What happens during a gout attack and how it's treated

A gout attack is sudden joint pain and swelling caused by uric acid crystals forming inside the joint. The pain usually peaks within 24 hours and can last days or weeks without treatment. Doctors treat active attacks with three main approaches: reducing inflammation, managing pain, and lowering the uric acid level in your blood to prevent future attacks.

During an acute attack, the goal is to stop the inflammation and pain as quickly as possible. Most people need medication within the first 24 hours for the best results. The longer you wait after symptoms start, the longer the attack typically lasts.

Key Takeaways

  • Anti-inflammatory medications like indomethacin, naproxen, or colchicine work best when taken within the first 24 hours of an attack.
  • Corticosteroids by mouth or injection are an option if you cannot take NSAIDs or colchicine, or if they do not work.
  • Long-term uric acid-lowering medications like allopurinol or febuxostat prevent future attacks but should not be started during an active attack.
  • Lifestyle changes—staying hydrated, limiting alcohol and high-purine foods, and maintaining a healthy weight—reduce how often attacks happen.
  • Your doctor will likely prescribe preventive medication if you have more than two attacks per year or have kidney stones or tophi (uric acid deposits).

Medications that stop an active gout attack

Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first choice. Common ones are indomethacin, naproxen, and ibuprofen. These reduce inflammation and pain at the same time. You take them at a higher dose at the start of an attack, then lower doses for a few days. NSAIDs work best if you start them within 24 hours of the first symptom.

Colchicine is an older medication that stops the inflammatory response that creates the pain. It works best in the first 12 hours of an attack. The dose is high at first, then drops. Colchicine can cause diarrhea, so your doctor will tell you exactly how much to take and for how long.

Corticosteroids are used when NSAIDs or colchicine do not work, or when you cannot take them because of other health conditions or medications. Your doctor can prescribe them by mouth (usually prednisone) or as an injection directly into the joint. Steroids reduce inflammation but do not lower uric acid levels, so they only treat the current attack.

Your doctor will choose based on your other health conditions, what medications you already take, and how severe the attack is. If you have kidney disease, heart failure, or stomach ulcers, some of these options may not be safe for you.

Medications that prevent future attacks

Allopurinol is the most commonly prescribed preventive medication. It blocks the enzyme that produces uric acid, lowering the level in your blood. You take it once daily by mouth. It takes weeks or months to reach its full effect, so it does not help an active attack and should not be started during one.

Febuxostat works similarly to allopurinol but may be used if allopurinol does not work well or causes side effects. It is also taken once daily by mouth.

Uricosuric agents like probenecid help your kidneys remove more uric acid through urine. These are less commonly used than allopurinol but may be an option if you have normal kidney function.

Your doctor will likely recommend starting a preventive medication if you have had more than two attacks in a year, have kidney stones, have tophi (hard deposits of uric acid under the skin), or have chronic kidney disease. The goal is to keep your uric acid level below 6 mg/dL, which prevents crystals from forming.

What to do right when an attack starts

Start medication as soon as possible—ideally within the first 12 hours. The sooner you treat it, the shorter the attack usually lasts. Rest the joint and keep it elevated if you can. Ice packs can help with pain and swelling.

Call your doctor the same day if this is your first attack or if the pain is severe. If you already have gout medication at home, your doctor may have told you to start it right away without waiting for an appointment. If you do not have medication yet, your doctor's office may be able to call a prescription to a pharmacy the same day.

Drink plenty of water to help flush uric acid from your body, but avoid alcohol and sugary drinks. Do not start a uric acid-lowering medication during an active attack unless your doctor specifically tells you to—it can make the attack worse at first.

Lifestyle changes that reduce attacks

Staying well hydrated is one of the most important steps. Drink enough water that your urine is clear or pale yellow. Dehydration concentrates uric acid in your blood and can trigger attacks.

Limit alcohol, especially beer, which raises uric acid levels more than wine or spirits. If you drink, keep it to one drink per day for women or two for men. Avoid or reduce foods high in purines—organ meats, red meat, certain seafood like anchovies and sardines, and high-fructose corn syrup. You do not need to cut these out completely, but eating less of them helps.

Maintain a healthy weight through gradual weight loss if needed. Rapid weight loss can trigger attacks, so aim for slow, steady progress. Regular exercise also helps, as long as you stay hydrated during activity.

When to see a doctor about gout treatment

See your doctor if you have sudden severe joint pain and swelling, especially if it is your first time. Your doctor will examine the joint and may take a sample of fluid from it to confirm gout by looking for uric acid crystals under a microscope. Blood tests can measure your uric acid level.

If you have been diagnosed with gout and have frequent attacks despite medication, tell your doctor. You may need a higher dose of preventive medication or a different medication altogether. If you develop tophi, have kidney stones, or have kidney disease, preventive treatment becomes more important.

Keep track of what triggers your attacks—certain foods, alcohol, dehydration, or stress—and share that information with your doctor. This helps guide your treatment plan.

Frequently Asked Questions

Can I take uric acid-lowering medication during an active gout attack?

No. Starting allopurinol or febuxostat during an attack can make it worse because the sudden drop in uric acid can trigger more crystal formation. Wait until the attack is completely over, then start the preventive medication. Your doctor may have you take colchicine or an NSAID for a few weeks after starting the preventive medication to protect against this.

How long does it take for preventive medication to work?

Allopurinol and febuxostat take several weeks to months to reach their full effect. Your doctor will check your uric acid level with a blood test and may adjust your dose. You should not expect fewer attacks until your uric acid level is consistently below 6 mg/dL, which can take two to three months or longer.

What if NSAIDs and colchicine do not work for my attack?

Corticosteroids are the next option. Your doctor can prescribe prednisone by mouth or inject a steroid directly into the joint. If you have other health conditions that make steroids risky, your doctor may try a different NSAID or a higher dose of colchicine under close supervision.

Do I have to take preventive medication forever?

If your attacks are infrequent and you can manage them with medication during attacks, you may not need preventive medication. However, if you have more than two attacks per year, have kidney disease, or have tophi, long-term preventive treatment is usually recommended to prevent permanent joint damage.

Can diet alone prevent gout attacks?

Diet helps reduce the frequency of attacks, but it usually is not enough on its own if you have had multiple attacks. Most people with recurrent gout need medication to keep uric acid levels low enough to prevent crystals from forming. Diet works best as part of a complete plan that includes medication and lifestyle changes.