It started as a barely detectable soreness. After a Brazilian jiu-jitsu class in April 2018, I felt a nagging stiffness in my left big toe. This is normal after 90 minutes of grappling with other sweaty dudes, so I naturally brushed off the pain as standard bodily wear and tear.

Except it wasn’t.

If the faint soreness was the gentle crackle of a fireplace, then the pain soon gave way to a giant wildfire sparked by kerosene and napalm. A few hours after getting home, the rhythmic throbbing in my toe was too intense to sleep. Putting on a sock was suddenly an agonizing task. Walking to the bathroom was out of the question.

Bereft of solutions in the early hours of the morning, I called my mom. Owing to her perceptiveness, she took a guess as to what was ailing me: “Maybe you have gout?” she said.

Sporting zombie eyes and a grimace the next day, I took a Lyft two blocks to the podiatrist’s office, where I received a fistful of medication to quell the attack and a blunt reality check. Mom was right; I had gout.

Even for a former college athlete and martial arts enthusiast like myself, suffering from gout isn’t as unusual as it seems.

You don’t need to lead a slovenly lifestyle to get gout, a form of acute arthritis characterized by redness, swelling, and extreme pain. Even for a former collegiate water polo player and nine-year martial arts enthusiast like myself, suffering from gout isn’t as unusual as it seems.

In popular lore, gout is the “disease of kings,” affecting only those who shamelessly indulge on red meat, shellfish, and booze. It was indeed a scourge among the aristocratic class when fiefdoms were scattered across Europe, but it isn’t a relic of Europe’s monarchial past: Numerous studies note that gout has been rising steadily in the modern age as junk food, obesity, and hypertension have soared in the U.S.

Gout affects roughly 8.3 million Americans today, which is nearly the population of New York City’s five boroughs. I’m one of these suffering souls, and people immediately assume that some overindulgent lifestyle decision is to blame for my plight. That isn’t the case. It’s true that a terrible diet crammed with red meat, alcohol, and sugar can give you gout, but this ancient affliction owes its roots primarily to genetics.

“You’re the genetics of half your father’s family and half your mother’s family,” says John FitzGerald, a rheumatologist and gout researcher at UCLA. “It might just be a combination of those genetics that have given you enough of the gout predisposition genes,” even if you lead a healthy lifestyle, he notes.

The disease strikes when a build-up of uric acid — a chemical compound produced during the digestive process — crystallizes in the joints. This usually happens in the base of the big toe, but it can also take hold of other regions, like the elbows, knees, or wrists.

It all begins after eating: Uric acid, or urate, is created after a person consumes purines — an organic compound found naturally in the body but also abundantly in all proteins. Red meat, shellfish, organ meats, and all alcohol (especially beer) are naturally purine-heavy. Urate normally dissolves in the blood and gets filtered through the kidneys and purged via urine. Sometimes, however, the process hits a roadblock: If the kidneys fail to filter out enough uric acid through urine or if your body produces too much uric acid for your kidneys to handle, the acid lingers and forms triangle-shaped urate crystals. These jagged formations nestle into the joint, kind of like kindling waiting for a blowtorch.

Oh yeah, and did I mention the attacks are pure agony? “First your toe feels tender, then it feels like you sprained it,” says New York Magazine food critic and gout sufferer Adam Platt. “Then it feels like you’ve broken it … then it feels like you’ve broken it and it’s also on fire.”

Luckily, there are short-term fixes for acute bouts like these. Colchicine is both the modern and ancient remedy — it was first used in Egypt a thousand years ago to treat swelling and rheumatism. It’s typically paired with anti-inflammatory medication like indomethacin to target an acute attack. Another drug, allopurinol, is the long-term gout solution favored by the medical industry since the 1960s. It lowers the body’s uric acid production and is highly effective with minimal side effects, albeit with one catch: People who get gout have to take it every day for the rest of their lives since coming off allopurinol heightens the risk of increased urate production and future attacks. (Starting allopurinol also briefly heightens the risk of attacks while the medicine flushes your system of urate.)

I’ve treated my attacks with doses of colchicine and indomethacin, but that hasn’t always worked with great effect. To throw some fire retardant on my gout flares, doctors have prescribed me prednisone, a steroid used to treat a number of different inflammatory ailments. It’s worked like a charm for me, though it isn’t the first choice of medicine for some doctors because of its side effects.

It’s smart for long-term sufferers to take allopurinol, and many of them do. Otherwise you can risk doing irreparable damage to your joints: “Any combination of frequent attacks … and radiographic evidence” of joint damage is enough to prescribe a urate-lowering medicine like allopurinol, says Jasvinder Singh, a rheumatologist at the University of Alabama, Birmingham, Hospital.