Gout Flare: What to Do
Also known as: Gouty arthritis, Podagra, Gout attack
What Is a Gout Flare?
A gout flare is a form of acute inflammatory arthritis caused by uric acid crystals building up in a joint. Gout affects an estimated 3.9% of U.S. adults, about 9.2 million people, and men are affected far more often than women: 5.2% of men against 2.7% of women. Gout is the most common form of inflammatory arthritis, and its incidence has climbed over the past several decades, a rise researchers attribute mainly to lifestyle changes such as higher protein intake and more sedentary living. National survey data show U.S. prevalence holding steady between 2007 and 2016.
Causes and Risk Factors
A gout flare results from hyperuricemia, meaning too much uric acid in the blood. Uric acid is a waste product the body makes when it breaks down purines. When the kidneys cannot clear it fast enough, levels rise and the excess can crystallize inside a joint.
Several things raise your risk:
- A diet high in purines: red meat, organ meats, and certain seafood such as shellfish, sardines, and anchovies
- Alcohol, especially beer, and drinks sweetened with high-fructose corn syrup
- Being overweight, high blood pressure, heart failure, or kidney disease
- Certain medications, including diuretics and low-dose aspirin
- A family history of gout
Men are affected far more often than women, who generally do not develop gout before menopause.
Symptoms
A flare typically causes sudden, intense joint pain, most often at the base of the big toe, a presentation doctors call podagra. The joint also turns red, swollen, and warm. The pain is often so severe that even the light touch of a bedsheet can be unbearable. Attacks frequently start at night, usually peak within 12 to 24 hours, and then settle over the following week or two. A mild fever can come with the flare.
Gout usually strikes one joint at a time. Besides the big toe, it can affect the ankle, the knee, and other joints. Left untreated over years, uric acid can form hard deposits called tophi, which damage bone and deform the joint.
Diagnosis
Diagnosis relies on a typical clinical exam together with a blood uric acid test, though uric acid can read normal during the flare itself, so a normal result does not rule gout out. Joint fluid aspiration, in which a doctor draws fluid from the painful joint and examines it under a microscope for urate crystals, is the best way to confirm the diagnosis. It also helps rule out a joint infection, an important condition not to miss. Ultrasound or a CT scan may be used as well.
Available Treatments
Management combines treating the acute flare and preventing future ones:
- NSAIDs or colchicine to relieve the acute flare. Colchicine works best when taken as soon as symptoms appear
- Corticosteroids if NSAIDs or colchicine are contraindicated, at the lowest effective dose
- Rest and ice on the affected joint during the flare
- Urate-lowering medications long-term, to prevent recurrence for people with repeated flares. Allopurinol, a xanthine oxidase inhibitor, is the most widely used
- Lifestyle adjustments covering diet, weight, and alcohol to lower uric acid levels
Long-term urate-lowering treatment does not have to wait for the flare to pass. When a doctor decides you need it, the American College of Rheumatology suggests starting it during the flare rather than after it has resolved.
Prevention and Practical Tips
Limit your intake of alcohol, especially beer, and purine-rich foods such as organ meats, shellfish, and excess red meat. Cutting back on sugary drinks helps too. Maintain a healthy weight and stay well hydrated. Dehydration raises the risk of a flare, including the dehydration that can come with fasting, so keep fluids up rather than going long stretches without them. Regular physical activity also helps reduce the risk of recurrence. Some doctors recommend the DASH eating plan, which fits these goals well.
With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis.
When Should You See a Doctor?
See a doctor promptly for sudden, intense joint pain, especially in the big toe, and particularly if it comes with a fever, which could suggest a joint infection. A doctor’s guidance is also recommended for recurrent flares, to consider long-term treatment.
Sources
- MedlinePlus, U.S. National Library of Medicine, health information on gout
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), overview, symptoms, and causes
- NIAMS: Diagnosis, Treatment, and Steps to Take, clinical management of gout
- Arthritis Foundation, patient education on gout flares and diagnosis
- American College of Rheumatology, clinical guidance on gout management
- 2020 American College of Rheumatology Guideline for the Management of Gout, timing of urate-lowering therapy relative to a flare, allopurinol as preferred first-line agent, topical ice as an adjuvant treatment
- Contemporary Prevalence of Gout and Hyperuricemia in the United States and Decadal Trends: NHANES 2007-2016, U.S. prevalence of gout overall and by sex, and the decadal trend
- Gout, StatPearls (NCBI Bookshelf), rising incidence over recent decades and its attributed drivers, rest and topical ice packs during a flare
- Arthritis Foundation: Fasting and Gout, dehydration from fasting as a flare risk