Gout occurs when urate crystals accumulate in the joint causing inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood. Normally, uric acid dissolves in blood and passes through the kidneys into the urine. But sometimes body either produces too much uric acid or kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.