Gout is a form of inflammatory arthritis characterized by sudden, severe attacks of pain in the joints, known as flares. While often associated with the big toe, these painful episodes can affect other joints and occur without warning. Understanding what happens during a flare, what triggers it, and how to manage it is important for those living with the condition.
What Happens During a Gout Flare
A gout flare is the body’s inflammatory reaction to monosodium urate crystals in a joint. These crystals form from an excess of uric acid in the bloodstream, a condition called hyperuricemia. Uric acid is a waste product from the breakdown of purines, which are substances in the body and certain foods. When uric acid levels become too high, it can crystallize in joints.
The symptoms of a flare appear suddenly, often waking individuals at night. The affected joint becomes extremely painful, swollen, red, and warm to the touch. The pain is often described as sharp or throbbing, and the joint can be so tender that even light pressure is intolerable.
Without intervention, a gout attack resolves within a week or two. However, the underlying high uric acid remains, making future flares likely. Repeated attacks can lead to chronic gout, causing permanent joint damage and the formation of tophi, which are hard lumps of urate crystals under the skin.
Common Triggers That Provoke an Attack
While high uric acid sets the stage for gout, specific triggers often provoke a flare by causing a rapid change in uric acid levels. Diet is a well-known trigger, as consuming foods high in purines can elevate uric acid and initiate an attack. These foods include red meats, organ meats like liver, and certain types of seafood such as shellfish.
Alcohol consumption, particularly beer and spirits, is another trigger. Alcohol increases uric acid production and makes it harder for the kidneys to excrete it. Sugary beverages, especially those with high-fructose corn syrup, also increase the risk of flares by boosting the body’s uric acid production.
Dehydration is a common factor, as it increases the concentration of uric acid in the blood. Other triggers include sudden illness, surgery, or a minor injury to a joint. These events can disturb deposited urate crystals, setting off a flare.
Immediate Relief for a Gout Flare
When a gout flare strikes, the goal is to manage the pain and inflammation. Self-care measures include resting and elevating the affected joint to reduce swelling. Applying ice packs for short periods can also provide relief, and staying hydrated with water helps the kidneys flush uric acid.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are a common first treatment because they reduce pain and inflammation. If NSAIDs cannot be taken or the pain is severe, a doctor may prescribe other medications.
Colchicine is a prescription medication that targets inflammation from urate crystals and is most effective when taken within the first 24 hours of an attack. Another option is corticosteroids, anti-inflammatory drugs that can be taken orally or injected into the joint for rapid relief. These treatments are for short-term use to control an active flare.
Long-Term Prevention and Management
Preventing future gout attacks requires a long-term strategy focused on consistently maintaining lower uric acid levels in the blood. This approach is fundamentally different from treating an acute flare and relies on sustained lifestyle adjustments and, in many cases, daily medication. The goal is to prevent urate crystals from forming in the first place, thereby reducing the frequency and severity of flares over time.
Lifestyle modifications are a foundational component of long-term management. This involves adopting a balanced diet that is low in high-purine foods. Limiting red meat, organ meats, and certain seafood while increasing the intake of vegetables and low-fat dairy products can be beneficial. Maintaining a healthy weight is also important, as excess body weight increases uric acid production and puts additional stress on joints. Consistent hydration by drinking water throughout the day supports kidney function and helps excrete uric acid.
For many individuals, lifestyle changes alone are not sufficient to prevent flares, and daily medication becomes necessary. Uric acid-lowering therapies are the standard of care for long-term gout management. Medications like allopurinol or febuxostat work by reducing the body’s production of uric acid. These medications are taken every day, even when there are no symptoms, to keep uric acid levels consistently low. It’s important to understand that these drugs are for prevention and are not used to treat an active flare.