How gout is treated depends on whether you're in an active attack or trying to prevent the next one

During an acute gout attack, the goal is to reduce pain and swelling as quickly as possible. Your doctor will typically prescribe one of three types of medication: nonsteroidal anti-inflammatory drugs (NSAIDs) like indomethacin or naproxen, colchicine (a drug that reduces inflammation), or corticosteroids if you can't take the other options. Starting treatment within 24 hours of the attack beginning works best.

Once the acute attack settles, the focus shifts to long-term management. This means lowering the uric acid level in your blood — the substance that forms crystals in your joints and causes gout. Medications like allopurinol or febuxostat work by either reducing how much uric acid your body makes or helping your kidneys remove more of it. These are taken daily, not just during attacks.

Most people need both approaches: fast relief during an attack, and prevention medication taken every day to stop future attacks from happening.

Key Takeaways

  • NSAIDs, colchicine, or corticosteroids can stop an active gout attack if started within 24 hours of symptoms beginning.
  • Daily medications like allopurinol lower uric acid levels in your blood and prevent attacks from recurring.
  • Dietary changes — reducing red meat, organ meats, certain seafood, and alcohol — can lower uric acid and reduce attack frequency.
  • Staying hydrated, maintaining a healthy weight, and managing conditions like high blood pressure help prevent gout attacks.
  • Your doctor may prescribe a low dose of colchicine or NSAIDs alongside uric acid-lowering medication during the first few months to prevent attacks while uric acid levels drop.

Medications that stop an active attack

When gout pain and swelling strike, your doctor will choose from three main medication classes. NSAIDs like indomethacin, naproxen, or ibuprofen reduce inflammation and pain. Indomethacin is often preferred for gout specifically because it works quickly. You take it at a higher dose when the attack starts, then taper down over several days.

Colchicine works differently — it doesn't reduce inflammation the way NSAIDs do, but it interrupts the inflammatory process itself. It works best if you start it within 24 hours of symptoms. The standard approach is a higher initial dose followed by smaller doses over the next day or two. Colchicine can cause diarrhea, so your doctor will discuss this side effect with you.

Corticosteroids (oral or injected) are used when NSAIDs and colchicine don't work or you can't take them — for example, if you have kidney disease or a stomach ulcer. Prednisone is a common choice. These work quickly but are usually given for just a few days to a week.

Daily medications that prevent future attacks

Allopurinol is the most commonly prescribed uric acid-lowering medication. It blocks an enzyme called xanthine oxidase, which your body uses to make uric acid. You take it once daily, usually starting at a low dose and increasing it until your uric acid level reaches the target range (typically below 6 mg/dL). It takes weeks to months for the full effect.

Febuxostat works similarly to allopurinol but is a newer option. It also blocks xanthine oxidase and is taken once daily. Some people switch to febuxostat if allopurinol doesn't work well or causes side effects.

Probenecid takes a different approach — instead of reducing uric acid production, it helps your kidneys excrete more uric acid in urine. It's taken daily and works well for some people, though it requires you to drink plenty of water to prevent kidney stones.

Your doctor will likely start you on a low dose of one of these medications and gradually increase it while monitoring your uric acid level with blood tests. During the first few months while your uric acid is dropping, you may actually have more attacks because crystals are breaking down. To prevent this, your doctor often prescribes a low dose of colchicine or an NSAID to take alongside the uric acid-lowering medication during this period.

Dietary and lifestyle changes that reduce uric acid

What you eat and drink directly affects your uric acid level. Foods high in purines — compounds your body breaks down into uric acid — should be limited. These include red meat, organ meats (liver, kidney), certain seafood (anchovies, sardines, shellfish), and high-fructose foods. You don't need to eliminate these entirely, but eating them less often helps.

Alcohol, especially beer, raises uric acid levels significantly. If you drink, limiting it to one drink per day for women or two for men may help. Staying well hydrated — drinking plenty of water throughout the day — helps your kidneys flush uric acid out of your body.

Maintaining a healthy weight reduces gout risk. If you're overweight, gradual weight loss (not crash dieting, which can trigger attacks) lowers uric acid. Managing other conditions like high blood pressure and high cholesterol also helps, since these often occur alongside gout and can worsen it.

What happens during the first months of treatment

When you start a uric acid-lowering medication, your uric acid level begins to drop. As it falls, the crystals that have built up in your joints start to dissolve. This process can actually trigger gout attacks in the short term — a frustrating paradox that surprises many people. This is why your doctor often prescribes a preventive medication (low-dose colchicine or an NSAID) to take alongside the uric acid-lowering drug for the first three to six months.

During this period, you'll have blood tests to check your uric acid level and adjust your medication dose if needed. Once your uric acid stays consistently below the target level and you've gone several months without an attack, your doctor may reduce or stop the preventive medication. The uric acid-lowering medication continues long-term.

When to see a doctor about gout

See your doctor as soon as possible during a gout attack — ideally within 24 hours of symptoms starting. The sooner you start treatment, the faster the attack resolves. If you've had one gout attack, your doctor will likely recommend starting uric acid-lowering medication to prevent future ones, especially if you have risk factors like a family history of gout, high blood pressure, or kidney disease.

If you have frequent attacks (more than two per year), you definitely need daily prevention medication. If you've had just one attack and have no other risk factors, your doctor might suggest waiting to see if another occurs before starting daily medication — but this is an individual decision based on your situation.

Seek immediate care if you have severe pain, fever, or swelling in multiple joints, as this could indicate a different condition or a complication.

Frequently Asked Questions

Can gout go away on its own without medication?

An individual gout attack will eventually resolve on its own, usually within a week or two, but the pain is severe during that time. Medication speeds recovery significantly. More importantly, without uric acid-lowering medication, attacks will keep recurring. Once you've had one attack, your uric acid level is high enough that future attacks are likely unless you address the underlying cause.

Will I have to take gout medication forever?

Most people with gout need to take uric acid-lowering medication long-term, possibly for life. However, if you make significant lifestyle changes — losing weight, eliminating alcohol, changing your diet — your doctor may eventually reduce your dose or stop it. This requires consistent effort and regular blood tests to monitor your uric acid level. Some people can maintain low uric acid through lifestyle changes alone, but this is uncommon.

What should I do if medication isn't working?

If you're still having frequent attacks despite taking daily medication, tell your doctor. Your uric acid level may not be dropping enough, which means your dose needs to increase or you may need a different medication. Sometimes switching from allopurinol to febuxostat, or adding a second uric acid-lowering drug, works better. Poor medication adherence — forgetting doses — is also a common reason attacks continue.

Can I stop taking my gout medication once I feel better?

No. The daily uric acid-lowering medication prevents attacks; it doesn't treat them. Stopping it once you feel better will allow uric acid to build back up, and attacks will return. Think of it like blood pressure medication — you take it to prevent problems, not because you currently have symptoms. The medication for acute attacks (NSAIDs or colchicine) is what you take during an attack and then stop.

Are there any foods I can eat freely with gout?

Yes. Low-fat dairy products, vegetables (including those high in purines like spinach and mushrooms, which don't seem to trigger gout the way meat does), fruits, whole grains, and nuts are generally safe. Coffee and vitamin C may actually help lower uric acid. The key is avoiding or limiting the high-purine foods — red meat, organ meats, certain seafood, and alcohol — rather than following a strict elimination diet.