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If you have gout, the damage to your joints is being done constantly, even if you don't have a flare-up. Gout can attack the toes, knees, hips, elbows, spine, shoulders, etc... Once the gout damage is done, osteoarthritis usually moves in and sets up shop in the damaged joint. You really need to get this under control before you have permanent damage done to your joints. Ask me how I know....