Read on to learn more about gout, including what causes it; how long an episode of gout typically lasts; complications of gout; and tips for treating gout symptoms during an acute flare, as well as long-term management for chronic gout.
What Causes Gout?
When levels of serum uric acid (sUA) are above 6.7 mg/dL, it is classified as a condition called hyperuricemia. Over time, an uncontrolled, high level of uric acid can lead to the development of gout, which causes pain during acute flares and can lead to other long-term complications and health issues down the road.
Everyone has at least some uric acid in their bodies, but too much uric acid in the blood can be problematic. When the body breaks down purines—found in common foods and beverages, such as red meat and alcohol—uric acid is created and processed by the kidneys. When there is too much for the kidneys to get rid of, it can lead to the formation of crystals in your joints and even a painful attack of gout.
Beyond elevated sUA levels, a family history of gout is the most common risk of gout.
You can reduce your risk for this painful form of arthritis by obtaining a lower uric acid level through ongoing treatment and disease management.
What Is it Like to Experience a Flare?
Gout symptoms include severe pain in one or more joints. The joint may be red, swollen and very tender to the touch. People with gout usually rate the pain of gout as a nine out of 10 on a standard pain scale. Research from the Gout Education Society has found that many people would rather be hit by a car than experience the intense pain from another flare.
Gout is most common in the big toe and the severe joint pain accompanied by flares often appears there first. However, gout can also appear in other joints, such as fingers, elbows, wrists, knees, ankles, and others. Over time, as crystals in the joints form, flares can become more frequent and more painful if the right treatment to prevent them is not in place.
How Long Does Gout Last?
Gout is a lifelong disease that must be treated and managed on an ongoing basis to keep flares under control. Typically, gout flares may last three to seven days, with symptoms usually dissipating within a few days after the proper treatment for pain in a joint and inflammation. If left untreated, a full recovery from an attack can last up to 14 days.
Untreated, gouty arthritis can lead to permanent joint damage, bone and tissue damage, and other complications, such as kidney stones or kidney disease; cardiovascular issues, such as heart attack or stroke; diabetes and more.
How Do You Treat a Flare?
Many people experiencing a flare for the first time will head to the emergency department to treat their pain. While this is okay, it is also important to follow up with a doctor after experiencing a flare so that the disease can be managed over time.
During a typical gout flare, it is helpful to keep the affected joint as still as possible and not do anything that requires movement or adding weight or pressure to the joint, until symptoms go away. If tolerated, it can be helpful to keep the joint cool with an ice pack or ice wrapped in a cloth, applying it for about 20 minutes at a time. A gout attack usually causes severe pain, so many sufferers can’t stand it to be touched—and even a bed sheet over the affected joint can cause searing pain.
To reduce pain and swelling of an acute flare, treatment often includes antiinflammatory medications—such as NSAIDs and/or colchicine. Corticosteroids, in the form of prednisone or Medrol, are occasionally used to treat flares when colchicine or NSAIDs cannot be used. Cortisone can be taken by mouth, but can also be used as an injection directly into the affected joint.
A doctor (whether it’s an emergency room doctor or primary care physician) can advise on the best course of treatment to ease the pain during a flare-up, and then a rheumatologist can help with the long-term management of the disease and help reduce future flares and overall amount of uric acid.
Beyond the Flares: Long-Term Treatment for Gout
After a first flare, it is important to get an official diagnosis from a doctor, and ideally a rheumatologist. Gout often presents itself as other conditions—such as a sprain or strain—and is subsequently often misdiagnosed or treated. Conversely, many who are diagnosed with gout may have another condition instead, such as pseudogout. While a blood test can measure uric acid in the body, the gold standard for making an official diagnosis is to take a sample of fluid from an infected joint as a way to detect the presence of uric acid crystals, since crystals form inside and around joints.
Lifelong treatment is typically necessary to reduce the risk of severe gout and long-term gout pain from future flares. A rheumatologist can advise on an effective treatment plan, including medication and lifestyle changes.
Once an official diagnosis of gout has been made, a daily medication to reduce uric acid may be prescribed. The two most common medications, which may be used to lower uric acid in your blood and prevent future flares, are allopurinol and febuxostat. These are both xanthine oxidase inhibitors. Like many other medications for conditions such as high blood pressure or high cholesterol, these are meant to be taken daily for life. They should not be discontinued—even when a gout flare-up is over—without first speaking with a doctor.
Without treatment, it is unlikely that your blood uric acid level will be lowered to the target of 6.09 mg/dL or less—as recommended by the American College of Rheumatology—and future pain and discomfort from flares will persist.
Diet and Lifestyle Modifications
To help prevent gout flares, many doctors will also recommend making dietary and lifestyle modifications—including making smart choices about foods and getting daily exercise.
While there is no such thing as an official “gout diet,” certain foods and diets (e.g., a diet high in purines, like red meat) have been known to cause a gout attack. Some foods to avoid if you have gout may include red meat, lamb, shellfish, processed foods, alcohol (especially beer and grain liquors), sugary soft drinks and other sweetened beverages and foods. The Gout Education Society recommends limiting table sugar, table salt and products with high-fructose corn syrup to help prevent potential flares, in addition to taking daily medications as prescribed.
While there is not a specific “gout diet,” many have found the Mediterranean and DASH diets to be helpful. It is also important to remain hydrated and drink plenty of water. More information about eating healthy with gout can be found at GoutEducation.org and through our “Gout Diet: Myth Vs. Fact” one-pager, here.
In addition to dietary changes, maintaining a healthy lifestyle is important. Those who have gout should talk to their doctor about a treatment plan that allows them to exercise regularly. Most adults will be encouraged to engaged in moderate-intensity physical activities for at least 30 minutes most days of the week. Examples include taking a brisk walk, swimming laps, mowing the lawn, dancing or bicycling. Always check with a physician before starting a new program or regimen.
Where to Learn More
Gout is an inflammatory arthritis caused by elevated uric acid levels, and it requires lifelong treatment and management. Anyone with gout can take steps to help relieve symptoms of gout flares and manage the disease for a healthier future.
More information about treatment and management can be found at GoutEducation.org.