As a female and in the minority of gout sufferers it has puzzled me as to the real root cause. Four years ago I had a serious fall onto my face doing much damage and breaking a bone in my left foot. Three days later I developed gout in the whole of my right foot. since then I have had some much smaller outbreaks and noted everything each time that could have had an effect.
Two days ago exactly to the day 4 years ago I had an identical attack. I have long thought that although food high in purines are to blame it goes much deeper. Now with all my research a clear pattern has come to light. STRESS and ANGER definitely triggers my attacks. This would make sense as it releases copious amounts of cortisol from the adrenal glands it also accounts for my comparatively high blood pressure leading to fear which results in the famous "white coat syndrome" Genetically my brother and I are closely linked but he decided some 36 years ago to go on allipuranol True he has avoided major attacks but the side effects from medication threw up other issues. This is a serious complaint as it causes osteoarthritis which is well researched and known. My point here is that it probably accounts for why no real cause has been found. No doubt a fault in the genetic makeup but fellow gout sufferers take note of your state of mind when an attack occurs. I hate to admit my shortcomings but I live with a very fraught situation 24/7 still no excuses, just worth writing my personal findings in the hope it ticks some boxes with others.