Gout is treated in two phases: stopping the painful flare you’re dealing with right now, and then lowering uric acid over the long term so flares stop coming back. Most people can manage gout effectively with medication and some targeted lifestyle changes, but the approach depends on whether you’re in the middle of an attack or trying to prevent the next one.
Treating an Acute Gout Flare
When a flare hits, the goal is to reduce inflammation and pain as quickly as possible. Three types of medication are commonly used, and treatment works best when started within the first 24 hours of symptoms.
Anti-inflammatory painkillers (NSAIDs) are the most common first step. Ibuprofen at prescription-strength doses or indomethacin taken several times daily can bring significant relief. These work by calming the intense inflammatory response your immune system mounts against uric acid crystals in the joint.
Colchicine is another option, particularly effective when taken early in a flare. It works by disrupting the ability of white blood cells to swarm toward the crystals in your joint, essentially turning down the immune overreaction that causes the swelling and pain. Lower doses are preferred because high doses tend to cause nausea and diarrhea that can be nearly as miserable as the flare itself.
Corticosteroids are used when NSAIDs aren’t an option, which is common for people with kidney problems or stomach ulcers. These can be taken as pills, typically starting at a moderate dose and tapering off over 10 to 14 days. In some cases, a steroid injection directly into the affected joint provides fast, targeted relief.
What to Do at Home During a Flare
While medication does the heavy lifting, a few practical steps can help. Ice the affected joint for 20 minutes at a time to numb pain and reduce swelling. Keep the joint elevated and avoid putting weight on it. Even the pressure of a bedsheet can be excruciating during a severe flare, so keeping the area uncovered or using a bed frame that lifts sheets off your feet can make a real difference.
Drink plenty of water. Gout patients benefit from 2,000 to 3,000 milliliters of water per day (roughly 8 to 12 cups), spread throughout the day rather than consumed all at once. About two-thirds of uric acid leaves your body through the kidneys, so staying well-hydrated helps your kidneys flush it out more efficiently and reduces the chance of crystal formation.
Long-Term Treatment: Lowering Uric Acid
Stopping a flare is only half the battle. If you’ve had multiple attacks, have visible lumps of uric acid deposits (called tophi), or already show joint damage, you’ll likely need daily medication to keep uric acid levels low enough that crystals dissolve and new ones stop forming.
The target most guidelines recommend is a uric acid level below 6 mg/dL. If you have tophi or continue to get frequent flares even after reaching that number, a stricter target of below 5 mg/dL may be more appropriate. The goal is to get uric acid low enough that existing crystal deposits gradually dissolve over months to years.
Urate-lowering medications work by reducing how much uric acid your body produces. Treatment typically starts at a low dose and gets increased gradually every few weeks until your uric acid hits the target. For people with kidney disease, starting doses are even lower to avoid a rare but serious hypersensitivity reaction, with careful upward adjustments over time.
Why Flares Can Worsen When You Start Treatment
One of the most frustrating aspects of gout treatment is that starting urate-lowering medication can actually trigger flares in the first few months. As uric acid levels drop, existing crystal deposits begin to shift and dissolve, which can provoke the immune system. This does not mean the medication isn’t working. It’s the opposite: it’s a sign that crystal deposits are breaking up.
To prevent these “mobilization flares,” doctors typically prescribe a low-dose anti-inflammatory (usually colchicine or an NSAID) alongside the urate-lowering medication for the first three to six months. This bridge period is critical. Many people quit their medication during this window because they assume it’s making things worse, but pushing through with the prophylactic anti-inflammatory on board leads to dramatically fewer flares over time.
Treatment-Resistant Gout
A small percentage of people don’t respond to standard urate-lowering medications, either because the drugs don’t bring their levels down far enough or because side effects prevent them from taking adequate doses. For these cases, an infusion therapy is available that uses an enzyme to break down uric acid directly in the bloodstream. It’s given intravenously every two weeks in a clinical setting and requires pre-treatment with antihistamines and corticosteroids to reduce the risk of allergic reactions. This option is reserved for people who have genuinely exhausted other approaches.
Foods and Drinks That Raise Uric Acid
Diet alone rarely controls gout, but certain foods can measurably raise uric acid levels and trigger flares. The biggest culprits are foods high in purines, compounds your body breaks down into uric acid.
- Organ meats like liver, kidney, and sweetbreads are among the highest-purine foods and are worth avoiding entirely.
- Red meat (beef, lamb, pork) should be limited in portion size rather than eliminated.
- Certain seafood including anchovies, sardines, shellfish, and cod are higher in purines than most other fish.
- Beer and liquor are strongly linked to both developing gout and triggering repeat attacks. Beer is particularly problematic because it contains purines of its own on top of the alcohol. Wine appears to carry less risk in moderate amounts.
- High-fructose corn syrup and excess sugar of any kind can raise uric acid. This includes sweetened cereals, baked goods, some salad dressings, and sugary drinks. Fructose is the only sugar that directly increases uric acid production during metabolism.
Foods and Habits That May Help
Cherries have the strongest evidence of any single food for gout management. A study of 633 gout patients found that cherry consumption was associated with a 35% reduction in flare risk. Tart cherry juice or tart cherry extract supplements are the most studied forms. The benefit likely comes from anthocyanins, the compounds that give cherries their deep red color, which have anti-inflammatory and mild uric acid-lowering effects.
Low-fat dairy products, coffee, and vitamin C-rich foods are also associated with lower uric acid levels, though the effects are modest compared to medication. Complex carbohydrates, vegetables (including higher-purine ones like asparagus and spinach, which don’t appear to trigger flares the way animal purines do), and adequate hydration round out a gout-friendly eating pattern.
Weight loss, if you’re carrying extra pounds, is one of the most effective non-drug interventions. Excess body weight increases uric acid production and decreases kidney excretion. Even gradual weight loss of a pound or two per week can lower uric acid levels. Crash dieting, however, can temporarily spike uric acid and trigger a flare, so slow and steady matters here.
How Long Treatment Takes
Acute flares typically improve within a few days of starting treatment, with most resolving within one to two weeks. Long-term urate-lowering therapy, on the other hand, is usually a lifelong commitment. It takes months for uric acid levels to stabilize and even longer for existing crystal deposits to fully dissolve. People with visible tophi may need two or more years of consistent treatment before those deposits shrink significantly.
The payoff for sticking with treatment is substantial. Once uric acid stays consistently below target and crystal deposits clear, flares can stop entirely. Many people who manage their levels well go years without a single attack, effectively putting the disease into remission while continuing their daily medication.