Gout: symptoms, uric acid, attack relief and when to see a doctor

Gout is a type of arthritis that causes sudden, very painful attacks in a joint, most often the big toe. Many Filipinos call any joint pain rayuma, and people with gout often say "may uric acid ako" (I have uric acid).

Your body makes uric acid when it breaks down purines, natural substances in your cells and in many foods. Normally the kidneys pass it out in your pee. When too much builds up for a long time, it can form tiny, needle-shaped crystals in a joint. The body reacts to the crystals, and the joint becomes red, hot, swollen and painful. This is a gout attack, or flare.

With early care, the right medicines and healthier habits, gout is one of the most controllable kinds of arthritis.

A gout attack usually starts suddenly, often at night or early morning:

• Severe pain in one joint. Gout in the toes, especially the big toe, is the classic sign. It can also hit the foot, ankle or knee, and less often the hands, wrists or elbows.
• Swelling, warmth and redness. Redness is harder to see on brown skin, so feel for heat and look for shiny, tight skin.
• Pain at the lightest touch. Even a blanket over the toe can hurt.
• Sometimes a fever. A fever with a hot, swollen joint always needs a same-day check (see below).

Without treatment, an attack usually lasts 1 to 2 weeks. Between attacks there may be no symptoms. If uric acid stays high, attacks tend to come more often and last longer.

Over years, untreated gout can cause tophi (hard lumps of uric acid under the skin, usually on the ears, fingers or elbows), joint damage and kidney stones.

A red, hot, swollen joint is not always gout. A joint infection can look the same and is an emergency, especially with fever or chills.

Uric acid builds up when the body makes too much or the kidneys pass out too little. In most people with gout, the kidneys pass out too little.

Your chance of gout is higher if you:

• Are a man, especially from middle age. Women can get gout too, mostly after menopause.
• Have family members with gout.
• Are overweight.
• Drink alcohol, especially beer.
• Eat a lot of red meat, organ meats (lamang-loob) or some seafood, or drink many sweet drinks.
• Have high blood pressure, diabetes, kidney disease, heart failure or high cholesterol.
• Take some medicines, such as water pills (diuretics like hydrochlorothiazide), some other blood pressure medicines, or low-dose aspirin.

Filipinos and gout. Filipinos in the United States have been reported to have more gout and high uric acid than other groups. A 2020 study of Filipino women in Hawaii found a gene variant linked to gout much more often than in samples from other groups. The researchers think genes may be part of the reason gout is common among Filipinos.

Common triggers are a heavy inuman session or a very large meal (fiestas, holidays), not drinking enough water, an illness with fever, a joint injury and surgery.

A doctor will ask about your symptoms, food, drinks and medicines, and examine the joint. Tests may include:

• Uric acid blood test. A result above about 7.2 milligrams per deciliter (mg/dL) is usually called high. Some labs use other units, so read the normal range printed on your result.
• Joint fluid test. A doctor takes a little fluid from the joint with a thin needle and looks for crystals. This also helps rule out infection.
• Ultrasound or X-ray if the cause is still unclear.
• Kidney tests such as creatinine and urinalysis, because your kidneys affect which medicines are safe.

Two things to know:

1. Uric acid can look normal during an attack. The UK's NICE guideline advises repeating the test at least 2 weeks after the attack settles if gout is still likely.
2. High uric acid is not the same as gout. Many people with high uric acid never get gout, and a high result without symptoms does not always need medicine.

Where to start: your barangay health station, rural health unit (RHU), health center or PhilHealth YAKAP clinic. PhilHealth's published primary care lab list includes creatinine and urinalysis, but the version we checked did not include a uric acid test, so you may pay for it at a lab. Ask your clinic first.

Treat a gout attack early: the sooner you start, the faster it usually settles. If your doctor gave you medicine for attacks, take it as soon as one starts. It often begins to work within 2 days.

Medicines doctors use

• NSAID pain relievers such as ibuprofen or naproxen. Some are sold without a prescription, but ask a doctor or pharmacist first. They can cause stomach ulcers and bleeding and raise the risk of heart attack and stroke. They may not be safe if you are older, pregnant, have kidney or heart disease or a past ulcer, or take blood thinners or steroids.
• Colchicine, a prescription medicine. Taking more than prescribed can be very dangerous. It may not suit people with kidney or liver disease, it reacts with some other medicines, and you should not eat grapefruit or drink grapefruit juice while taking it.
• Steroid medicines (corticosteroids) such as prednisone, as a short course of tablets. An injection into the joint or muscle is an option when other medicines are not suitable or do not work.
• Paracetamol can ease pain but does not calm the swelling.

Your doctor chooses based on your kidneys, heart, stomach and other medicines. This guide gives no doses: follow your doctor or pharmacist, and do not share gout medicines with family.

Home care during an attack

• Rest and raise the joint on a pillow.
• Keep it cool with an ice pack wrapped in a towel, for up to 20 minutes at a time. Never put ice right on the skin.
• Drink plenty of water, unless your doctor limits fluids.
• Keep blankets off the joint at night.
• Do not press or massage it. Hilot or hard rubbing can make the pain worse.
• Skip alcohol until the attack is over.

Not sure what is safe with your other medicines? Ask our free AI symptom guide, ask a nurse or book a call.

Attack medicines calm the swelling but do not remove the crystals. To stop attacks coming back, many people need a daily prescription medicine that lowers uric acid, such as allopurinol or febuxostat. Doctors usually offer it if you have repeated attacks, tophi, joint damage, kidney disease or kidney stones, or take water pills.

What to expect:

• The doctor starts low and checks your uric acid about once a month, raising the dose slowly. A common goal is below 6 milligrams per deciliter, or lower if you have tophi.
• Attacks can increase in the first months as crystals dissolve. Your doctor may add colchicine to prevent them. Keep going: attacks become fewer.
• It is usually lifelong. Keep taking it even when you feel well, and do not stop it during an attack without talking to your doctor. If you run out or cannot afford it, talk to your doctor or YAKAP clinic instead of stopping.
• Watch for a rash. Rarely, allopurinol causes a serious skin reaction (see the red box).

If you take water pills or low-dose aspirin for your heart or blood pressure, do not stop them on your own because of gout. Ask your doctor. See also our guides on high blood pressure and chronic kidney disease.

Gout needs regular follow-up. These can lower the cost:

• PhilHealth YAKAP clinics give free check-ups to the people registered with them. A private YAKAP clinic may charge up to ₱900 per patient for the whole year (as of mid-2025). See our PhilHealth YAKAP guide.
• Medicines through GAMOT. Medicines your YAKAP doctor prescribes from the GAMOT list are free at accredited pharmacies, up to ₱20,000 per person a year. As of 2026, the list includes colchicine and naproxen for acute gout, and ibuprofen. Prednisone and paracetamol are also on PhilHealth's list of 21 medicines that YAKAP clinics keep (January 2026). The lists we checked did not include allopurinol or febuxostat, so ask your YAKAP clinic what is covered.
• Lab tests such as creatinine and urinalysis are covered when your YAKAP doctor orders them.
• Malasakit Centers are one-stop offices in hospitals where you can ask the DOH, PhilHealth, PCSO and DSWD for medical and financial help in one place, for example if you need hospital care for a joint infection or kidney stones. See our Malasakit Center guide.

To find a health center or clinic near you, use Find care.

There is not enough proof that any special diet prevents attacks or lowers uric acid, and food changes do not replace medicine. Still, a healthy, balanced diet and these habits help:

• Drink less alcohol, especially beer. Have several alcohol-free days each week.
• Drink plenty of water, unless your doctor limits fluids.
• Limit sweet drinks and snacks, such as soft drinks and sweetened juice or milk tea. Their fructose (fruit sugar) can raise uric acid.
• Eat red meat, organ meats and shellfish less often, in small portions. Lamang-loob dishes such as dinuguan, bopis, isaw and papaitan are examples.
• Fill up on vegetables, less-sweet fruits, whole grains, beans, nuts and milk products.
• Lose weight slowly if you are overweight. Avoid crash diets.
• Stay active with walking, swimming or biking, without pounding sore joints.
• Stop smoking.
• Ask your doctor before taking vitamin C or other supplements.

These habits also protect your blood pressure, blood sugar and heart. For more on eating well and weight, see our guide to preventing diabetes.

"Bawal ang monggo at tokwa." (Beans and tofu cause gout.) Health guidance lists beans and other legumes among healthy foods for people with gout. Beer, organ meats, red meat and sweet drinks matter more.

"A hot compress or liniment will melt the uric acid." There is no proof that heat or rubbing removes crystals, and pressing the joint can hurt more. Gout guidance advises a wrapped ice pack instead.

"I feel fine, so I can stop my uric acid medicine." Stopping lets crystals build up again, and attacks return.

"Gout only comes from eating too much." Genes, kidneys and some medicines matter too. There is no need for shame.

"Herbal tea can replace my medicine." Herbal teas are not among the treatments that gout guidelines recommend, and they are not a substitute for uric acid medicine. Tell your doctor and pharmacist about any herbal product you take, because some can mix badly with medicines.