout Is Gone
A gout flare can settle completely, sometimes leaving the joint feeling normal again. However, this does not necessarily mean the underlying gout has resolved.
This misconception is understandable because gout often occurs in distinct attacks. The pain, swelling and redness may improve within days, followed by a symptom-free period that can last for months or even years. During this time, however, urate crystals may remain in the joints even though they are not causing symptoms.
Without appropriate management, further flares can occur and become more frequent. Over time, urate crystals can also build up into firm lumps under the skin, known as tophi, and contribute to joint damage.
Myth #4: Gout Treatment Is Only Needed During a Flare
Because gout is most noticeable when a joint becomes suddenly painful and swollen, it is easy to think that treatment is only necessary during an attack. Medication used during a flare can reduce pain and inflammation, but this addresses the attack rather than the underlying problem of elevated uric acid and urate crystal deposits.
For people who have recurrent gout or certain complications of the condition, treatment may also involve lowering uric acid over the longer term. Keeping uric acid below a target level allows existing urate crystals to gradually dissolve and helps reduce the risk of future flares.
Not everyone with gout will need the same long-term treatment. The approach depends on factors such as how often flares occur, uric acid levels, the presence of tophi and other aspects of the person’s health.
When Should You See a Rheumatologist for Gout?
Not every painful or swollen joint is gout, so a first suspected attack should be medically assessed rather than self-diagnosed. A rheumatology review may be particularly useful if:
Your gout attacks are becoming more frequentThis may indicate that uric acid levels are not adequately controlled.- A flare is not improving as expectedPersistent or worsening symptoms may need reassessment.
- You notice firm lumps around the jointsThese may be tophi caused by accumulated urate crystals.
- Gout is affecting your joints between attacksOngoing pain, stiffness or reduced movement may suggest that the condition is no longer limited to occasional flares.
A hot, swollen and very painful joint accompanied by fever or feeling unwell requires prompt medical attention. A joint infection can cause similar symptoms to gout and needs urgent treatment.
Managing Gout Beyond the Flare With Dr Poh Yih Jia
Gout treatment is not only about relieving the pain of an acute attack. If flares keep returning, assessing uric acid levels and the pattern of your gout can help determine whether longer-term treatment is needed.
At Centre for Rheumatology & Arthritis, patients with gout can receive assessment and treatment for both acute flares and longer-term uric acid management. Dr Poh Yih Jia can assess recurrent gout and advise on treatment to help reduce future flares and protect the joints from further damage.
Schedule a consultation if you are experiencing recurrent gout attacks or would like to discuss your gout treatment options.
FAQs About Gout
Yes. Although the joint at the base of the big toe is a common site for gout, attacks can also affect the ankles, knees, wrists, fingers and elbows. Gout may affect one or more joints, and the joints involved can change between attacks.
Yes. Some people have elevated uric acid levels without ever developing gout. Gout occurs when urate crystals form and trigger inflammation in the joints, so a high uric acid result alone does not necessarily mean that someone has gout.
No. A uric acid blood test can support the assessment, but it cannot confirm gout on its own. Uric acid levels can also be normal during an acute flare. Diagnosis may involve examining the affected joint and, where necessary, testing joint fluid for urate crystals or using imaging.
Dr Poh Yih Jia
Senior Consultant Rheumatologist
Dr Poh Yih Jia is a senior consultant rheumatologist with a special interest in lupus, arthritis and the
management of autoimmune diseases during pregnancy. Before entering private practice, she spent over a
decade at Singapore General Hospital, where she established the Rheumatology Obstetrics Clinic and
spearheaded the development of its multidisciplinary Gout Clinic.
Her work extends beyond clinical practice to improving how rheumatological conditions are managed. Dr
Poh has contributed to regional lupus collaborations and served on the expert panel for the Ministry of
Health Agency for Care Effectiveness (ACE) Clinical Guidance on Gout. She has also been actively
involved in rheumatology research, medical education and the training of future specialists.
