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 relief comes from nonsteroidal anti-inflammatory drugs (NSAIDs) like indomethacin, naproxen, or ibuprofen, taken at the first sign of pain. Starting early matters — these drugs work better if you take them before the swelling gets severe.

If NSAIDs don't work or you can't take them, colchicine is a second option. It reduces inflammation and works best within the first 12 hours of symptoms. Your doctor can prescribe it, and it often brings relief within hours, though it can cause stomach upset.

For severe attacks that don't respond to either drug, corticosteroids (usually prednisone or a steroid injection into the joint) can stop the inflammation. These are prescription-only and work within hours to days. Ice on the joint, elevation, and rest also help while you wait for medication to work.

Key Takeaways

  • NSAIDs like indomethacin or naproxen work fastest if you take them within the first 12 hours of an attack.
  • Colchicine and corticosteroids are alternatives if NSAIDs don't work or you cannot take them.
  • Long-term prevention requires lowering uric acid levels with daily medication like allopurinol or febuxostat, not just treating attacks as they happen.
  • Reducing purine-rich foods (red meat, organ meats, certain seafood, alcohol), staying hydrated, and maintaining a healthy weight all lower your gout risk.
  • You need a doctor to diagnose gout and prescribe preventive medication — home remedies alone do not stop recurring attacks.

Medications that prevent future attacks

Stopping one attack is not the same as stopping gout from coming back. If you have more than two attacks a year, or if one attack was severe, your doctor will likely recommend urate-lowering therapy — daily medication that keeps uric acid levels low enough that crystals don't form in your joints.

Allopurinol is the most common choice. It blocks the enzyme that produces uric acid, and most people take 100 to 800 mg daily depending on their uric acid level. Febuxostat works the same way and is an option if allopurinol causes side effects. Both take weeks to months to reach full effect, so your doctor may also prescribe colchicine or an NSAID to take daily during that time to prevent attacks while the uric acid drops.

A third option, probenecid, works differently — it helps your kidneys excrete more uric acid. It is less commonly used but may be right for you depending on your kidney function and other medications you take. Your doctor will check your uric acid level with a blood test to see if the dose is working.

Foods and habits that trigger gout

Uric acid comes partly from what you eat. Purine-rich foods break down into uric acid in your body. Red meat, organ meats (liver, kidney), and certain seafood (anchovies, sardines, shellfish) are the biggest culprits. You don't have to cut them out entirely, but eating them less often and in smaller portions lowers your risk.

Alcohol, especially beer, raises uric acid and dehydrates you at the same time — a double trigger for gout. If you drink, limiting yourself to one or two drinks a day and staying hydrated helps. Sugary drinks and foods with high-fructose corn syrup also raise uric acid, so swapping soda and juice for water is one of the easiest changes to make.

Being overweight increases gout risk, and losing weight lowers uric acid levels. Crash dieting can actually trigger attacks, though, so gradual weight loss is safer. Staying hydrated — drinking enough water to urinate regularly — dilutes uric acid and helps your kidneys clear it, which is why dehydration is a common trigger.

When to see a doctor about gout

You should see a doctor if you have sudden severe joint pain, especially if it's your big toe, ankle, or knee. A doctor can confirm it's gout by testing your uric acid level and, if needed, testing fluid from the joint itself under a microscope to look for uric acid crystals. Self-diagnosis can be wrong — other conditions like infection or rheumatoid arthritis cause similar pain.

If you've had gout before and recognize the symptoms, you can start an NSAID right away while you contact your doctor. But if this is your first attack, or if the pain is in an unusual joint, get it checked before assuming it's gout. Once gout is confirmed, your doctor can prescribe preventive medication and tell you which foods and habits matter most for your specific situation.

Tell your doctor about all the medications you take, because some drugs (like diuretics for blood pressure or heart disease) raise uric acid and may need to be changed. Your kidney function also affects which gout medications are safe for you, so your doctor will likely order blood tests before starting prevention.

Lifestyle changes that work alongside medication

Medication prevents gout, but it works better when you also change the habits that raise uric acid. The combination of a urate-lowering drug plus lower purine intake, less alcohol, and good hydration stops most people from having another attack. You don't have to be perfect — small, steady changes add up.

Some people find that certain foods trigger their attacks more than others. Keeping a simple food diary for a few weeks can help you spot your personal triggers. If you notice that shellfish or red wine always leads to pain a day or two later, you have a clear reason to avoid it. For other people, the trigger is dehydration or stress rather than food.

Exercise and maintaining a healthy weight both lower uric acid. Walking, swimming, or other moderate activity most days of the week helps, and it also reduces stress, which can trigger attacks. You don't need intense exercise — consistency matters more than intensity.

What happens if gout keeps coming back despite treatment

If you're taking a urate-lowering drug and still having attacks, the most common reason is that your uric acid level is not low enough yet. Your doctor may increase your dose or switch to a different medication. Some people need higher doses than others, and it can take trial and error to find what works for you.

Another reason attacks continue is that you're not taking the medication every day as prescribed. Urate-lowering drugs only work if you take them consistently — skipping doses lets uric acid creep back up. If cost or side effects are making it hard to take your medication, tell your doctor so you can find a solution together.

Rarely, gout is caused by an underlying condition like kidney disease or a blood disorder that needs separate treatment. If standard prevention isn't working, your doctor may refer you to a rheumatologist (a specialist in joint and inflammatory diseases) to look for other causes and adjust your treatment plan.

Frequently Asked Questions

Can I treat gout without going to a doctor?

You can manage pain at home with ice, elevation, and over-the-counter NSAIDs during an attack. But preventing future attacks requires a doctor's diagnosis and prescription medication to lower uric acid. Home remedies and diet changes alone don't stop recurring gout for most people.

How long does it take for gout medication to prevent attacks?

Urate-lowering drugs like allopurinol take 2 to 4 weeks to start working and 2 to 3 months to reach full effect. Your doctor may prescribe a daily NSAID or colchicine during this time to prevent attacks while uric acid levels drop. Once your uric acid is stable, attacks usually stop.

Is gout caused by eating too much meat?

Diet contributes to gout, but it's not the only cause. Genetics, kidney function, and certain medications also play a role. Reducing purine-rich foods helps, but most people with recurring gout need medication to keep uric acid low enough to prevent attacks.

Can I stop taking gout medication once attacks stop?

No. Urate-lowering medication works only while you take it. If you stop, uric acid levels rise again and attacks return. Your doctor will tell you how long to take it — usually for years or indefinitely if you have frequent attacks or kidney problems.

What should I do if an NSAID doesn't stop my gout pain?

Contact your doctor. Colchicine or a corticosteroid can work when NSAIDs don't. Your doctor can also check whether the pain is actually gout or something else that needs different treatment. Don't wait through severe pain hoping it will pass on its own.