Cases of gout, a painful form of arthritis that often begins in the big toe joint, have climbed steadily in recent decades -- and discomfort can be severe.

"I've seen patients who can't walk or even stand," says Dr. Kimberly Smith, a family practice physician in Newport News, Va.

To avoid flare-ups:

Maintain a healthy weight. Obesity is a risk factor for gout, which is caused by a build-up of a chemical called uric acid around joints. So is high blood pressure, a frequent complication of obesity. But avoid fasting or rapid weight loss plans; both can trigger an attack.

Eat less meat. Animal proteins are high in purine, a substance that the body converts into uric acid. Limit intake of meat, poultry and seafood to between 4 and 6 ounces a day -- roughly the width of your fist -- to lower gout risk.

Avoid high-purine foods. Offenders include organ meats such as liver and kidney, sardines, anchovies, mussels, veal, bacon, salmon, asparagus and mushrooms. Talk to your doctor or a nutritionist.

Drink wisely. More than one or two daily alcoholic beverages, particularly beer, interfere with elimination of uric acid from the body. Water, on the other hand, helps flush it out.

Follow a low-fat diet. The usual advice applies: Eat lots of fresh fruits and vegetables, whole grains and low-fat or fat-free dairy products.

Know your risk factors. Gout is more common in men than women and typically strikes adults rather than children. Family history also may indicate risk.

Seek medical attention. If you develop unexplained joint pain or hot, red or swollen joints, see a doctor. A number of medications can prevent flare-ups and control pain, while untreated gout can become chronic and lead to severe joint damage.