Gout treatment: stop flares fast and lower uric acid for good
Gout hurts like hell and comes back if you only treat the pain. You need two things: quick relief for attacks and a plan to lower uric acid so attacks become rare. Here’s clear, practical advice you can use today.
Treating an acute gout attack
When a joint suddenly becomes red, swollen, hot and painful—act fast. First-line options are NSAIDs (like naproxen or ibuprofen) if your doctor says they’re safe for you. Colchicine works well if started within 24–36 hours; modern low-dose regimens cut side effects. If NSAIDs or colchicine aren’t possible, oral steroids or a steroid injection into the joint can calm the flare.
If you haven’t had a formal diagnosis, a doctor may remove fluid from the joint (aspiration) to confirm gout and rule out infection. Don’t try to self-diagnose: treatment differs for septic arthritis.
Preventing future attacks: urate-lowering therapy (ULT) and lifestyle
Long-term control focuses on lowering serum uric acid. Allopurinol is the most common first choice; it’s safe for many people and affordable. Your doctor will start low and increase the dose until your uric acid is below target (usually <6 mg/dL, lower if you have tophi or frequent attacks). Some people need febuxostat—useful if allopurinol isn’t tolerated, but discuss heart risk with your doctor. Probenecid helps by increasing uric acid excretion, but it’s not for everyone (not great with kidney stones or poor kidney function). For severe, refractory cases there are IV options like pegloticase.
Important safety notes: test for HLA‑B*5801 in some ethnic groups before allopurinol to reduce the risk of severe rash. Monitor kidney function and uric acid as your dose changes. You can usually start ULT during a flare if you’re also being treated for the flare, but follow your doctor’s plan.
Small, smart lifestyle changes make a real difference. Lose weight gradually if you’re overweight, drink water, cut sugary drinks and reduce beer and spirits (wine is lower risk but still not zero). Limit red meat, organ meats and some seafood; aim for more low‑fat dairy, vegetables, and whole grains. Some people find cherries or vitamin C helpful as small aids, but they don’t replace medicine.
When to see a doctor: if pain is severe, fever or you can’t move the joint, or if attacks happen more than once a year. Also talk to your provider if you take diuretics or have kidney or heart disease—treatment choices change with those conditions.
Bottom line: stop attacks quickly with NSAIDs, colchicine, or steroids, then work with your doctor on urate‑lowering therapy and sensible diet changes to prevent recurrence. Gout is manageable when you treat the flare and treat the cause.
