Can stress cause gout?

In this article:

• Does stress cause gout?
• The science behind stress and uric acid
• Managing stress to control gout
• How to treat a gout flare-up

In this article

• Does stress cause gout?
• The science behind stress and uric acid
• Managing stress to control gout
• How to treat a gout flare-up

Gout is a form of inflammatory arthritis that affects the joints. It results from inflammation triggered by uric acid crystals deposited in the joints in individuals with elevated uric acid levels in the blood ( hyperuricemia). Not everyone who has hyperuricemia develops gout. Gout flares often come on suddenly at night, causing throbbing pain, redness, swelling, and tenderness that lasts a few days to a few weeks. Symptoms commonly start in the big toes, but gout attacks can also affect the ankles, knees, elbows, wrists, and fingers. While stress can trigger gout flare-ups, it does not directly cause gout. Luckily, stress-reduction techniques can help keep these types of flares at bay.

Does stress cause gout?

Gout typically develops in patients with hyperuricemia or chronically elevated uric acid levels in the blood. “Stress can impact your hormonal balances and metabolism, potentially affecting how uric acid is processed in your body,” says  Raj Dasgupta, MD, a quadruple board-certified physician specializing in internal medicine based in California. Additionally, stress-related behaviors, like a poor diet and increased alcohol intake, can elevate uric acid levels and trigger gout flare-ups, adds Dr. Dasgupta.

Uric acid forms as a byproduct when the body breaks down the endogenous chemicals called purines, which are also found in red meat, alcohol, high fructose corn syrup, and shellfish like shrimp, scallops, mussels, and lobster. Normally, uric acid is dissolved in the blood, traveling through the kidneys before being eliminated in the urine. But when levels get too high, and the kidneys can’t remove them, needle-like uric acid crystals build up in tissues, potentially leading to gout or kidney stones.

There are four stages of gout:

• Hyperuricemia, which can be asymptomatic
• Gout flares, or acute attacks of intense pain and swelling in the joints
• Interval or intercritical gout, the time between gout flares when no symptoms are present
• Tophi, late-state gout, a buildup of crystals in the skin or other areas of the body that can lead to irreversible damage to the joints, kidneys, and other internal organs

Men are at a higher risk of developing the condition, as are women after menopause.

According to Dr. Dasgupta, several health conditions and lifestyle factors can put you at increased risk of gout, including:

• Obesity
• High blood pressure
• Chronic kidney disease
• Consuming excessive amounts of alcohol
• Consuming large quantities of meat or seafood
• Taking medications that affect blood levels of urate, such as immunosuppressants or diuretics

Like other forms of arthritis, gout causes pain and inflammation in the joints.

RELATED: Understanding risk factors for gout

The science behind stress and uric acid

Stress doesn’t directly cause gout, but it might increase oxidative stress in the body, and uric acid is a byproduct of these reactions, says Elizabeth Sharp, MD, a board-certified internal medicine physician and founder of Health Meets Wellness. “Higher levels of uric acid can be correlated with higher levels of oxidative stress if uric acid is not cleared through the kidneys and intestines,” Dr. Sharp says.

A growing body of evidence has shown that oxidative stress can contribute to increased uric acid levels. For example, a 2022 research review and meta-analysis point to a link between increased uric acid levels and oxidative stress from cardiovascular disease, chronic kidney disease, and diabetes mellitus or metabolic syndrome. Even so, more data is needed to establish a direct cause-and-effect relationship, Dr. Sharp says.

The connection between stress and uric acid also lies in the body’s stress response. When your body is under physical or emotional stress, it releases cortisol, a hormone that increases the production of uric acid. A recent study found a strong correlation between high levels of cortisol from stress and anxiety and high levels of uric acid. Dr. Dasgupta points out that, over time, too much uric acid can contribute to hyperuricemia and chronic gout.

Managing stress to control gout

Incorporating stress-reduction techniques into your daily routine can help manage stress and control gout flare-ups. Drs. Dasgupta and Sharp recommend the following tips:

• Engaging in regular exercise
• Eating a balanced diet that avoids gout triggers
• Getting enough sleep (seven to nine hours)
• Using relaxation techniques like meditation, yoga, or breathwork
• Talking to a therapist or counselor

RELATED: 6 surprising ways stress can affect your body

How to treat a gout flare-up

“The goal of treatment of gout flares is to quickly and safely reduce inflammation and therefore pain and disability,” says Dr. Dasgupta. The best medications for gout flares include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as over-the-counter Advil (ibuprofen) or Aleve (naproxen), and prescription Indocin (indomethacin) or Celebrex (celecoxib).
• Colicine, an anti-inflammatory medication that reduces gout side effects (brand names include Colcrys, Gloperba, and Mitigare).
• Corticosteroids, such as prednisone, to reduce swelling.

The ultimate goal for managing gout and preventing flares is to treat hyperuricemia—to reduce the level of uric acid in the body—by using the following urate-lowering medications:

• Allopurinol and Uloric (febuxostat) to block uric acid production.
• Probalan (probenecid) to help your kidneys remove excess uric acid from the body.

Typically, providers also prescribe anti-inflammatory medications like NSAIDs or colchicine for the initial 3 to 6 months of starting urate-lowering therapy.

Additionally, the following lifestyle changes can help prevent gout flares:

• Lose weight if you are overweight or obese to decrease the frequency of your gout flares as well as uric acid levels.
• Follow the Dietary Approaches to Stop Hypertension (DASH) diet to improve your blood pressure and lower urate levels. The DASH diet is high in whole grains, fruits and vegetables, and low-fat dairy, and low in saturated fats and sugary foods and drinks.
• Avoid purine-rich foods, including alcohol, shellfish, red meat, organ meat, and sugar-sweetened beverages like soda.
• Stay hydrated. While you can’t “flush out” gout, Dr. Sharp says that adequate fluid intake can help lower uric acid levels; on the flip side, dehydration can trigger a flare. Try drinking 16 eight-ounce servings of water daily to keep gout pain at bay.
• Get regular exercise when you’re symptom-free to prevent future flares. However, during a gout flare—when the inflammatory process is at its worst—you should rest, advises Dr. Dasgupta. “Consider elevating your legs if the pain is affecting your lower body,” he recommends.

By effectively managing stress and following appropriate treatment strategies, you can reduce the frequency and severity of gout flare-ups. Contact a healthcare provider, such as a rheumatologist, for advice on the best treatment plan for you.

RELATED: What foods does the DASH diet include?