The patient experience of a gout flare is multi‐dimensional. There is a need to understand the complete flare experience to establish the most appropriate flare measurement methods. This qualitative study aimed to examine what factors contribute to a flare’s severity from the patient perspective. Face‐to‐face interviews were conducted with people with gout. Participants were asked to share their experience with their worst gout flare and contrast it to their less severe or mild flare experience. Interviews were audio‐recorded and transcribed verbatim. Data were analyzed using a reflexive thematic approach.

Twenty‐two participants with gout (17 males, mean age 66.5 years) were interviewed at an academic center in Auckland, New Zealand. Four key themes were identified as contributing to the severity of a flare: flare characteristics (joint swelling, redness and warmth, duration, location, and pain intensity), impact on function (involving sleeping, walking,  wearing footwear, and activities of daily living), impact on family and social life (dependency on others, social connection, and work) and psychological impact (depression, anxiety, irritability, and sense of control).

In conclusion, a wide range of interconnecting factors contribute to a gout flare’s severity from the patient perspective. Capturing these domains in long‐term gout studies would provide a more meaningful and accurate representation of the cumulative flare burden.