How to Treat a Gout Flare-Up

Gout is a type of inflammatory arthritis that can be very painful. It usually affects one joint at a time—often the big toe—but it can affect other joints as well, including the thumbs, elbows, wrists, ankles, and knees.

It occurs in people with hyperuricemia (high uric acid levels in their blood). Uric acid is created when the body breaks down purines, chemicals naturally found in the body and present in some foods. 

Gout goes through periods of flares (or flare-ups), when symptoms worsen, and remission periods, when you have few or no symptoms. In this article, we will cover the symptoms and causes of gout flares, treatment, and prevention. 

Symptoms of a Gout Flare-Up

Gout flare-ups, also called gout attacks, can be very painful. They might happen suddenly, often waking a person up in the middle of the night in intense pain and feeling like their affected joint is on fire.  

Additional symptoms of a gout attack might include:

• Redness
• Swelling
• Stiffness
• Tenderness

Once this attack has subsided, it is possible to not have symptoms for quite some time. You may even only experience one or two flares per year. Gout can also be a chronic, recurring condition for some people.

Gout Flare-Up Causes

The cause of gout is too much uric acid in the body, which leads to uric acid crystals forming and building up in the body’s joints, fluids, and tissues. Hyperuricemia does not always lead to gout, and hyperuricemia without gout usually does not need any treatment.

Some people are more likely to have high uric acid levels. This group might include people who:

• Are male
• Are overweight
• Have certain health conditions, such as congestive heart failure (the heart does not pump enough blood for the body's needs), metabolic syndrome (a group of conditions that can lead to heart disease, diabetes, and stroke and includes high blood glucose, low levels of “good” cholesterol in the blood, high levels of triglycerides, large waist size, and high blood pressure), insulin resistance (the body does not respond to insulin as it should), diabetes, kidney stones, or poor kidney function
• Use diuretics (water pills)
• Drink too much alcohol
• Eat or drink foods high in fructose sugars
• Eat a diet high in purines, including red meat, organ meat, and some kinds of seafood, such as anchovies, sardines, and tuna 

Gout attacks can be triggered by certain foods, medications, and behaviors. Knowing what triggers your gout can be vital for reducing flares in the future.

Triggers of gout attacks might include: 

• Consuming foods high in purines
• A joint injury, such as bumping your big toe
• Drinking too much alcohol
• Becoming dehydrated
• Not taking daily gout medicines as prescribed

Treatment 

There are different treatments available for managing gout. However, when you are in the middle of a flare, your healthcare provider will want to focus on pain management and bringing down the gout attack as quickly as possible. 

If you are taking medications designed to reduce uric acid levels, you should continue to take these during the gout attack. Examples include Zyloprim (allopurinol) and Uloric (febuxostat). 

For the flare-up, your healthcare provider will likely prescribe high doses of a nonsteroidal anti-inflammatory drug (NSAID) to reduce the pain and swelling. You might also be given a corticosteroid to help decrease pain and swelling quicker—either as a pill or an injection. 

Another treatment option for a gout attack is a drug called Colcrys (colchicine). It is given by mouth and can reduce pain and inflammation if taken within the first 24 hours of the gout attack. 

You might also consider home remedies for managing a gout flare-up to ease your discomfort. 

Home remedies to consider might include:  

• Resting the affected joint: Try elevating the affected joint. Walking with a cane can help to keep pressure off your painful joint.
• Icing your affected joint to bring down swelling and soothe discomfort
• Eating cherries or drinking tart cherry juice: Some studies have suggested that tart cherries can
  lower uric acid levels and reduce the length of a gout attack.
• Not eating problem foods
• Avoiding alcohol and drinking lots of beverages without alcohol to flush out uric acid 

Prevention

You might not be able to predict when a gout attack will strike next. But it is possible to take action to prevent future attacks, such as by doing the following: 

• Adjust your diet: Eat a healthy and balanced diet that includes fruits and vegetables, low-fat dairy, whole grains, and beans. Avoid foods and beverages that can increase uric acid levels, such as red meat, shellfish, and alcohol. 
• Drink plenty of fluids: You will want to drink plenty of fluids, especially water, to avoid dehydration. Avoid sugary drinks that contain high fructose corn syrup as they can increase the potential for a gout flare.
• Keep your alcohol intake low: Beer, wine, and stout can also increase your risk for a gout attack. The less alcohol you drink, the lower your risk of an attack. 
• If overweight, shed some pounds: If you are overweight, losing even a few pounds can reduce the amount of uric acid in your blood, which can mean fewer flares. Less weight can also reduce pressure on your joints.
• Get some exercise: Increasing your activity level helps with weight loss and reduces your risk for conditions like high blood pressure and diabetes, common in people with gout. Of course, you should not exercise when experiencing a gout flare.
• Take your gout medications regularly: If your healthcare provider has prescribed medicines for gout, you will want to take these regularly to prevent gout attacks. Missing doses increases your risk for a flare-up.

Summary    

A gout flare can cause severe pain, swelling, tenderness, and redness in one or more joints—most commonly the big toe. Flares are sudden, often waking you up in the middle of the night to the feeling that your big toe, or other joint, is on fire.

Gout flares come and go, but it is possible to manage symptoms and prevent flares. You want to avoid their triggers—things like certain foods and alcohol. You will also want to regularly take any prescribed medications to decrease your risk for future attacks. 

A Word From Verywell

If you experience sudden, intense pain in a joint, reach out to your healthcare provider right away. If your joint is hot and inflamed, you might have gout, an infection, or another condition. 

Untreated gout can cause permanent joint damage. But if diagnosed early and properly treated, most people with gout have a normal quality of life. With medication and lifestyle changes, you can ease symptoms and reduce the severity and frequency of gout flares.