Shamard Charles, MD, is a physician-journalist and public health doctor who advances health policy through health communication and health promotion.

Anita Chandrasekaran, MD, MPH, is board-certified in internal medicine and rheumatology and currently works as a rheumatologist at Hartford Healthcare Medical Group in Connecticut.

Gout , also known as gouty arthritis, is an extremely painful form of arthritis caused by the buildup of uric acid crystals in the soft tissue space of one or more joints. The joint of the big toe is most often affected, triggering an inflammatory reaction that can cause severe pain, redness, and swelling.

Gout affects over 8 million people in the United States. Many manage their pain with a combination of over-the-counter (OTC) anti-inflammatory medication and lifestyle modifications, including weight loss, regular exercise, and avoiding food triggers.

Although gout is a chronic condition with no cure, treatment can help manage the disease. This article will discuss what to expect when you have gout, including flare-ups, treatment, and managing symptoms.

A typical gout flare, or flare-up, comes without notice, causing significant joint pain and disability. Triggers include shellfish, red meat, alcohol, and high fructose corn syrup (which is in sugary soda).

The buildup of uric crystals in the joint space causes intense pain—usually in one joint, but two or more joints may be affected. The big toe is the most commonly affected joint, although other lower extremity joints like your ankle and knee may be affected. 

The pain of gout flares may be so severe that they wake you up in the middle of the night. Gout symptoms include:

Gout flares can last days or weeks. Your symptoms may resolve on their own without treatment. But treatment leads to quicker resolution of symptoms and less permanent destruction of the tissues in the joint space.

Gout flares are followed by long periods of remission (periods of no symptoms)—sometimes months or even years—with prophylactic (preventive) medication and lifestyle changes. 

Treatment for gout flares includes medications to relieve pain and shorten the flare duration.

Colcrys (colchicine ) is one of the primary medications used to treat acute gout flares and prevent future flares from occurring. It is an especially important option for those who cannot take nonsteroidal anti-inflammatory drugs (NSAIDs) or standard OTC anti-inflammatory medication.

Colchicine is prescribed by a healthcare provider. The dose will depend on factors that include your allergy profile and kidney and liver function. If taken early and as prescribed by your healthcare provider, colchicine may bring about rapid and complete resolution of your symptoms.

NSAIDs like Advil or Motrin (ibuprofen) and Aleve (naproxen) are readily available because they can be bought over the counter. Therefore, they are the most commonly used treatment for acute gout flares. Indocin (indomethacin ) is an NSAID available by prescription for gout.

Talk to your healthcare provider before starting OTC NSAIDs to determine if they are appropriate for you, the correct dosages, and potential side effects. Once your symptoms go away, you should stop these medications.

Oral glucocorticoids such as prednisone and prednisolone are steroids that may be prescribed for gout flares. They are as effective as NSAIDs and colchicine. Treatment often requires taking a pill by mouth once or twice per day.

Of note, if you experience frequent gout flares, NSAIDs and colchicine may be better options to limit steroid-associated toxicity, which can include elevated blood sugar and blood pressure, increased appetite and weight gain, mood changes/anxiety, insomnia, and decreased bone mineral density.

Corticosteroids may also be injected directly into the affected joint to relieve inflammation and pain.

Kineret (anakinra) is an IL-1 receptor antagonist drug that works by blocking chemical messengers that promote inflammation. It is typically used to treat rheumatoid arthritis. It has been shown to be as effective as traditional first-line agents for gout (colchicine, NSAIDs, and glucocorticosteroids).

Studies have shown that a 100- or 200-milligram injection (administered by your healthcare provider once per day for five days) can rapidly reduce the severity of your gout symptoms, making this a viable option for the treatment of acute gout flares.

Most side effects are mild and go away on their own. Potential side effects include:

Anakinra is used in Europe for gout treatment but has not been approved by the Food and Drug Administration (FDA) to treat gout in the United States. Kineret may be used off-label under the supervision of your healthcare provider if traditional medications are unsuccessful.

Diet and lifestyle are important for preventing flares and managing symptoms of gout.

Changes in your diet may help prevent gout flares. Knowing which foods are gout-friendly and which ones to avoid can help reduce the risk of an acute flare. Foods that can help treat your gout include:

Food and drinks that can trigger a gout flare include:

Drinking plenty of water and losing excess weight are two ways that you can lower uric acid levels in the body naturally. If you have excess weight, a weight loss program centered around regular exercise and a diet high in leafy fruits and vegetables may limit the frequency of your gout flares and the severity of your symptoms when they occur.

A gout flare can be extremely painful, and over time more than one joint may be affected at the same time, impairing your quality of life. Early treatment is key to the rapid resolution of your symptoms, although it may take a few days or a week for your symptoms to go completely away.

Ultimately, the frequency of your gout flares will depend on your lifestyle. If you identify certain foods as triggers, you may want to limit your intake or avoid them entirely.

Drinking plenty of water and exercising also help promote an anti-inflammatory state in the body, staving off a buildup of uric acid crystals.

If someone has frequent gout flares (more than two per year) or has other associated conditions (such as chronic kidney disease, kidney stones, etc.), a daily medication to reduce serum uric acid and prevent flares is recommended, usually Aloprim (allopurinol) or Uloric (febuxostat).

Acute gout flares typically last for one to two weeks, but your symptoms may resolve more quickly with recommended first-line treatments—colchicine, NSAIDs, and glucocorticoids. In Europe, a new medication, Kineret (anakinra), has proven to be an equally effective treatment for acute gout.

Gout is an inflammatory form of arthritis that can usually be well managed with diet modifications and medication. Staying hydrated, maintaining a healthy weight, and making small changes to your diet can reduce your risk of an acute flare and shorten the duration of flare symptoms.

If you have more than one gout flare, consult a healthcare professional to determine which medication treatment is right for you. 

Symptoms of a gout flare come on suddenly and are worst in the first 24 to 48 hours. Symptoms can linger for up to two weeks without treatment. A flare usually resolves within a matter of days with standard treatment.

A gout attack can last from five to 14 days without treatment, although the duration of your symptoms is different for each person and depends on your overall health status.  

There are many conditions that can mimic gout including other forms of arthritis, pseudogout, stress fracture, and skin infection.

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By Shamard Charles, MD, MPH Shamard Charles, MD, MPH is a public health physician and journalist. He has held positions with major news networks like NBC reporting on health policy, public health initiatives, diversity in medicine, and new developments in health care research and medical treatments.

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