Gout is a particularly painful form of crystalline or inflammatory arthritis in which high levels of serum urate cause swollen, stiff joints. Often related to genetics, gout is not the lifestyle consequence it’s been portrayed as. Forget the stereotype of carousing, overindulgent men such as King Henry VIII ending up stricken with gout.

“That’s just victim-blaming, While it does affect men more than women, and can be exacerbated by obesity and diet, genetics are a more important factor,” says John FitzGerald, MD, PhD, with the department of rheumatology at the UCLA Health in Los Angeles and coauthor on the American College of Rheumatology’s clinical practice guidelines for gout.

Many Risk Factors May Contribute to Gout and Gout Flare-Ups

Women can develop gout too, especially later in life after menopause.

Other risk factors and conditions for developing gout include:

Diabetes
Insulin resistance
Congestive heart failure
Metabolic syndrome
High cholesterol
High blood pressure,
Kidney disease and the medications taken for it, because they increase uric acid levels.

Your 10-Point Plan: Easing a Gout Attack

During a gout attack, the affected joint becomes swollen, warm to the touch, and appears very red. Even the slightest pressure on the joint can be very painful. The attacks more often occur in the middle of the night; about 50 percent start in the big toe, according to the Alliance for Gout Awareness.

Want to get ahead of the intense pain? Make sure you have a plan:

1. Get a Diagnosis

If this is the first time you have had an attack, see your doctor immediately. “Gout is one of the most underdiagnosed diseases because data on how to treat high uric acid has been lacking. We have better information now. If you are experiencing a flare, you should have an action plan in place, created with your doctor,” says Payam Shakouri, MD, nephrologist with Advanced Kidney Care in Newburgh, New York. The sooner you start treatment and pain management, the more quickly you will be back on your feet.

2. Take the Right Anti-Inflammatory Medications

There are three different kinds that are effective: over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), aspirin (Vazalore), or naproxen sodium (Aleve); prescription steroids; or a prescription anti-inflammatory called colchicine (Colcrys), which influences the way your body reacts to uric acid crystals. “Your doctor will figure out which is the best for your unique needs. NSAIDs, for example, are not appropriate if you have renal disease, and steroids could make your blood sugars worse if you have diabetes,” points out Dr. FitzGerald.

3. Free the Joint!

The least pressure on the affected area can be very painful. People report they can’t even bear to be under a bedsheet. Make sure there are no constraints on the joint when it is flaring up.

4. Rest and Elevate

Stay off the affected joint and keep it elevated as much as possible.

5. Apply Ice — if You Can Bear It

“Apply ice if you can do so comfortably without creating pain,” says FitzGerald. And if icing is hard to tolerate for you, consider using a heating pad instead.

6. Watch Your Diet

You can lower uric acid levels by limiting foods high in purines (like red meat, organ meat, and seafood), and alcohol intake (particularly beer and hard liquor).

7. Stay Hydrated

Drinking water can help flush the uric acid crystals that cause gout out of your system. “A well-hydrated patient should drink enough to urinate every two to three hours,” says Dr. Shakouri.

8. Practice Mindfulness and Meditation

The good news: A gout attack is self-limited and will clear in time. In the meantime, meditation, yoga breathing, mindfulness, and guided imagery can help you deal with the pain, according to the Arthritis Foundation.

9. Create a Support Network

Many patients suffer in silence because of the stigma around gout. Let trusted friends and family know that you have this disease, and reach out for support when you are having a flare.

10. If You Are Having Repeated Attacks, See Your Doctor

Some patients can go a long time between attacks. In fact, for about 60 percent of patients, the next attack will be more than a year away, and some won’t have another attack in the next 10 years, according to research. However, if you begin to have more frequent attacks, talk to your doctor about escalating treatment. “People think it’s normal to have flares every now and then, but it’s not. The gout can be doing damage to your joints. It means you still have too much uric acid,” says Shakouri. In particular, ask about allopurinol (Zyloprim). It won’t help with an acute attack, but it will help prevent future attacks by reducing uric acid production.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Resources

FitzGerald JD, Abeles AM, Dalbeth N, et al. 2020 American College of Rheumatology Guideline for the Management of Gout [PDF]. Arthritis Care & Research. June 2020.
What Is Gout? Alliance for Gout Awareness.
Types of Meditation for Arthritis. Arthritis Foundation.
Harris MD, Siegel LB, Alloway JA. Gout and Hyperuricemia. American Family Physician. February 15, 1999.

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