At least 9 million Americans are said to experience this discomfort—and experts say suffering through it is, in part, due to a stigma.
Most people wouldn’t hesitate to seek treatment for an illness that hinders quality of life and increases long-term health risks. Yet a recent New York Times highlights that roughly two-thirds of people living with a particularly painful, inflammatory form of arthritis aren’t taking medication to manage it—and that gap matters more than many patients realize.
Gout is described by the Mayo Clinic as being a “common and complex” type of arthritis, with symptoms usually involving a sudden flare of intense pain, tenderness, and swelling in the big toe, though other joints can be affected as well. According to the Alliance for Gout Awareness, an estimated 9 million Americans experience gout—and that number is predicted to rise in coming years. A 2024 review published in The Lancet Rheumatology journal declared that global gout incidences will grow by at least 70% by the year 2050.
Though your body makes uric acid while breaking down chemicals from foods and drinks, the kidneys typically handle flushing it out of your system. However, gout can develop when the kidneys can’t remove it quickly, the Cleveland Clinic says “uric acid crystals can build up and settle into your joints. The sharp crystals clump together and cause sudden episodes of pain, swelling and other symptoms.”
A 2019 study published in Arthritis & Rheumatology found that these flares can significantly reduce quality of life, impair physical function, and drive up care costs. Beyond the joints, gout is closely associated with metabolic syndrome and conditions such as heart attack, type 2 diabetes, chronic kidney disease, and even premature death.
Despite this, the study showed that only about one-third of people with gout take medication to manage it. This matters because untreated or undertreated gout isn’t just about occasional joint pain—it’s linked to permanent joint damage and chronic illness.
Even among those who do, treatment often falls short. The New York Times report suggests many patients are prescribed doses that are too low to effectively reduce uric acid levels, leaving them vulnerable to ongoing flares and joint damage. A 2024 review in the Journal of Rheumatology adds that the most commonly used drug, allopurinol, frequently “fails” in practice—not because the medication is ineffective, but because it isn’t dosed appropriately, isn’t continued long enough, or is stopped due to side effects that could be managed.
So why do so many people forgo treatment? A 2022 Journal of Rheumatology study points to perception and lifestyle concerns, noting that stigma still surrounds the illness: “The most frequently endorsed reasons for not taking their urate-lowering therapies (ULT) were because participants wanted to lead a normal life (23%) or think of themselves as a healthy person again (20%).”
The study continues: “Patients also reported not taking allopurinol as a way of testing if they really needed it (22%)” or “to see if they could reduce the dose without getting symptoms.” Younger and single patients were less likely to take their medications as prescribed.
The problem with such an approach is that gout doesn’t go away on its own. While flare-ups may improve, high uric acid levels remain, even absent of symptoms. When the condition is left untreated, these flare-ups can become more frequent or painful, putting the individual at risk of permanent joint damage and various chronic health conditions.
Altogether, the studies’ findings highlight missed opportunities for better communication—helping patients understand that urate-lowering therapy is not a sign of illness or failure, but a proven way to prevent pain, protect joints, and reduce broader health risks over time. Those diagnosed with gout should make a treatment plan with their doctors—and, importantly, stick to it.
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