What Is Uncontrolled Gout and Why Does It Happen? Featuring Brittany Panico, DO

The Educated Patient’s “Managing Uncontrolled Gout: Insights from Top Doctors” series begins with an important topic: What is uncontrolled gout and why does it happen? In this first installment, Brittany Panico, DO, chief of rheumatology at Summit Rheumatology, sheds light on the complexities of this condition, emphasizing that gout is more than just a dietary issue — it’s a genetic and systemic disorder that requires careful medical management.

Panico explains that gout occurs due to a buildup of uric acid, a byproduct of the body’s metabolism, particularly of proteins. While the kidneys work to filter out uric acid, some individuals lack the ability to efficiently remove excess amounts, leading to the formation of uric acid crystals.

She compares this buildup to rock candy: “You start off with little granules of sugar, and then you place a string inside of that container and it blossoms into rock candy,” she says. “Uric acid does the exact same thing in our body. And when there’s enough of it to concentrate and form these crystals, it just explodes.”

This explosion triggers an intense inflammatory response, causing severe joint pain, swelling and redness — hallmarks of a gout flare.

The transition from occasional gout flares to uncontrolled gout happens when attacks become more frequent and prolonged. Even patients taking medication may experience ongoing attacks if their dosage isn’t properly adjusted.

"Managing gout is a lot like managing high blood pressure,” Panico explains. “We don’t give every patient the same dose of medication and call it a day. We have to check your uric acid levels to make sure that the dose we give you is actually working."

A common misconception about gout is that it’s solely caused by diet. While consuming high-purine foods like red meat and alcohol can contribute to increased uric acid levels, the root cause is genetic. If you have a family member with gout, you are at higher risk. Certain populations, such as some Asian and African American groups, may also have a higher genetic predisposition.

If left untreated or undertreated, gout can lead to serious long-term complications beyond joint pain.

“Gout can create what we call an inflammatory arthritis, meaning it can cause swelling in the hands, feet, knees and any joint,” she warns. “It can cause swelling and damage over time to that joint if you continue to have flares and attacks.”

It can also lead to decreased kidney function, increased risk of heart disease and even diabetes. Mental health is another overlooked aspect, Panico says. Chronic pain, missing work and being unable to enjoy life can take a huge toll, and many patients struggle with depression and anxiety because of their condition.

For those suffering from recurrent gout flares, seeking specialized care is critical. Panico emphasizes patients need a provider who truly understands gout and knows how to get uric acid levels low enough to prevent flares. She also advises patients to always carry their rescue medication, even when their gout seems controlled. Flares often happen at the worst times — such as after flying or on vacation — so being prepared is key.

Luckily, there are treatments that work, and the landscape of gout management is changing, with more tools available than ever before to help patients live pain-free.

“My best advice is just to keep going in the journey and know that it’s not your fault,” she concludes. “There is hope that we can help you through this.”