The first symptom of gout-a condition that most often affects older adults-is an excruciatingly painful attack, usually in the joint at the base of the big toe, which often occurs at night. The pain can be so severe that even the touch of a sheet is unbearable. Given this sequence, it would seem that gout strikes without warning. But to the contrary, gout develops over time, the result of an abnormal buildup of uric acid in the blood. Doctors have identified risk factors and claim that the disease can be controlled-in some cases prevented-through diet, exercise, and medication.