What does a gout attack feel like?

Sudden, intense joint pain, most often in the big toe, with swelling, redness, warmth, and tenderness. It frequently starts at night and is most severe in the first 4 to 12 hours.

What foods trigger gout?

High-purine foods and drinks: red meat, organ meats, some seafood and shellfish, beer and other alcohol, and sugary drinks or foods with high-fructose corn syrup. Low-fat dairy, vegetables, whole grains, and plenty of water are generally protective.

Can gout be cured, or just managed?

Gout cannot be permanently cured, but it is highly controllable. Lowering your serum uric acid below 6 mg/dL with urate-lowering therapy plus lifestyle changes can stop flares and, over time, dissolve existing crystal deposits.

Do I need to take gout medication for life?

For people with frequent flares (2 or more a year), tophi, or joint damage, urate-lowering therapy like allopurinol is usually long-term and taken continuously, even between flares. Stopping often lets crystals and flares return.

Why did my gout get worse right after I started a new gout medicine?

Starting urate-lowering therapy can temporarily trigger flares as crystal deposits shift. That is expected, which is why guidelines recommend anti-inflammatory prophylaxis (such as low-dose colchicine or an NSAID) for the first 3 to 6 months. Do not stop your urate-lowering drug during a flare.

Is diet alone enough to control gout?

Usually not for established or frequent gout. Diet and weight management help, but dietary change alone lowers uric acid only modestly. It is an adjunct to medication, not a replacement, when treatment is indicated.

Rheumatology

Gout: Symptoms, Triggers, and Treatment

A rheumatologist's plain-language guide to gout: what causes flares, which foods and drinks trigger them, and how urate-lowering therapy keeps them away.

Shante Hinson, MD, Rheumatology

Gout in plain language

Gout is a form of inflammatory arthritis caused by tiny, needle-like crystals that form in a joint when a waste product called uric acid builds up too high in your blood. It usually starts as a sudden, severe attack in one joint, most often the big toe, and it is highly treatable. The goal of care is to lower your uric acid and keep it low, which stops flares and, over time, clears the crystals away.

Gout affects about 3.9% of U.S. adults, roughly 9.2 million people (from 2015 to 2016 national survey data), and men are about three times more likely than women to develop it.

Key takeaways

Gout happens when uric acid gets too high and forms sharp crystals in a joint, triggering sudden pain and swelling.
A flare comes on fast, peaks within 4 to 12 hours, and most often hits the big toe, frequently at night.
Common triggers are red meat, organ meats, some seafood, alcohol (especially beer), and sugary drinks.
The cornerstone of long-term treatment is urate-lowering therapy aimed at a uric acid level below 6 mg/dL, with allopurinol as the preferred first-line medicine.
A hot, swollen joint with fever can be a joint infection, which is a medical emergency, not a routine flare. Get seen promptly.

What causes gout

Uric acid is a waste product your body makes when it breaks down chemicals called purines. Purines come from two places: about two-thirds are made by your own body, and the rest come from food. Normally your kidneys filter uric acid out in your urine.

Gout starts when uric acid rises too high, a state called hyperuricemia. That happens when your kidneys do not clear enough uric acid, or your body simply makes too much. Once levels stay high, uric acid forms sharp, needle-like crystals in the joint, and your immune system reacts to them with intense inflammation. That reaction is the flare.

What a gout flare feels like

Gout attacks are hard to miss. Symptoms almost always come on suddenly, often at night, and the pain is most severe in the first 4 to 12 hours. The classic spot is the big toe, though gout can strike the ankle, knee, midfoot, or other joints.

During a flare you may notice:

Sudden, intense pain in one joint
Swelling, redness, and warmth over the joint
Tenderness so sharp that even a bedsheet feels painful

After the peak, joint discomfort can linger for days to weeks before settling down.

Common triggers

Certain foods and drinks raise uric acid and can set off a flare. The usual culprits are high-purine and high-fructose items:

Red meat and organ meats such as liver and sweetbreads
Certain seafood and shellfish
Beer and other alcohol
Sugary drinks and foods made with high-fructose corn syrup

On the protective side, low-fat dairy, vegetables, whole grains, and drinking enough water are generally helpful. If gout runs alongside other joint pain, our guide to osteoarthritis and joint pain may also be useful, since the two can overlap.

How gout is treated

Treating gout has two parts: calming the current flare, and lowering uric acid so future flares stop.

Treating the flare

Acute attacks are treated with anti-inflammatory medicines: NSAIDs, colchicine, or corticosteroids. The sooner you start, the faster relief tends to come. Your clinician picks the option that fits your other health conditions.

Lowering uric acid for the long term

The real fix is keeping uric acid low. The 2020 American College of Rheumatology guideline strongly recommends urate-lowering therapy with a "treat-to-target" goal of serum urate below 6 mg/dL, checked with periodic blood tests. Urate-lowering therapy (ULT) simply means a daily medicine that brings uric acid down.

Allopurinol is the preferred first-line urate-lowering drug, including for people with moderate-to-severe kidney disease. It is started at a low dose (for example, 100 mg a day or less) and slowly increased until your uric acid reaches target, rather than starting high.

Long-term treatment is strongly recommended for anyone with frequent flares (2 or more a year), tophi (visible lumps of crystal deposits under the skin), or joint damage from gout on X-ray.

Why a new medicine can trigger a flare

It is common to have a flare soon after starting urate-lowering therapy, as crystal deposits begin to shift. This is expected. To cover that window, guidelines strongly recommend anti-inflammatory prophylaxis, such as low-dose colchicine, an NSAID, or low-dose steroid, continued for 3 to 6 months. Do not stop your urate-lowering drug when a flare hits.

Our rheumatology team can help you find the right medicine, dose it safely, and track your uric acid over time.

When to seek urgent care

A hot, swollen, painful joint is not always gout. A septic (infected) joint is a medical emergency with very similar symptoms. Seek prompt or urgent care if:

It is your first flare, so the diagnosis can be confirmed and infection ruled out. (Mayo Clinic)
You have fever or chills along with the hot, swollen joint, which can signal a joint infection. (Mayo Clinic)
Symptoms keep worsening after about 48 hours, or do not resolve within about a week despite treatment. (Mayo Clinic)

Do not start, stop, or change a prescription gout medicine (such as allopurinol, febuxostat, colchicine, or a corticosteroid) without talking to your clinician.

Medical disclaimer

This article is for general information and is not a substitute for professional medical advice. Talk to your clinician about your specific situation.

Ready to get your gout under control?

If flares keep coming back, you do not have to just wait for the next one. Our rheumatology team can confirm the diagnosis, start you on the right treatment, and keep your uric acid at target. Book an appointment with Morningside Medical today.