Gout flare

Overview

Gout is a type of arthritis that happens when tiny crystals of uric acid form inside a joint, causing sudden and severe pain, swelling, and redness. This sudden attack is called a gout flare.

Yes, gout is one of the most common forms of inflammatory arthritis, affecting millions of people worldwide.

Gout is more common in men, especially after age 40. Women are more likely to develop it after menopause. People with high blood pressure, diabetes, obesity, or kidney problems are at higher risk.

Symptoms

Common symptoms

• Sudden, intense pain in a joint (often the big toe)
• Swelling and redness around the joint
• The joint feels hot and tender to touch
• Pain is worst in the first 12 to 24 hours
• The skin over the joint may look shiny and tight

Symptoms in children

• Gout is very rare in children. If it occurs, symptoms are similar to adults: sudden joint pain, swelling, and redness.

Symptoms in older adults

• In older adults, gout may affect multiple joints, including the fingers, wrists, and knees.
• Symptoms may be less intense but can cause chronic pain and joint damage over time.
• Older adults may also develop tophi — lumps of uric acid crystals under the skin.

Causes

Main causes

• High levels of uric acid in the blood. When uric acid builds up, it can form sharp crystals in a joint, causing sudden inflammation and pain.
• The body may produce too much uric acid or the kidneys may not remove enough uric acid from the body.

Risk factors

• Eating a diet high in purines (found in red meat, organ meats, shellfish, and some fish like sardines)
• Drinking alcohol, especially beer and spirits
• Being overweight or obese
• Having high blood pressure, diabetes, or kidney disease
• Taking certain medicines, such as diuretics ('water pills') or low-dose aspirin
• Family history of gout
• Dehydration

When to see a doctor

See a doctor urgently if:

• If you have sudden severe pain along with a fever or chills — this could be a sign of a joint infection that needs immediate treatment.
• If you are unable to use the joint at all.

Book a routine appointment if:

• If you have a first gout flare — it's important to get a proper diagnosis.
• If you have repeated flares or ongoing joint pain between flares.
• If you notice lumps (tophi) under your skin near joints.

Diagnosis

A doctor will ask about your symptoms and medical history, and examine the affected joint. They may also take a small sample of fluid from the joint to look for uric acid crystals under a microscope.

Tests that may be done

• Joint fluid analysis (arthrocentesis) — the most reliable test to confirm gout
• Blood test to check your uric acid level (though high uric acid alone doesn't confirm gout)
• Ultrasound or X-ray to look for crystal deposits or joint damage

What to expect at your appointment

Diagnosis is usually straightforward. The doctor will numb the skin before taking fluid from the joint, so it may be uncomfortable but not very painful. Results can help rule out other conditions, such as infection or pseudogout.

Treatment

Treatment for a gout flare aims to reduce pain and inflammation quickly. After the flare settles, long-term treatment focuses on lowering uric acid levels to prevent future flares and joint damage.

Self-care at home

• Rest the affected joint and avoid using it until the pain improves.
• Apply an ice pack (wrapped in a cloth) to the joint for 15–20 minutes at a time, several times a day.
• Elevate the joint (for example, prop up your foot on pillows) to help reduce swelling.
• Drink plenty of water to help your kidneys flush out uric acid.
• Avoid alcohol and foods high in purines during a flare.

Medical treatments

Doctors may prescribe anti-inflammatory medicines to reduce pain and swelling. These can be taken by mouth or applied as a cream or gel on the skin. For more severe flares, a short course of steroid tablets or a steroid injection into the joint may be given. After a flare, your doctor may recommend long-term medicine to lower uric acid levels. This medicine is taken daily to prevent crystals from forming. Your doctor will work with you to find the safest and most effective option based on your health.

When is surgery considered?

Surgery is rarely needed for gout. However, in severe cases where large tophi cause pain, limit movement, or damage joints, surgery may be considered to remove the urate deposits. This is uncommon.

Living with this condition

Gout flares can be painful and unpredictable, but with the right treatment and lifestyle changes, most people can manage their condition well. Between flares, you can live a normal, active life.

Lifestyle tips

• Maintain a healthy weight — losing weight if you are overweight can lower uric acid levels.
• Stay well hydrated — drink at least 8 glasses of water a day.
• Limit alcohol, especially beer and spirits.
• Limit foods high in purines, such as red meat, organ meats, and certain seafood (like sardines, mussels, and anchovies).
• Regular, gentle exercise (like walking or swimming) can help keep joints healthy, but avoid stressing a joint during a flare.

Diet and exercise

Eating a balanced diet with plenty of fruits, vegetables, whole grains, and low-fat dairy can help control uric acid. Choose lean proteins like chicken or tofu, and include sources of vitamin C (such as oranges or strawberries), which may help lower uric acid. Exercise regularly, but listen to your body — rest during a flare and resume activity once pain and swelling have subsided.

Mental health and emotional wellbeing

Living with a painful condition like gout can be frustrating and affect your mood. It's normal to feel upset or anxious, especially during flares. Talking to your doctor, family, or a counsellor can help. Remember that gout is manageable, and most people find relief with treatment.

Prevention

While you cannot always prevent gout flares, you can greatly reduce the risk by keeping uric acid levels in check. This means following a healthy diet, staying hydrated, maintaining a healthy weight, limiting alcohol, and taking prescribed long-term medicines as directed by your doctor.

Complications

If left untreated

• Recurrent flares that become more frequent and severe
• Joint damage and deformity over time
• Formation of tophi (lumps of uric acid crystals under the skin, often around joints)
• Kidney stones or kidney damage due to high uric acid levels

Long-term outlook

With proper treatment and lifestyle changes, most people with gout can control flares and prevent long-term damage. The outlook is very good — many people are able to live without symptoms for long periods. Work with your doctor to find the best plan for you.

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