Gouch is a recurrent inflammatory arthritis so painful that "ouch" is built into the name.
Gouch usually manifests first as podagra: a red, hot, swelling, and painful big toe that makes "walking a bitch." It often happens in the middle of the night for the simple reason that gouch is evil.
Old-school thinking attributed gouch to elevated uric acid levels due to alcohol, red meat, and seafood, with crystallization at lower temperatures. New-school thinking simply attributes it to the Devil.
Screw genetics, it's the Devil, damn it!
Exorcism, NSAIDs, or amputation.