Gout is one of the most common forms of inflammatory arthritis in the UK, and one of the most painful. It tends to arrive without warning, often overnight, and the sudden, intense pain in a single joint (most often the big toe) can be frightening the first time it happens.
The good news is that gout is well understood and very treatable. This guide explains what causes it, how a flare is managed, the long-term options for preventing further attacks, and when it is worth seeing a doctor rather than managing it yourself.
What causes gout
Gout develops when there is too much uric acid (also called urate) in the blood. Over time, this excess urate can form sharp, needle-like crystals that settle in and around a joint. The immune system reacts to these crystals as if they were a threat, triggering sudden, intense inflammation, which is what causes the pain, swelling, redness and warmth of a gout flare.
The big toe is the classic site, accounting for a large proportion of first attacks, but gout can also affect the ankles, knees, fingers, wrists and elbows. Several things can raise uric acid levels or trigger a flare, including a diet rich in purines (found in red meat, offal and some seafood), regular alcohol, particularly beer and spirits, being overweight, dehydration, certain medicines such as some diuretics, and other health conditions including high blood pressure and kidney disease. Gout also runs in families, so genetics play a role in how efficiently the body clears urate.
It is worth knowing that having a high uric acid level on a blood test does not automatically mean someone has, or will develop, gout. Many people with raised urate never have a flare, and diagnosis is based on the pattern of symptoms as much as the blood result.
Recognising a gout flare
A typical flare starts suddenly, often waking someone from sleep, with severe pain in one joint that builds quickly and can peak within 24 hours. The joint usually looks red or purplish, feels warm to the touch, and becomes swollen and tender, sometimes so sensitive that even the weight of a bedsheet is uncomfortable.
Left untreated, a flare typically eases on its own within one to two weeks, but most people find that starting treatment as early as possible in an attack brings much faster relief and shortens how long it lasts. Some people have only one flare in their lifetime, while others go on to have repeated attacks, sometimes affecting more than one joint at a time as the condition progresses.
Treating an acute gout flare
The main goal during a flare is to bring the inflammation and pain under control as quickly as possible. A non-steroidal anti-inflammatory drug (NSAID) such as naproxen is usually the first choice for otherwise healthy adults, taken at a full anti-inflammatory dose for the first few days and then reduced once symptoms improve. Colchicine is another effective option, and is often used for people who cannot take NSAIDs, for example because of stomach ulcers, kidney problems or certain heart conditions.
Alongside medication, simple self-care measures can make a real difference: resting and elevating the affected joint, applying an ice pack wrapped in a cloth for short periods, and keeping tight shoes, socks or bedding away from the area. Most people notice a clear improvement within a few days of starting treatment, though full resolution can take a little longer.
Preventing future flares
For people who have frequent gout attacks, visible urate deposits (tophi), or early signs of joint damage, long-term urate-lowering therapy is usually recommended rather than simply treating each flare as it happens. Allopurinol is the medicine most commonly used for this in the UK. It is started at a low dose and increased gradually over time, with the dose adjusted according to regular blood tests, until uric acid levels are low enough to stop new crystals forming and gradually dissolve existing ones.
Because starting or increasing allopurinol can occasionally trigger a flare in the short term, it is usually combined with a low dose of colchicine or an NSAID for the first few months as cover while the dose is being adjusted. This is a normal, expected part of treatment rather than a sign that something has gone wrong, and it is generally stopped once urate levels have stabilised.
Lifestyle changes can support medical treatment, though they are rarely enough on their own for people with frequent flares. Helpful steps include moderating high-purine foods such as red meat, offal and some shellfish, cutting back on alcohol (particularly beer and spirits), staying well hydrated, and working towards a healthy weight gradually rather than through rapid weight loss, which can itself trigger a flare.
Living with gout day to day
Between flares, most people with gout feel completely normal, which can make it tempting to skip long-term treatment once symptoms settle. However, urate crystals can continue to build up silently in the joint even without symptoms, so it is worth sticking with any long-term treatment plan a clinician has recommended, and attending monitoring blood tests, rather than only seeking help when a flare strikes.
Keeping a simple note of what you were doing, eating or drinking before a flare can help identify personal triggers over time, since these vary from person to person. Many people also find it useful to keep a suitable anti-inflammatory on hand at home so treatment can start at the very first sign of a flare, when it tends to work best.
When to see a doctor or pharmacist
It is worth getting a first suspected gout attack properly assessed, since other conditions, including joint infections and other types of arthritis, can look similar in the early stages, and confirming the diagnosis helps guide the right treatment. A pharmacist can often advise on suitable anti-inflammatory treatment for a flare once gout has previously been confirmed.
Seek urgent medical attention if a joint becomes hot, very swollen and increasingly painful alongside a fever or feeling generally unwell, since this combination needs to be checked to rule out a joint infection (septic arthritis), which is a medical emergency. You should also see a GP if flares keep happening despite treatment, if more than one joint is affected at once, or if you notice firm lumps (tophi) developing near a joint, as these are signs that long-term urate-lowering treatment may need to be started or reviewed.