Whether you’ve been plagued by gout in the past or have never experienced it before, chances are that when a gout flare strikes you’ll quickly know something is very, very wrong: The excruciating pain and swelling, which often occurs in a single joint (often the big toe), is pretty hard to ignore.
If you’ve never had a gout attack and are thinking that people with gout must be exaggerating, consider this: 37 percent of people with gout said that they’d willingly give up a winning lottery ticket if they never had to experience a gout flare again, according to a patient survey.
Of course, making that sort of trade-off isn’t an option. So what real-life choices do you have? Your best bet is to call your doctor — stat. “As soon as you feel a twinge, you need to get medical attention,” says Joseph Huffstutter, MD, a rheumatologist with Arthritis Associates in Hixson, Tennessee. “The sooner you treat a gout attack, the easier it will be to treat.”
Here’s a look at why gout flares happen and how to rein in the pain as quickly as possible.
Symptoms of Gout Flares
Gout is a type of arthritis that flares and subsides, especially at first. Common symptoms of a gout flare include:
- Intense joint pain that comes on suddenly, often in the middle of the night
- Most commonly affects the big toe; can occur in other toe joints, ankle, knee, and more
- Typically strikes one joint at a time; more can be affected as the disease progresses
- Affected joint is swollen, painful, warm to the touch, and red
- Pain from a flare can last up a week or two with long periods of remission in between
Causes of Gout Flares
Gout, a type of inflammatory arthritis, happens when levels of uric acid — a normal byproduct of metabolic reactions in your body — become too high, says Kenneth Saag, MD, professor of medicine in the division of clinical immunology and rheumatology at the University of Alabama at Birmingham. When this substance can’t be sufficiently dissolved and excreted in the urine, it starts to crystallize, and those crystals deposit themselves in joints where they cause severe inflammation.
Certain risk factors, such as having a family history/genetic predisposition or having chronic kidney disease, can affect the development of gout over time. Taking certain medications (such as diuretics for high blood pressure), a high alcohol or sugar intake, or eating high-purine foods can trigger a gout flare. Read more about what causes gout here.
If you’re new to gout, your doctor will need to confirm the diagnosis, as it can sometimes masquerade as other ailments that impact the joints (like rheumatoid arthritis). (Read more about gout vs. rheumatoid arthritis symptoms.) Your doctor will likely use a needle to remove some fluid from the swollen joint, then examine it under a microscope to confirm that it contains uric acid crystals.
How to Treat a Gout Flare
Different medications can be used to address gout, but when you’re in the midst of a gout flare, the number-one goal is pain management. “Because the pain is so severe, it’s really important to try to bring it under control quickly,” says Dr. Saag.
Even though gout is caused by uric acid buildup, now is not the time to start a drug that’s specifically designed to lower uric acid levels. (If you’re already taking one of these drugs, which include allopurinol and febuxostat, you should continue taking them during a gout flare.)
Instead, your doctor will likely prescribe a higher dose of a non-steroidal anti-inflammatory drug (NSAID), such as naproxen, or a steroid medication like prednisone. Your doctor might also inject a steroid directly into the affected joint, or, if the pain is bad enough, start you on an intravenous version of it, says Dr. Saag.
Colchicin is another medication that is sometimes used to manage gout flares. This drug is not a traditional pain reliever, since it doesn’t seem to relieve pain caused by other conditions. According to a Cochrane Review, about 40 out of 100 people who use colchine during a gout attack rated their pain 50 percent lower than those who took a placebo, but there’s also a high risk of side effects like vomiting, nausea, and diarrhea, especially when taken at high doses.
If you’ve had gout flares before and are now seeing a new provider or are being treated in the emergency room, be sure to tell the doctor about the treatments you’ve previously tried during an acute episode and how well (or not) they worked for you.
With treatment, a gout flare usually clears up within a few days, says Dr. Saag. If you don’t treat it, you could be dealing with it for a week to two weeks.
Home Remedies for Gout Flares
While you taking medication to fight the pain and inflammation during a gout flare, there are a few other simple gout home remedies you can use to ease the discomfort. Rest is important; try to keep the impacted joint higher than your heart. (For example, elevate your foot if your toe is the problem.) Ice may also be helpful, because it brings down swelling. Research shows that ice is particularly soothing for gout; if you’re dealing with a different type of arthritis, a heating pad may be a better choice.
Some people also say that eating cherries or drinking tart cherry juice helps during a gout flare. While studies have shown that cherry lovers may be less likely to have frequent gout flares, it’s not clear whether loading up on this fruit during an attack will make an immediate difference. Cherries may be helpful because they’re rich in antioxidants, and tart cherries may help lower uric acid levels (though more research is needed).
What to Do After a Gout Flare
While it’s possible to have an isolated gout attack, “normally once gout strikes you’ll need prolonged therapy to manage it,” says Dr. Saag. If you don’t take regular uric-acid lowering medication or find another way to get your uric acid levels down — cutting back on alcohol, losing weight, and cutting back on high-purine foods may make a difference — over time you will likely experience shorter intervals between gout flares, he explains. “Gout ultimately becomes a chronic arthritis, and it can be quite disabling.”
Track Your Gout Symptoms with ArthritisPower
Join CreakyJoints’ patient-centered research registry and track symptoms like flares and pain. Learn more and sign up here.