Gout
Gout is an inflammation of a joint caused by uric acid crystals. You notice it as sudden, severe pain in one joint, often the big toe, which turns red, warm and swollen. One value in your blood goes with it: uric acid. An attack in the big toe is called podagra.
What are the symptoms of gout?
How strong is the evidence?
- strong
- In the Dutch guideline, or confirmed in several controlled trials.
- fair
- From one controlled trial, an international guideline or a review of research.
- limited
- The research does not point one way.
Evidence as of October 2026. New research can shift this.
A raised uric acid you do not feel. Most people with a raised uric acid never get a gout attack, and between two attacks gout is free of complaints while uric acid usually stays high. A value alone is therefore not a diagnosis, and an attack in a joint other than the big toe is often missed.
None of these complaints belongs to gout alone, and a measurement explains no complaint: the reading and the diagnosis belong with your GP. The complaint list follows the Dutch GP guideline on arthritis (NHG).
How does gout develop?
Gout starts with a high uric acid, long before you notice anything.
- Your uric acid is too highYou do not feel it.Your uric acid
- An attackCrystals in a joint suddenly cause severe pain, usually in one joint.
- Lumps under the skinIf your uric acid stays high for years, crystals can build up.
When is your uric acid too high?
Normal for men:
0.21 to 0.42 mmol/L
Enter your value as it appears on your results. Range for adults.
No value yet? How to get it measured
What do you do about gout?
Cooling and an anti-inflammatory
Have your uric acid measured
A medicine that lowers uric acid
Less beer, soft drinks and meat
The timings follow the Dutch GP guideline on arthritis (NHG) and Thuisarts.nl.
What causes gout?
Excretion
Most common
Excretion
Most common- Reduced kidney function, in about 25% of people with gout
- Water tablets (diuretics), which slow the removal of uric acid
- Some other blood pressure medicines, such as beta blockers and ACE inhibitors
Production and diet
Cause not proven
Production and diet
Cause not proven- Alcohol, beer in particular
- Fructose-rich soft drinks
- A lot of meat and fish
Predisposition and age
Predisposition and age
- Age: gradually from puberty in men, faster after the menopause in women
- Gout in the family, which about 25% of people with proven gout report
How to get gout measured
Every value below has its own page: what is normal, and what your value means.
| Value | What it shows | Points here when |
|---|---|---|
| Uric aciddefining | The substance itself. Above 0.35 mmol/L it is called hyperuricaemia, while labs call up to 0.42 normal in men. | high |
And 8 values that complete the picture
| Value | What it shows | Points here when |
|---|---|---|
| eGFR | Kidney function, and the main reason uric acid climbs: in about 25% of people with gout it sits below 60. | low |
| CRP | Rises with the inflammation during an attack and falls again afterwards. Says nothing about the cause. | high |
| Triglycerides | Raised uric acid often travels with the metabolic syndrome; the fats show that side. | high |
| Fasting glucose | The same side: the sugar handling that often derails together with gout. | high |
Also in this test
- The comprehensive test (€229, single test) measures the values on this page.
- Every draw is fasted: nothing to eat or drink from midnight, only water. Appointments are therefore in the morning, until 12:00.Your uric acid can also be measured during an attack.
- You can draw at 600+ locations near you, no referral needed. See the locations
- Results within 24 hours of analysis, in the app.
What is gout?
Uric acid is a waste product of metabolism, from the breakdown of purines from your own cells and from meat, fish and beer. Two thirds leave the body through the kidneys, a third through the gut, and the vast majority is taken back by the kidneys. If the concentration in the blood rises above what is soluble, crystals can form. If those land in a joint, the immune system responds with a fierce inflammation: the gout attack. How the crystals exactly end up in a joint is largely unknown, but what lifts uric acid is not. It rises with age, in men gradually from puberty and in women faster after the menopause, and further with belly fat and insulin resistance, which make the kidneys excrete less, with alcohol and above all beer, with fructose from soft drinks, with a lot of meat and offal, with diuretics, and with a kidney function that declines. Disposition counts: in about 25% gout runs in the family. During an attack uric acid is raised in about 95% of cases, and a normal value during an inflamed joint makes gout unlikely. Between attacks the joint is quiet, and uric acid meanwhile usually still just as high. Gout often goes together with high blood pressure, in 50%, with cardiovascular disease, about 30%, and with a reduced kidney function, about 25%, because the same belly and the same kidneys sit behind all three.
What is gout confused with?
Each with the one value that tells the two apart.
Pseudogout (CPPD)
Also a crystal arthritis, but of calcium pyrophosphate, often in knee or wrist and at older age. Uric acid does not separate the two; only joint fluid under the microscope does.
Bacterial arthritis
The same fierce inflammation of one joint, but with fever and feeling ill, and an emergency. CRP is high in both; a puncture of the joint decides.
Rheumatoid arthritis
A creeping start, several small joints on both sides. Rheumatoid factor and anti-CCP belong to that picture, uric acid does not.
Frequently asked questions
Mostly in the big toe: in 50 to 70% it is first the base joint of that toe, but foot, ankle, knee and wrist also occur. An attack starts suddenly, often within a day: the joint becomes severely painful, red, warm and swollen, so tender that a sheet already hurts. After longer-standing gout whitish-yellow lumps can form under the skin, the tophi. Between attacks there is nothing to feel, and precisely then uric acid can be lowered.
Sources 3
- 1.NHG-Standaard Artritis. 2017. richtlijnen.nhg.org
- 2.Richette P et al., 2016 updated EULAR evidence-based recommendations for the management of gout, Annals of the Rheumatic Diseases. 2017. doi.org
- 3.Thuisarts.nl, Ik heb jicht. 2025. thuisarts.nl
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This page explains what a result means. It is not a diagnosis and not treatment advice. Discuss complaints or an abnormal value with your doctor.
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