Gout does not have a permanent cure, but attacks can be stopped quickly and prevented from happening again

There is no medication or procedure that eliminates gout entirely. What exists instead are two separate treatments: one that stops an active attack within hours or days, and another that prevents attacks from recurring by lowering the uric acid in your blood. Most people with gout need both, used at different times.

An acute attack—the sudden, severe pain in your big toe or another joint—responds to anti-inflammatory drugs. The most common are colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs) like indomethacin or naproxen, and corticosteroids. Starting one of these within 24 hours of pain onset typically brings relief within 24 to 72 hours.

Long-term prevention requires urate-lowering therapy—drugs that reduce the uric acid level in your blood so crystals do not form in your joints. The most common are allopurinol and febuxostat. These are taken daily, usually for years or indefinitely, and work only if you stay on them.

Key Takeaways

  • Stopping an active gout attack requires an anti-inflammatory drug started within 24 hours of pain onset, usually colchicine, an NSAID, or a corticosteroid.
  • Preventing future attacks requires daily urate-lowering therapy—most commonly allopurinol—which reduces the uric acid in your blood to a target level.
  • Urate-lowering drugs work only while you take them; stopping them allows uric acid to rise again and attacks to return.
  • Dietary changes and weight loss can lower uric acid modestly but rarely prevent attacks on their own without medication.
  • Your doctor will test your uric acid level to decide whether you need long-term prevention therapy and to adjust your dose.

How to stop pain during an active attack

The goal during an acute attack is to reduce inflammation and pain as quickly as possible. Colchicine is often the first choice because it is effective and has been used for gout for centuries. A typical dose is 1.2 mg at the first sign of pain, followed by 0.6 mg one hour later. It works best when started within 24 hours of the first twinge. After that window, it becomes less effective. Common side effects are nausea and diarrhea.

NSAIDs like indomethacin, naproxen, or ibuprofen reduce inflammation and pain directly. Indomethacin is often dosed at 50 mg three times daily during an attack. NSAIDs work within hours and are very effective, but they carry risks for people with kidney disease, heart disease, or a history of ulcers. Your doctor will know whether an NSAID is safe for you.

Corticosteroids—oral prednisone or an injection—are used when colchicine and NSAIDs are not an option or have not worked. A typical course is prednisone 30 mg daily for three to five days, then tapered. Steroids work quickly but are usually reserved for people who cannot take the other two classes.

Rest, ice, and elevation of the affected joint support whatever drug you take. Most attacks resolve within a week even without treatment, but medication speeds recovery to one to three days.

Long-term prevention with urate-lowering drugs

Allopurinol is the most widely prescribed urate-lowering drug. It blocks xanthine oxidase, an enzyme that produces uric acid. A typical starting dose is 50 to 100 mg daily, increased every two to five weeks until your uric acid level reaches the target—usually below 6 mg/dL. Most people end up on 200 to 400 mg daily. It takes weeks to months for uric acid to drop and attacks to become rare.

Febuxostat works the same way as allopurinol but is newer and may be preferred if you have kidney disease or need a faster dose increase. The starting dose is 40 mg daily, increased to 80 mg if needed. Both drugs are taken once daily, usually for life.

Uricosuric agents like probenecid work differently—they increase the amount of uric acid your kidneys excrete. They are less commonly used now but may be an option if allopurinol or febuxostat do not work or cause side effects. Probenecid is dosed at 250 to 500 mg twice daily, increased gradually.

Pegloticase is a newer drug that breaks down uric acid directly. It is reserved for severe, refractory gout—cases that do not respond to standard therapy—because it is expensive and requires intravenous infusion every two to four weeks. Your doctor will consider it only after other options have failed.

When to start prevention therapy

Not everyone with one gout attack needs lifelong prevention. Your doctor will recommend starting urate-lowering therapy if you have had two or more attacks in a year, a single attack with uric acid level above 9 mg/dL, or any attack if you also have kidney disease, heart disease, or tophi (deposits of uric acid crystals under the skin).

If you have had only one mild attack and your uric acid is below 9 mg/dL, your doctor may suggest waiting and managing with diet and lifestyle changes. However, many people do have a second attack within months or years, so prevention is often started sooner rather than later.

Starting urate-lowering therapy during an acute attack can paradoxically trigger more attacks as uric acid levels drop and crystals dissolve. For this reason, most doctors wait until the acute attack has resolved, then start prevention therapy. Some also give colchicine or an NSAID for the first few weeks of prevention to reduce the risk of new attacks during the adjustment period.

Dietary and lifestyle changes that lower uric acid

Diet changes the uric acid level modestly—usually by 1 to 2 mg/dL—and work best alongside medication, not instead of it. Foods high in purines (compounds that break down into uric acid) include red meat, organ meats, certain seafood like anchovies and sardines, and alcohol, especially beer. Limiting these can help. Fructose—in sugary drinks and some fruits—also raises uric acid, so reducing added sugars matters.

Weight loss lowers uric acid in overweight people. Losing 5 to 10 percent of body weight can reduce uric acid by 1 to 2 mg/dL and may reduce attack frequency. However, rapid weight loss can trigger attacks, so gradual loss over months is preferable.

Staying well-hydrated helps your kidneys excrete uric acid. Drinking 2 to 3 liters of water daily is a reasonable target. Coffee and vitamin C may have modest protective effects, though the evidence is not strong enough to recommend them as primary prevention.

These changes are worth making because they improve overall health and may reduce how much medication you need. But they are not a substitute for urate-lowering drugs if your uric acid stays elevated or attacks keep happening.

Monitoring and adjusting your treatment

Once you start urate-lowering therapy, your doctor will check your uric acid level every two to five weeks until it reaches the target, then every six to twelve months to confirm it stays there. The target is usually below 6 mg/dL, though some doctors aim for below 5 mg/dL in people with tophi or very frequent attacks.

If your uric acid is not dropping, your doctor may increase your dose, switch to a different drug, or add a second urate-lowering agent. Some people need combination therapy—for example, allopurinol plus probenecid—to reach target.

Side effects of allopurinol are uncommon but can be serious. A rash is the most frequent; a severe rash (Stevens-Johnson syndrome) is rare but requires stopping the drug immediately. Febuxostat has a similar safety profile. Report any new rash, fever, or joint pain to your doctor right away.

Urate-lowering drugs work only while you take them. If you stop, uric acid rises again within weeks, and attacks return. For this reason, these drugs are usually lifelong. Your doctor will discuss whether stopping is ever appropriate in your case.

What happens if standard treatments do not work

Most people respond well to allopurinol or febuxostat and have few or no attacks once uric acid is controlled. A small number continue to have frequent attacks despite reaching the uric acid target. This is called refractory gout.

If you have refractory gout, your doctor may add a second urate-lowering drug, increase the target uric acid level even lower (below 5 mg/dL), or switch to pegloticase. Some people also benefit from long-term low-dose colchicine or NSAIDs to prevent breakthrough attacks while adjusting therapy.

Refractory gout is more common in people with severe kidney disease, those taking diuretics for heart or blood pressure problems, and those with very high uric acid levels at baseline. Your doctor may also check whether you are taking your medication consistently, because missed doses are a common reason for ongoing attacks.

Frequently Asked Questions

Can gout go away on its own without treatment?

An individual attack will resolve on its own within a week or two, but the underlying condition—high uric acid—does not go away. Without urate-lowering therapy, attacks typically recur within months or years. Medication is needed to prevent that cycle.

Is there a surgery to cure gout?

No. Surgery cannot lower uric acid or prevent gout. In rare cases, surgery may be used to remove large tophi (deposits of uric acid crystals) that damage joints, but this is done only after medical therapy has failed and is not a cure for gout itself.

How long do I have to take urate-lowering drugs?

Most people take them indefinitely. Uric acid rises again if you stop, and attacks return. Your doctor may discuss stopping in rare cases—for example, if you have had no attacks for many years and your uric acid stays low on its own—but this is uncommon and requires close monitoring.

Can I prevent gout attacks with diet alone?

Diet can lower uric acid by 1 to 2 mg/dL and may reduce attack frequency, but it rarely prevents attacks entirely if your uric acid is significantly elevated. Diet works best alongside medication, not instead of it. Talk to your doctor about whether medication is needed in your case.

What should I do if I have a gout attack at night or on a weekend?

If you have colchicine or an NSAID at home, take it immediately—the sooner you start, the faster the attack resolves. If you do not have medication and the pain is severe, go to an urgent care or emergency room, where they can give you an injection or prescription. Do not wait until Monday if the pain is unbearable.