What to do during a gout attack

A gout attack usually peaks within 24 to 48 hours and can last a week or longer without treatment. The fastest way to shorten it is to start an anti-inflammatory medication as soon as symptoms begin — ideally within the first 12 hours. Your doctor can prescribe indomethacin, naproxen, or colchicine, all of which reduce swelling and pain. If you have a prescription already, take it immediately rather than waiting to see if the attack passes on its own.

While waiting for medication to work, rest the joint, keep it elevated, and apply ice for 20 minutes at a time. Over-the-counter ibuprofen or naproxen can help if you do not have a prescription, though prescription-strength doses work faster. Drink water steadily — dehydration makes attacks worse and longer. Avoid alcohol, sugary drinks, and foods high in purines (organ meats, certain seafood, red meat) until the attack clears, as these can extend it.

If the pain is severe enough that you cannot walk or bear weight, contact your doctor or go to an urgent care clinic. Severe attacks sometimes need an injection of corticosteroids directly into the joint or a systemic steroid dose to bring swelling down quickly.

Key Takeaways

  • Start anti-inflammatory medication within the first 12 hours of an attack to shorten its duration and reduce pain.
  • Rest, elevate, ice, and drink water during an attack; avoid alcohol and high-purine foods until it clears.
  • Long-term prevention requires lowering uric acid levels, usually with daily medication like allopurinol or febuxostat.
  • You need a baseline uric acid blood test before starting prevention medication, and regular testing afterward to confirm the dose is working.
  • Lifestyle changes alone rarely prevent gout if you have had more than one attack; medication is usually necessary.

Medications that prevent future attacks

Stopping attacks from happening in the first place means lowering the uric acid level in your blood. Uric acid crystals form joints when levels stay too high, so bringing them down prevents new attacks. The most common medication is allopurinol, a daily pill that reduces how much uric acid your body makes. Febuxostat works the same way and is an option if allopurinol does not work or causes side effects.

Before starting either medication, your doctor will order a blood test to measure your current uric acid level. This baseline matters because the goal is to bring it below 6 mg/dL, and your dose will be set to reach that target. You will need repeat blood tests every 2 to 5 weeks at first to check whether the dose is working, then less often once you are stable.

Starting prevention medication can actually trigger an attack in the first few weeks as crystals break down and move through the joint. To prevent this, doctors often prescribe a short course of colchicine or an anti-inflammatory alongside the new uric acid-lowering drug. Do not stop the prevention medication if an attack happens — continue it and treat the attack separately with anti-inflammatory medication.

Lifestyle changes that reduce attack frequency

Diet and hydration matter, but they rarely prevent gout entirely if you have had multiple attacks. Still, they can reduce how often attacks happen and may lower the dose of medication you need. Drink at least 2 to 3 liters of water daily to keep urine dilute, which helps your body excrete uric acid. Limit alcohol, especially beer, which raises uric acid levels more than other drinks.

Reduce foods high in purines: organ meats (liver, kidney), certain seafood (anchovies, sardines, mussels), red meat, and high-fructose corn syrup. You do not need to eliminate these entirely, but eating them less often helps. Low-fat dairy products, coffee, and vitamin C may actually lower uric acid, so these are safe to eat freely.

Losing weight if you are overweight can lower uric acid levels, but crash dieting can trigger attacks because rapid weight loss releases uric acid into the bloodstream. Aim for slow, steady weight loss of 1 to 2 pounds per week if your doctor recommends it.

When to see a doctor about gout

See your doctor if you have had one attack, even if it resolved on its own. A single attack means your uric acid is high enough to form crystals, and a second attack is likely without prevention. Your doctor will order the baseline uric acid test and discuss whether prevention medication makes sense for you.

See a doctor immediately if an attack is severe, you cannot move the joint, you have fever along with joint pain, or the attack does not improve within a few days of treatment. These can signal a different problem or a complication that needs urgent care.

If you are already on prevention medication and attacks keep happening, contact your doctor. Your uric acid level may not be low enough yet, or your dose may need adjustment. Bring records of when attacks occurred so your doctor can see whether they are becoming less frequent.

Gout versus other joint problems

Gout attacks feel sudden and severe — usually one joint, often the big toe, becomes red, swollen, and extremely painful overnight. Other conditions like rheumatoid arthritis or osteoarthritis develop more slowly and usually affect multiple joints. If you are not sure whether you have gout, your doctor can test the fluid from the joint during an attack to confirm uric acid crystals are present.

Some people confuse gout with pseudogout, which is caused by calcium pyrophosphate crystals instead of uric acid. The symptoms look identical, but the treatment is different. A joint fluid test is the only way to tell them apart, so do not assume a sudden joint attack is gout without confirmation.

What happens if gout is not treated

Repeated attacks over months or years can damage the joint permanently, causing chronic pain and limited movement even between attacks. Uric acid can also form deposits called tophi in the skin around joints and ears. In rare cases, very high uric acid levels can damage the kidneys or cause kidney stones.

Starting prevention medication early — after the first or second attack — prevents this damage. Once damage occurs, it cannot be reversed, so prevention is far more effective than waiting to treat attacks after they happen.

Frequently Asked Questions

Can gout go away on its own without medication?

A single attack will resolve on its own within a week or two, but without treatment to lower uric acid, more attacks will follow. Lifestyle changes alone rarely prevent gout if you have had multiple attacks. Most people need daily medication to keep uric acid low enough to prevent crystals from forming.

Is it safe to take pain medication during a gout attack if I am on prevention medication?

Yes. Treat the attack with anti-inflammatory medication or colchicine while continuing your daily prevention medication. Do not stop the prevention drug because an attack happened — the two work differently and both are needed.

How long does it take for prevention medication to work?

It takes 2 to 4 weeks for allopurinol or febuxostat to lower uric acid enough to prevent new attacks. Your doctor will check your uric acid level with blood tests to confirm the dose is right. Attacks may still happen during this time, so continue treating them as they occur.

What if I cannot afford prevention medication?

Talk to your doctor about generic options — allopurinol is inexpensive and widely available as a generic. Some pharmaceutical companies offer patient assistance programs if cost is a barrier. Your doctor can also help you explore whether you may have access to for programs that cover medications.

Can I stop prevention medication once my uric acid is low?

No. Prevention medication must be taken daily for life to keep uric acid low. Stopping it will allow uric acid to rise again, and attacks will return. Your doctor may adjust the dose over time, but the medication itself is ongoing.