What are the first signs of gout?

Usually a sudden, very painful joint that comes on over a few hours, often at night. The base of the big toe is the most common place, but the ankle, top of the foot, knee, wrist or fingers can be affected. The joint is hot, red or purple and swollen, and so tender that even a bedsheet hurts. The first flare usually settles within 1 to 2 weeks.

What are the symptoms of high uric acid in women?

The same as in men: often none, and when there are symptoms, gout flares, kidney stones or, after years, lumps under the skin. Gout is less common in women and rare before menopause, because oestrogen helps the kidneys remove uric acid. After menopause the risk rises. Lab normal ranges for women are usually a little lower than for men.

Can high uric acid cause symptoms without gout?

Most people with high uric acid have no symptoms at all. When it does cause problems, it's through crystals: gout in the joints or stones in the kidneys. Tiredness, aches all over or general weakness aren't typical of high uric acid, so if you have them, ask a doctor to look for other causes rather than assuming it's uric acid.

What is a normal uric acid level?

There's no single normal range: each lab prints its own on your report, and before menopause women's levels are usually a little lower than men's. The number doctors act on is 360 micromol/L (6 mg/dL). Above it, crystals are more likely to form, and people with gout are treated to stay below it, or below 300 micromol/L (5 mg/dL) if they have lumps or frequent flares.

What uric acid level causes gout?

There isn't a level at which gout always starts. The higher the level and the longer it stays high, the more likely crystals and gout become. In someone with typical symptoms, a level of 360 micromol/L (6 mg/dL) or more supports the diagnosis. But many people above that never get gout, and a level can be normal during a flare.

Why was my uric acid normal during a gout attack?

Uric acid often drops during a flare, as crystals form in the joint and the body reacts to the inflammation. So a normal result during an attack doesn't rule gout out. If gout still seems likely, the test is repeated at least 2 weeks after the flare has settled. A joint fluid test can also confirm it by showing the crystals.

Which foods and drinks raise uric acid?

Alcohol, sugar-sweetened drinks and drinks with high fructose corn syrup, red meat, organ meats such as liver and kidney, and some seafood. Even so, no single diet is proven to prevent gout flares or lower uric acid enough on its own. A healthy, balanced diet, keeping a healthy weight and cutting down on alcohol and sugary drinks is what's advised.

Does drinking water lower uric acid?

Drinking enough fluid helps the kidneys pass uric acid, lowers the chance of kidney stones, and avoids dehydration, which can set off a flare. But water alone usually won't bring a high level down to target: for people with gout, urate-lowering medicine does most of that. If you've been told to limit fluids, for example with heart or kidney failure, follow that advice.

How long does a gout attack last?

A gout flare usually lasts 1 to 2 weeks if it isn't treated, and is often at its worst in the first day or two. Treatment started early, such as an anti-inflammatory painkiller, colchicine or steroids from a doctor, can shorten it. Without treatment that lowers uric acid, flares usually come back, and more often over time.

Gout is a long-term condition, but it can be controlled very well. Taking urate-lowering medicine every day to keep uric acid below the target dissolves the crystals over time: flares stop for most people and lumps shrink. Treatment is usually lifelong, because stopping it lets the uric acid and the crystals come back.

Can high uric acid damage the kidneys?

It can cause kidney stones, and long-standing gout is linked with kidney disease. It works the other way too: kidney disease makes it harder to clear uric acid, so levels rise. That's why doctors check kidney function (creatinine and eGFR) in people with gout or high uric acid, and why people with kidney disease are offered urate-lowering medicine if they get gout.

Can uric acid cause knee or ankle pain?

Yes, gout can affect the knee, ankle and top of the foot, not just the big toe. Gout pain comes in sudden attacks with a hot, red, swollen joint. A knee or ankle that aches slowly over months, worse with use, is more likely to be wear-and-tear arthritis. A doctor can tell them apart, sometimes with a blood test or joint fluid test.

Can young people get gout?

Gout usually starts in middle age, and women rarely get it before menopause. Younger people can get it, especially with a strong family history, kidney disease, or some medicines, and in them it can be more severe. A young person with a sudden, hot, swollen joint should see a doctor, as a joint infection or another type of arthritis needs ruling out.

High uric acid and gout symptoms: the signs, the levels, and when it needs a doctor

A uric acid number on your report, or a sudden, swollen, very painful toe? Here's what high uric acid does, what gout feels like, and what helps.

Updated November 15, 2026 · Sources

Quick answer

What are the symptoms of high uric acid?

High uric acid often causes no symptoms at all. Symptoms start when it forms crystals: gout, a sudden, very painful, hot, red and swollen joint, often the big toe, usually starting overnight; kidney stones, with severe pain in the side or lower back; or, after years, hard lumps under the skin. Only a blood test shows your level.

Ask about my symptoms Explain my report

Health information, not medical advice. Your doctor knows your full picture; ask them about your result.

Side by side

Gout vs osteoarthritis: telling joint pain apart

Gout and wear-and-tear arthritis (osteoarthritis) are both common, especially as people get older, but they start and feel very differently. These are the usual differences.

What you notice	Gout	Osteoarthritis
How it starts	Suddenly, often overnight, over a few hours	Slowly, over months or years
Which joints	Usually one joint at a time, most often the big toe; also the foot, ankle, knee, wrist, hand or elbow	Knees, hips, hands and the spine, often on both sides
How the pain behaves	Very severe during a flare, then settles within 1 to 2 weeks; often no pain between flares at first	An ache that's worse when you use the joint and better with rest
The skin over the joint	Hot, red or purple, shiny and swollen; even a bedsheet hurts	Usually a normal colour; may be a little swollen
Stiffness	Not the main problem	Stiff after resting or first thing in the morning, easing within about 30 minutes
Lumps	Hard, chalky lumps (tophi) after years of high uric acid	Bony, knobbly swelling at the finger joints
Who it affects most	Men, and women after menopause	Older adults, more often women
The test that helps tell	Uric acid blood test, sometimes a joint fluid test	Usually a doctor's examination, sometimes an X-ray

A hot, swollen joint with a fever can be an infection inside the joint (septic arthritis), which needs a doctor the same day. Calcium crystals (pseudogout) and rheumatoid arthritis can also look like gout, which is why a doctor confirms it.

What is uric acid, and when is it too high?

Uric acid is a waste product. The body makes it when it breaks down purines, natural substances found in your own cells and in some foods and drinks. Normally it dissolves in the blood and the kidneys pass it out in urine.

It builds up when the body makes too much or the kidneys don't remove enough. A high level is called hyperuricaemia. It's common, and many people with a high level never have any problem from it.

When the level stays high, though, uric acid can form tiny, needle-shaped crystals in and around the joints and in the kidneys. Those crystals cause the symptoms: gout in the joints, and kidney stones.

What counts as high? Each lab prints its own normal range on the report, and before menopause women's levels are usually a little lower than men's. The number doctors act on in the UK guideline is 360 micromol/L (6 mg/dL): at or above it, gout is more likely in someone with symptoms, and treatment for gout aims to keep the level below it. To compare units, 1 mg/dL is about 60 micromol/L.

What are the symptoms of high uric acid and gout?

Often there are none. High uric acid on its own usually causes no symptoms, and it's often found by chance on a routine blood test. Vague symptoms such as tiredness or aches all over aren't typical of high uric acid, so they're worth checking for other causes.

Gout flares are the most common symptom:

sudden, severe pain in one joint, often starting at night and building over a few hours
most often the base of the big toe, but also other joints of the foot, the ankle, knee, wrist, hand or elbow
the joint is hot, swollen and red or purple, with shiny skin, and so tender that even a bedsheet hurts
a flare usually settles within 1 to 2 weeks, even without treatment, but flares tend to come back, more often over time

Kidney stones: pain in the side of the tummy or lower back that can spread to the groin and come and go in waves, with feeling sick, needing to pee often, or cloudy pee.

After years of high uric acid:

hard, chalky lumps under the skin (tophi), on the fingers, toes, elbows or ears
joints that stay stiff and sore between flares, and joint damage

In women: gout is less common and rare before menopause, because the hormone oestrogen helps the kidneys remove uric acid. After menopause the risk rises, and the symptoms are the same as in men.

What causes high uric acid and gout?

Uric acid rises when the body makes more of it or the kidneys clear less. Things that raise it, or make gout more likely:

Alcohol, and sugar-sweetened drinks, including those with high fructose corn syrup
Purine-rich foods: red meat, organ meats such as liver and kidney, and some seafood
Overweight, high blood pressure, high cholesterol, diabetes and kidney disease
Medicines: water tablets (diuretics), low-dose aspirin, some blood pressure medicines (ACE inhibitors), ciclosporin and high-dose niacin. Don't stop a prescribed medicine on your own: ask the doctor who prescribed it.
Your genes and age: gout runs in families, is more common in men, usually starts in middle age, and becomes more likely in women after menopause
More rarely, some blood cancers and their treatment (chemotherapy)

What sets off a flare: drinking a lot of alcohol, a very large meal, not drinking enough fluid, an illness with a fever, an injury or an operation, and starting or changing some medicines.

Which tests check uric acid and confirm gout?

A uric acid blood test (also called serum urate) measures the level. In someone with typical gout symptoms, a level of 360 micromol/L (6 mg/dL) or more supports the diagnosis. The level can fall during a flare, so if it's lower and gout still seems likely, the test is repeated at least 2 weeks after the flare has settled. A high result on its own, without symptoms, doesn't mean you have gout.

Uric acid level	What it usually means
360 micromol/L (6 mg/dL) or more	Supports gout in someone with typical symptoms; many people at this level never get gout
Below 360 micromol/L (6 mg/dL)	The usual treatment target for people with gout
Below 300 micromol/L (5 mg/dL)	A lower target for people with lumps (tophi), lasting joint damage, or flares that keep coming

A joint fluid test: if the diagnosis isn't clear, a doctor draws a little fluid from the joint with a thin needle and looks for crystals under a microscope. It also checks for infection.

Scans: an X-ray, ultrasound or a special CT scan (dual-energy CT) if fluid can't be taken.

Other checks, because gout often comes with other conditions: kidney function (creatinine and eGFR), blood sugar (HbA1c), cholesterol and blood pressure. A urine test for uric acid can help when kidney stones are the problem. Our kidney disease guide explains how the kidneys fit in.

What happens if high uric acid or gout isn't treated?

High uric acid without symptoms: many people never have a problem. If you've never had gout or kidney stones, ask your doctor whether anything needs doing; often the advice is to work on the causes, such as weight, alcohol, sugary drinks and blood pressure, rather than take medicine.

Gout is different. Without treatment that lowers uric acid, new crystals keep forming, and over time:

flares come more often, last longer and spread to more joints
tophi form under the skin
joints can be permanently damaged (chronic gouty arthritis)
kidney stones become more likely

Gout also often goes with high blood pressure, kidney disease, diabetes and heart disease, so doctors check for these too. Treated well, most people with gout stop having flares and the lumps shrink.

How is gout treated, and what helps lower uric acid?

During a flare:

rest the joint and raise it, keep bedsheets off it, and cool it with an ice pack wrapped in a towel
drink plenty of fluids
a doctor may offer an anti-inflammatory painkiller (an NSAID), colchicine, or a short course of steroid tablets; the sooner it's started, the better it works

Lowering uric acid for the long term: doctors offer urate-lowering medicine, usually allopurinol or febuxostat, to people with repeated or troublesome flares, kidney disease, tophi, joint damage, or who take water tablets, and discuss it with anyone who has had a flare. It's usually started 2 to 4 weeks after a flare settles, increased step by step with blood tests until the level is on target, and taken long term, often for life. Flares can happen in the first months, so a doctor may add medicine to prevent them: keep taking the urate-lowering medicine.

Habits that help:

keep to a healthy weight, and lose weight slowly if you need to
cut down on alcohol and sugary drinks, and have alcohol-free days
drink enough water through the day
stay active in ways that are gentle on painful joints, and stop smoking

No single "uric acid diet" is proven to prevent flares or lower uric acid; a healthy, balanced diet is what's advised.

Which medicine, and how much, is your doctor's decision. Anti-inflammatory painkillers aren't safe for everyone, for example with kidney disease, stomach ulcers or some heart conditions, so ask a pharmacist or doctor first. Be wary of "uric acid cure" powders, teas and supplements sold online: ask a doctor or pharmacist before trying them.

When to see a doctor

Book an appointment

A first attack of sudden joint pain and swelling: see your GP or family doctor within a few days, even if it's settling.
Gout flares that keep coming back, or treatment that isn't helping: see your GP within a week or two.
Hard lumps under the skin, or joints that stay sore between flares: book a GP appointment within a few weeks.
A high uric acid result without symptoms: talk about it at your next routine visit, and ask whether your kidneys, blood pressure and blood sugar need checking.
Taking urate-lowering medicine: have your uric acid checked as often as your doctor advises, and don't stop the medicine during a flare unless your doctor tells you to.

Get emergency help now (call your local emergency number) if someone has:

a hot, swollen, painful joint with a high temperature, shivering, or feeling very unwell
severe pain in the side or lower back with a fever or shivering
severe side or back pain and can't pee, or pain that painkillers don't ease, with vomiting

High uric acid and gout are long-term conditions managed over years. These signs are the exceptions that can't wait: an infected joint or a blocked, infected kidney can be damaged quickly.

A painful joint, or a uric acid number you don't understand? Talk it through.

Saluvo listens to your symptoms in your own words and language, asks the right follow-up questions, and tells you which doctor to see and how soon. Already have blood test results? It explains every value, uric acid included.

Ask about my symptoms

Free to start. Describe what you feel in your own words and language.

Questions people ask

Usually a sudden, very painful joint that comes on over a few hours, often at night. The base of the big toe is the most common place, but the ankle, top of the foot, knee, wrist or fingers can be affected. The joint is hot, red or purple and swollen, and so tender that even a bedsheet hurts. The first flare usually settles within 1 to 2 weeks.
The same as in men: often none, and when there are symptoms, gout flares, kidney stones or, after years, lumps under the skin. Gout is less common in women and rare before menopause, because oestrogen helps the kidneys remove uric acid. After menopause the risk rises. Lab normal ranges for women are usually a little lower than for men.
Most people with high uric acid have no symptoms at all. When it does cause problems, it's through crystals: gout in the joints or stones in the kidneys. Tiredness, aches all over or general weakness aren't typical of high uric acid, so if you have them, ask a doctor to look for other causes rather than assuming it's uric acid.
There's no single normal range: each lab prints its own on your report, and before menopause women's levels are usually a little lower than men's. The number doctors act on is 360 micromol/L (6 mg/dL). Above it, crystals are more likely to form, and people with gout are treated to stay below it, or below 300 micromol/L (5 mg/dL) if they have lumps or frequent flares.
There isn't a level at which gout always starts. The higher the level and the longer it stays high, the more likely crystals and gout become. In someone with typical symptoms, a level of 360 micromol/L (6 mg/dL) or more supports the diagnosis. But many people above that never get gout, and a level can be normal during a flare.
Uric acid often drops during a flare, as crystals form in the joint and the body reacts to the inflammation. So a normal result during an attack doesn't rule gout out. If gout still seems likely, the test is repeated at least 2 weeks after the flare has settled. A joint fluid test can also confirm it by showing the crystals.
Alcohol, sugar-sweetened drinks and drinks with high fructose corn syrup, red meat, organ meats such as liver and kidney, and some seafood. Even so, no single diet is proven to prevent gout flares or lower uric acid enough on its own. A healthy, balanced diet, keeping a healthy weight and cutting down on alcohol and sugary drinks is what's advised.
Drinking enough fluid helps the kidneys pass uric acid, lowers the chance of kidney stones, and avoids dehydration, which can set off a flare. But water alone usually won't bring a high level down to target: for people with gout, urate-lowering medicine does most of that. If you've been told to limit fluids, for example with heart or kidney failure, follow that advice.
A gout flare usually lasts 1 to 2 weeks if it isn't treated, and is often at its worst in the first day or two. Treatment started early, such as an anti-inflammatory painkiller, colchicine or steroids from a doctor, can shorten it. Without treatment that lowers uric acid, flares usually come back, and more often over time.
Gout is a long-term condition, but it can be controlled very well. Taking urate-lowering medicine every day to keep uric acid below the target dissolves the crystals over time: flares stop for most people and lumps shrink. Treatment is usually lifelong, because stopping it lets the uric acid and the crystals come back.
It can cause kidney stones, and long-standing gout is linked with kidney disease. It works the other way too: kidney disease makes it harder to clear uric acid, so levels rise. That's why doctors check kidney function (creatinine and eGFR) in people with gout or high uric acid, and why people with kidney disease are offered urate-lowering medicine if they get gout.
Yes, gout can affect the knee, ankle and top of the foot, not just the big toe. Gout pain comes in sudden attacks with a hot, red, swollen joint. A knee or ankle that aches slowly over months, worse with use, is more likely to be wear-and-tear arthritis. A doctor can tell them apart, sometimes with a blood test or joint fluid test.
Gout usually starts in middle age, and women rarely get it before menopause. Younger people can get it, especially with a strong family history, kidney disease, or some medicines, and in them it can be more severe. A young person with a sudden, hot, swollen joint should see a doctor, as a joint infection or another type of arthritis needs ruling out.

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Updated November 15, 2026. Health information, not medical advice. Your doctor knows your full picture; ask them about your result.