How To Prevent Gout Flare-Ups

Gout flare-ups manifest as painful swelling in the joints. Gout is an increasingly common condition, with an estimated 7.⁴ million cases per year.¹ 

Most gout patients can manage their condition very effectively using prescribed medication and dietary changes. Preventative drug therapies can help to reduce the likelihood of recurrent gout flare-ups.

In this article, we explore the causes and risk factors for gout - and explain how this condition can be treated. 

Understanding gout flare

A gout flare (or gout attack) is an episode of inflammation in a joint caused by gout. Gout is the most common type of arthritis (inflammation or swelling of the joints) - over 41 million people worldwide experience the condition.1 With appropriate treatment, the recurrence of gout flares can often be reduced or eliminated. 

Causes

Gout results from the accumulation of crystals made of a substance called monosodium urate (or “uric acid”) inside a joint. 

As the body breaks down purines (substances that are found in some foods but also naturally in the body), it produces uric acid. Uric acid dissolves in the blood and passes through the kidneys into the urine.² However, if the body produces too much, or if the kidneys are unable to process it fast enough, the uric acid can accumulate.² 

Excess uric acid can form sharp urate crystals in a joint (the urate crystals may also be deposited throughout the body in the skin and soft tissues).³ The crystal formations trigger an immune response and inflammation, which leads to pain and swelling. 

Symptoms

Gout causes sudden, severe pain in the affected joints; the skin on the joint may appear red, shiny, or swollen.² Gout most commonly affects a joint on the foot, just below the big toe (the first metatarsophalangeal joint), as well as joints in the elbows, wrists, fingers, knees, and ankles.³ 

As gout progresses, it may become difficult to move the affected joint normally.² Over time, untreated gout can lead to irreversible damage to the joints, leading to chronic pain and deformation.³

Diagnoses

Gout is usually diagnosed clinically - the healthcare practitioner will consider symptoms and risk factors that are indicative of the disease, including:⁴

• Rapid development of pain, swelling, and redness in a joint
• Most severe pain on the first day of the onset of the disease
• The joint affected is in the foot, under the big toe
• Underlying conditions such as high blood pressure (hypertension) and cardiovascular disease
• Previous episode of joint pain or arthritis

If the diagnosis is uncertain or if the doctor suspects that the joint may be infected, a sample of the synovial fluid may be taken for testing (usually by a technique called polarised light microscopy).⁴ Synovial fluid is the thick liquid found between the joints, which lubricates them and allows their smooth movement. The presence of urate crystals in the synovial fluid sample can confirm the gout diagnosis.

An imaging technique called computer tomography (CT) may be used to help with the diagnosis of gout. CT can show bone erosion (wearing down) in the joints, as well as the urate crystals.⁴ 

Who is at risk

Certain ethnic groups - including Taiwanese, Pacific Islanders, New Zealand Maori, and those living in high-income countries - are at a higher risk of developing gout.⁴ 

In Western high-income countries, gout affects 3-6% of men and 1-3% of women.⁴ The incidence of gout is lower in pre-menopausal women - this is because oestrogen (a female sex hormone) increases the removal of uric acid from the kidneys.⁵ 

Many patients with gout experience underlying health conditions such as:¹

• High blood pressure (hypertension)
• Kidney disease
• Obesity
• Ischemic heart disease
• Diabetes

The risk of developing gout increases with age; the condition is rare before the age of 20,4 but the prevalence of gout peaks at 12% of people above 80 years old.³ 

Which foods have been linked to an increased risk of gout?

Gout has been linked to the consumption of certain types of foods and drinks, including:⁴

• Fish (anchovies, sardines)
• Seafood (scallops, mussels)
• Red meat (e.g. beef, veal)
• Wild game meat (e.g. venison)
• Organ meat (e.g. liver)
• Sugar-sweetened soft drinks (more than two per day)
• Fruits (or fruit juices) high in fructose
• Beer

Despite their high purine content, foods such as nuts, oatmeal, asparagus, legumes, and mushrooms do not seem to increase the risk of gout.³

How many days does it last?

A gout flare or gout attack can occur suddenly, with the most severe pain within 12 hours of the onset.² According to the Mayo Clinic, after the initial severe pain subsides, the joint pain may remain from a few days to a few weeks - however, symptoms usually fully resolve within 1-2 weeks.² 

Tips to prevent gout flare-ups

Dietary recommendations for preventing gout

Dietary changes can help to prevent gout flare-ups. The DASH diet (Dietary Approaches to Stop Hypertension) aims to lower high blood pressure; the plan recommends a reduction in salt intake and emphasises grains, fruits, and vegetables.6 A study has found that following the DASH diet can reduce the risk of developing gout.⁴ 

To reduce the recurrence of gout attacks, doctors may recommend limiting the consumption of certain purine-rich foods, including organ meats, shellfish, beer, and beverages sweetened with high fructose corn syrup (HFCS).⁴ If you are unsure how best to plan your meals to manage any other underlying conditions, consult your doctor for guidance.  

Prescribed medication to treat and prevent gout

The reduction of urate levels is key to keeping gout attacks at bay. A patient with gout may be prescribed urate-lowering drugs by their doctor; allopurinol and Febuxostat are the preferred first-line medications for urate-lowering therapy.⁴ 

Prophylactic treatment (taking medication to prevent new gout flares) is recommended, particularly if a patient experiences at least two flare-ups per year and/or suffers from chronic gouty arthritis, kidney disease, or joint damage.⁴  

The patient’s serum uric acid levels may be monitored after a gout episode to determine if the condition is progressing or resolving. Treatment often continues for at least three to six months after uric acid levels reach the target.³ 

How do you stop gout when you feel it coming on?

If you feel a gout flare starting, it is important to act fast - to resolve symptoms quickly and completely, treatment should ideally start within 24 hours of the onset of acute symptoms (when you start noticing pain, swelling, and/or redness on the affected joint).³

If you are experiencing symptoms of gout for the first time, seek medical care as soon as possible - a healthcare professional will take into consideration any underlying conditions you may have to decide on the best course of treatment. If you have previously been diagnosed with gout, take medication as directed by your doctor, and seek medical advice if you have any concerns. 

What is the fastest way to get rid of gout?

Gout can often be resolved relatively quickly with an appropriate course of medication. Drugs used for the management of acute attacks of gout include:

• Non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs should be avoided in patients with chronic kidney disease, coronary artery disease, gastroesophageal reflux disease (GORD), and patients who are taking oral anticoagulants.⁴
• Colchicine. Several types of medication can interfere with colchicine - it should only be prescribed if it is safe to do so for the patient.⁴
• Corticosteroids. Can be taken orally or intravenously.³ 

In addition to drug therapy, applying an ice pack to the affected area may help to soothe gout symptoms.⁵

When to seek medical attention

It is important to see a doctor if you are experiencing gout symptoms, as gout that goes untreated can lead to sustained pain and joint damage.3 Gout flares may also become more frequent over time if left unresolved. 

Seek medical care immediately if the affected joint feels hot to the touch and/or if you have a fever (raised body temperature), as this can be a sign of infection.