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You don’t forget your first gout attack. Pain wakes you up in the middle of the night. Of all things, it’s your big toe that hurts. You try to go back to sleep, but the pain keeps getting worse and by morning, your poor toe can’t even stand the pressure from the bed sheet. Gout, which affects mainly middle-aged men, begins with unusually high blood levels of a waste product called uric acid. Normally uric acid is excreted in the urine, but in a gout-prone person, it precipitates as crystals in certain joints (the big toe, knees, elbows, fingers). The result is a local (and painful) inflammation. The crystals can also accumulate in the skin and in the kidneys (where they can cause kidney stones or even kidney failure).