What Causes Gout to Flare Up? The Biomarkers Behind the Pain
A gout flare is not random. Something in your body triggered it – too much uric acid, inflammation, or your immune system overreacting. Blood tests can measure exactly what is going on.
Gout happens when there is too much uric acid in your blood. The excess uric acid forms tiny, needle-shaped crystals that settle in your joints – most commonly the big toe, but also ankles, knees, wrists, and elbows. Your immune system treats these crystals like a threat and attacks them, causing intense inflammation. That is a gout flare: sudden, severe pain, swelling, redness, and heat.
The good news: the things that trigger flares are measurable. A blood test can show you exactly what is out of balance – and give you a clear starting point for getting it under control.
8 Things That Cause Gout to Flare Up
🍖 Purine-Rich Foods
Red meat, organ meats (liver, kidneys, brains), shellfish, and sardines contain purines – a natural compound your body converts into uric acid. One heavy braai weekend can push your uric acid high enough to trigger a flare.
🍺 Alcohol
Beer is the worst – it contains purines AND slows your kidneys from flushing out uric acid. A double hit. Spirits are moderate risk. Wine has the least effect, but too much of any alcohol raises your levels.
💧 Dehydration
When you are dehydrated, uric acid becomes more concentrated in the blood. South Africa's hot climate, combined with insufficient water intake, makes dehydration a common and underappreciated trigger – especially for outdoor workers and athletes.
🍬 Sugary Drinks and Fructose
The sugar in cool drinks, fruit juice, and sweets (fructose) is the only carbohydrate that directly increases uric acid production. Regular consumption of sugary drinks is strongly linked to gout.
⚖️ Rapid Weight Change
Both gaining weight quickly and crash dieting can trigger flares. Weight gain increases uric acid; crash diets cause your body to break down tissue fast, releasing purines. Slow, steady weight loss is safer.
💉 Kidney Function
Your kidneys flush out about two-thirds of the uric acid your body makes. If your kidneys are not working at full capacity – even slightly – uric acid builds up. Kidney disease and gout often go hand in hand, making each other worse.
🚔 Physical Stress or Injury
An injury, surgery, or intense exercise can knock loose uric acid crystals that were already sitting in your joints, triggering a flare. This is why gout sometimes hits after an injury to a completely different part of your body.
🧠 Chronic Stress
Stress raises cortisol, which increases inflammation and can slow your kidneys down. It also leads to poor food choices, not drinking enough water, and bad sleep – all of which make gout worse.
Gout gets worse over time if left unchecked. Flares become more frequent, last longer, and spread to more joints. Uric acid crystals can also form visible lumps under the skin (called tophi) and permanently damage your joints and kidneys. Knowing your numbers is the first step to stopping this cycle.
The Biomarkers Behind Gout: What Each Test Measures
Epicentre offers three levels of gout testing. The markers below explain what each test checks and why it matters for gout. The Functional Gout Testing Panel (R5,708) includes all 21. The Essential Panel (R3,863) includes 17. The Arthritis Profile Bundle (R949) covers the 6 core markers.
Uric Acid (UA)
The main gout test. Measures how much uric acid is in your blood. High levels (called hyperuricaemia) confirm your body is making too much, flushing out too little, or both. One important catch: uric acid can look normal during a flare because your body is actively turning it into crystals. Testing between flares gives the most accurate reading.
Normal: <0.42 mmol/L (men) | <0.36 mmol/L (women)C-Reactive Protein (CRP)
A protein your liver releases when there is inflammation anywhere in your body. During a gout flare, CRP shoots up – often 10 to 20 times higher than normal. If CRP stays elevated between flares, it means your body is still inflamed even when you feel fine – a sign that crystals are still causing damage quietly.
Normal: <5 mg/L | Gout flare: often 50 – 200+ mg/LErythrocyte Sedimentation Rate (ESR)
Measures how fast your red blood cells settle in a test tube – the faster they settle, the more inflammation you have. ESR goes up during flares and can stay high for weeks afterwards. It tells you whether the inflammation is actually going away or just hurting less.
Normal: <15 mm/hr (men) | <20 mm/hr (women)Full Blood Count (FBC)
A general blood health check. High white blood cells during a flare confirm your immune system is actively fighting. Low red blood cells (anaemia) can point to chronic disease. The FBC also helps rule out infection, which can look very similar to gout.
Rheumatoid Factor (RF)
Helps tell the difference between gout and rheumatoid arthritis (RA). Both cause joint pain and swelling, but gout comes from uric acid crystals while RA is your immune system attacking your own joints. About 5 – 10% of gout patients also have RA, which is why testing for both matters.
Antinuclear Antibody (ANA)
Checks whether your immune system might be attacking your own body – a sign of autoimmune conditions like lupus, which can cause joint pain that looks a lot like gout. A positive result does not mean you have lupus, but it tells your doctor to investigate further.
Anti-Cyclic Citrullinated Peptide (Anti-CCP)
The most accurate blood test for rheumatoid arthritis – even more specific than RF. It can detect RA years before it becomes severe. If your joint pain has been called gout but does not quite fit the pattern – pain in both hands, stiffness for over an hour every morning, or small joints affected – this test can confirm or rule out RA.
Fasting Glucose, HbA1c & Fasting Insulin
Insulin resistance is one of the biggest hidden drivers of high uric acid. When your insulin is too high, your kidneys cannot flush uric acid out properly. HbA1c shows your average blood sugar over 2 – 3 months. Fasting insulin catches the problem early – often before blood sugar itself looks abnormal. Many standard tests miss this.
Lipogram (Cholesterol, HDL, Triglycerides, LDL)
Metabolic syndrome – high triglycerides, low "good" cholesterol (HDL), belly fat, and insulin resistance – is closely linked to gout. High triglycerides in particular go hand in hand with high uric acid. This test checks whether metabolic syndrome is part of your picture.
Urea, Electrolytes & Creatinine (U&E)
Your kidneys flush out about two-thirds of the uric acid your body makes. Creatinine and eGFR show how well your kidneys are filtering. Even a small drop in kidney function can cause uric acid to build up. Gout and kidney disease often feed off each other.
Liver Function Test (LFT)
Your liver is where uric acid gets made. If your liver is not working well – from fatty liver, alcohol damage, or other causes – it can overproduce uric acid. This test also gives a baseline before starting any treatment that might affect the liver.
TSH & Free T4 (Thyroxine)
An underactive thyroid slows your kidneys down, which means less uric acid gets flushed out. This is a surprisingly common and often overlooked reason for high uric acid. If your thyroid is the problem, treating it can bring uric acid down without any other changes.
Magnesium
Low magnesium is linked to higher uric acid and more inflammation. Your body uses magnesium in over 300 processes, including how it handles purines. Magnesium deficiency is common in South Africa and easy to fix once you know about it.
Vitamin D
Low vitamin D is linked to higher uric acid and more inflammation throughout your body. It also helps regulate your immune system – which matters because a gout flare is essentially your immune system overreacting to crystals. Surprisingly common in sunny South Africa due to sunscreen, indoor work, and darker skin producing less vitamin D.
Additional markers in the Comprehensive Panel
Apolipoprotein A/B
Goes deeper than a standard cholesterol test by measuring the actual particles – protective ones (ApoA) and harmful ones (ApoB). People with gout have a much higher risk of heart disease, and this test catches that risk when standard cholesterol numbers look fine.
LDH (Lactate Dehydrogenase)
Shows how much cell damage is happening in your body. When cells break down faster than normal – from illness, intense exercise, or other stress – they release purines, which your body turns into uric acid. High LDH means more raw material for uric acid production.
hs-CRP (Ultrasensitive CRP)
A more sensitive version of the CRP test that picks up low-level inflammation that standard CRP misses. If hs-CRP is elevated between flares, it means inflammation is quietly simmering in your body even when you feel fine – raising your heart disease risk. Only in the Comprehensive panel.
Vitamin B12
Your liver needs B12 to process waste efficiently, including the purines that turn into uric acid. When B12 is low, your liver struggles to keep up, and uric acid can rise as a result. Common in vegetarians, vegans, and older adults.
Zinc
Zinc controls the enzyme that converts purines into uric acid. When zinc is low, that enzyme can go into overdrive, producing more uric acid than it should. Zinc also supports your immune system and healing – both relevant when gout is causing joint damage.
Why test more than just uric acid? Because gout is rarely just a uric acid problem. It overlaps with blood sugar issues, kidney problems, metabolic syndrome, thyroid problems, and vitamin deficiencies – all of which can push uric acid higher. Testing the full picture in one blood draw tells your doctor exactly what to target.
Should You Get Your Biomarkers Tested?
Gout in South Africa
Urban and Suburban South Africans
Braai culture, beer, and red meat are part of everyday life in South Africa – and all of them drive uric acid up. Gout is often brushed off as a "lifestyle thing" without anyone actually checking the numbers. A single blood test shows you exactly where you stand.
Lower-Income Communities
Seeing a specialist for joint pain is extremely difficult in public healthcare. Many people are diagnosed and treated without blood tests to confirm what is actually going on. Walking into an Epicentre branch requires no doctor's referral and no appointment.
Chronic Kidney Disease Patients
South Africa has high rates of kidney disease, driven by diabetes and high blood pressure. When kidneys struggle, uric acid builds up. If you have kidney issues and keep getting joint pain, tracking your uric acid and inflammation levels is especially important.
Which Gout Panel Is Right for You?
Functional Gout Testing Panel – 21 Tests
Functional Gout Panel (Essential) – 17 Tests
Arthritis Profile Bundle – 6 Tests
Not sure which panel? The Functional Gout Testing Panel (R5,708, 21 tests) is the most comprehensive option – it maps every upstream driver including cardiovascular risk (Apolipoprotein A/B), cell turnover (LDH), ultrasensitive inflammation (hs-CRP), and the full nutritional picture (B12, Zinc, Vitamin D, Magnesium). The Essential Panel (R3,863, 17 tests) covers the core functional systems at a lower price point by excluding those advanced markers. The Arthritis Profile Bundle (R949, 6 tests) is the entry-level option for confirming gout and differentiating from RA. All three are customisable – add or remove any test.
Frequently Asked Questions
What Triggers a Gout Flare-Up?
What Blood Tests Diagnose Gout?
Can Gout Be Confused with Rheumatoid Arthritis?
What Uric Acid Level Indicates Gout?
Can Diet Alone Control Gout?
Do I Need a Doctor's Referral?
References
- Dalbeth, N. et al. (2021). Gout. The Lancet, 397(10287), 1843 – 1855.
- FitzGerald, J.D. et al. (2020). American College of Rheumatology Guideline for Management of Gout. Arthritis Care & Research, 72(6), 744 – 760.
- Bardin, T. & Richette, P. (2017). Impact of comorbidities on gout and hyperuricaemia. Rheumatology, 56(suppl 1), i48 – i52.
Related Tests and Packages
Kidney Function Tests
Creatinine, eGFR, urea – your kidneys excrete 70% of uric acid. Even mild impairment causes build-up.
View tests →Diabetes Screening
HbA1c, fasting glucose, insulin – insulin resistance is one of the strongest drivers of hyperuricaemia.
View package →Heart Health Panel
Lipogram, cardiovascular risk markers – gout doubles your risk of cardiovascular events.
View package →All Tests and Packages
Every blood test Epicentre offers. Individual tests from R95. All packages customisable.
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