Gout flares

Overview

A gout flare is a sudden, intense attack of pain, redness, swelling, and tenderness in a joint, most often the big toe. It happens when tiny crystals of uric acid form inside the joint, causing inflammation (the body's response to irritation).

Yes, gout is a relatively common form of arthritis. It affects about 1 in 40 adults in the UK and is more common in men than women.

Gout mostly affects men over the age of 40, but women can develop it after menopause. It can also occur in younger people, especially if they have other health conditions or a family history of gout.

Symptoms

Common symptoms

• Sudden, severe pain in a joint – often described as throbbing or crushing
• Redness and warmth around the joint
• Swelling that makes the joint look puffy
• Extreme tenderness – even a light touch or bedsheet can hurt

Symptoms in children

• Gout flares are very rare in children. When they do occur, they may affect joints other than the big toe and can be mistaken for other conditions.

Symptoms in older adults

• In older adults, gout flares may affect multiple joints at once, such as fingers, wrists, or knees.
• The pain and swelling may last longer and take more time to fully resolve.
• Older adults are also more likely to have other health issues that can complicate treatment.

Causes

Main causes

• Gout flares are caused by a buildup of uric acid in the blood, which forms sharp crystals that settle in the joints.
• The body produces uric acid when it breaks down substances called purines, which are found naturally in the body and in certain foods.

Risk factors

• Eating foods high in purines, such as red meat, organ meats (like liver), and shellfish
• Drinking too much alcohol, especially beer and spirits
• Being overweight or obese
• Having high blood pressure, diabetes, kidney disease, or high cholesterol
• Taking certain medications, like water tablets (diuretics) or low-dose aspirin
• Having a family history of gout
• Recent surgery or injury

When to see a doctor

See a doctor urgently if:

• If you have a fever along with joint pain, redness, and swelling – this could be an infection.
• If the pain is so severe that you cannot function or sleep.
• If you have a history of gout but the attack does not improve with your usual treatment.

Book a routine appointment if:

• If you think you are having your first gout flare – it's important to get a proper diagnosis.
• If you have frequent gout flares (more than two a year) – your doctor may recommend treatment to prevent future attacks.
• If you have other health conditions like kidney disease, diabetes, or high blood pressure.

Diagnosis

A doctor will usually diagnose a gout flare by asking about your symptoms and examining the affected joint. They may also do tests to confirm the diagnosis and rule out other conditions.

Tests that may be done

• Blood test to check your uric acid level – although levels can be normal during a flare.
• Joint fluid test (arthrocentesis) – a small sample of fluid is taken from the joint to look for uric acid crystals under a microscope.
• Ultrasound or X-ray to check for crystal deposits or joint damage (more often used in long-standing cases).

What to expect at your appointment

If your doctor suspects gout, they may start treatment for the flare before all test results are back. A joint fluid test can be uncomfortable but is quick and provides a definite diagnosis. Most people are treated in their GP surgery, but if the diagnosis is uncertain or you have other health problems, you may be referred to a rheumatologist (joint specialist).

Treatment

Treatment for a gout flare focuses on quickly reducing pain and swelling. This often involves anti-inflammatory medication and self-care measures. After the flare settles, treatment may focus on lowering uric acid levels to prevent future attacks.

Self-care at home

• Rest the affected joint – avoid walking or using it if possible.
• Apply an ice pack (wrapped in a cloth) to the joint for 15–20 minutes at a time, several times a day.
• Keep the joint elevated above the level of your heart (e.g., on pillows) to help reduce swelling.
• Drink plenty of water to help flush excess uric acid from your body.
• Avoid alcohol and foods that may have triggered the flare.

Medical treatments

A doctor may prescribe a non-steroidal anti-inflammatory drug (NSAID) to reduce pain and swelling. Other options include a medication called colchicine, or a course of corticosteroid tablets or injections. The choice depends on your health, other medications, and the severity of the flare. Always follow your doctor's advice and do not take more than the recommended dose.

When is surgery considered?

Surgery is rarely needed for gout. In very severe cases where large uric acid deposits (tophi) cause joint damage or press on nerves, a procedure to remove them may be considered. Your doctor will discuss this if it applies to you.

Living with this condition

Living with gout means learning to manage triggers and take care of your joints. Most people can lead a normal active life with proper treatment. It helps to know the early signs of a flare so you can start treatment quickly.

Lifestyle tips

• Maintain a healthy weight – losing weight if you are overweight can lower uric acid levels and reduce flares.
• Limit alcohol, especially beer and spirits, and avoid binge drinking.
• Drink plenty of water – aim for 2–3 litres a day unless your doctor advises otherwise.
• Choose lower-purine foods – eat more fruits, vegetables, whole grains, and low-fat dairy.
• Avoid crash diets or fasting, which can raise uric acid.
• Exercise regularly, but avoid stressing the joint during a flare.

Diet and exercise

A balanced diet that is low in purines can help prevent gout flares. Good choices include vegetables, fruits, low-fat dairy, eggs, nuts, and whole grains. Red meat, organ meats, and shellfish should be limited. Regular, gentle exercise like walking, swimming, or cycling can help with weight management and joint health. During a flare, rest the joint completely.

Mental health and emotional wellbeing

Sudden, severe pain can be distressing and may affect your mood and sleep. Some people worry about when the next flare will happen. It is important to talk to your doctor if you feel anxious or depressed – they can offer support or refer you to a mental health professional.

Prevention

You can reduce the chance of gout flares by making lifestyle changes, such as eating a low-purine diet, drinking less alcohol, staying hydrated, and maintaining a healthy weight. If you have frequent flares, your doctor may prescribe a medication (like allopurinol) to lower your uric acid level over time. Always take such medication as directed, even if you feel well.

Complications

If left untreated

• Repeated gout flares can damage the joint, leading to chronic arthritis and loss of movement.
• Large deposits of uric acid crystals (tophi) can form under the skin around joints and in other tissues.
• High uric acid levels can increase the risk of kidney stones and kidney damage.

Long-term outlook

With proper treatment and lifestyle changes, most people with gout can control their symptoms and enjoy a good quality of life. Flares become less frequent and less severe over time. Gout is a long-term condition, but active management can make a big difference.

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