10 Steps to Ease a Gout Attack

Pain management is a crucial part of living with gout. Try these simple tips to manage a painful gout attack, which include resting, keeping all pressure off the joint, and taking the right medicine.

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By
Beth Levine
Updated on April 15, 2023
Medically Reviewed
by
Samir Dalvi, MD

Gout stands as a particularly painful form of crystalline or inflammatory arthritis, characterized by elevated levels of serum urate that lead to swollen, stiff, and intensely tender joints. Historically, gout has often been misattributed to lifestyle choices, particularly in men known for overindulgence. This misconception, however, overlooks the fundamental role of genetics. The popular image of figures like King Henry VIII suffering from gout has fostered a pervasive, yet inaccurate, stereotype that suggests the condition is simply a consequence of excessive living.

This pervasive stereotype often leads to a form of victim-blaming, unjustly placing the onus of the condition on individuals' choices rather than biological predispositions. While gout does indeed affect men more frequently than women and can be exacerbated by factors such as obesity and dietary habits, genetic inheritance plays a far more significant role in its development. As John FitzGerald, MD, PhD, with the department of rheumatology at UCLA Health in Los Angeles and coauthor of the American College of Rheumatology’s clinical practice guidelines for gout, emphasizes, understanding this genetic component is key to accurate diagnosis and effective management.

Many Risk Factors May Contribute to Gout and Gout Flare-Ups

While often considered a male-dominated condition, women are also susceptible to developing gout, particularly later in life, following menopause. The physiological changes associated with this life stage can influence uric acid metabolism, increasing the risk. Beyond gender and genetic predisposition, several other risk factors and co-existing health conditions can significantly contribute to the onset of gout or increase the likelihood of recurrent flare-ups. These factors create an environment where the body struggles to regulate uric acid effectively, paving the way for crystal formation.

These additional risk factors encompass a range of metabolic and cardiovascular conditions. Individuals with diabetes, insulin resistance, or metabolic syndrome are at an elevated risk, as these conditions often involve complex metabolic imbalances that can affect uric acid levels. Similarly, chronic health issues such as congestive heart failure, high cholesterol, and high blood pressure have been linked to an increased incidence of gout. Furthermore, kidney disease presents a significant risk, as compromised kidney function directly impairs the body's ability to excrete uric acid, leading to its accumulation. Even certain medications prescribed for kidney conditions can inadvertently elevate uric acid levels, underscoring the intricate interplay of health factors in gout development.

Your 10-Point Plan: Easing a Gout Attack

A gout attack, medically known as a flare, manifests acutely and intensely. The affected joint typically becomes noticeably swollen, remarkably warm to the touch, and appears distinctly red. The pain associated with a gout flare can be excruciating; even the lightest touch or pressure, such as from a bedsheet, can provoke severe discomfort. These attacks often strike suddenly, frequently waking individuals in the middle of the night. A significant majority, about 50 percent, according to the Alliance for Gout Awareness, begin in the big toe, though other joints can also be affected. Given the overwhelming pain, having a clear, proactive plan is essential to effectively manage a flare-up.

1. Get a Diagnosis

If you are experiencing what you suspect might be your first gout attack, seeking immediate medical attention is paramount. Gout is regrettably one of the most frequently underdiagnosed conditions, partly due to historical gaps in understanding how to effectively treat elevated uric acid levels. However, medical knowledge and diagnostic tools have advanced considerably, providing clearer pathways for treatment. As Payam Shakouri, MD, a nephrologist with Advanced Kidney Care in Newburgh, New York, advises, if you are undergoing a flare, it is crucial to establish an action plan in collaboration with your physician. Initiating appropriate treatment and pain management strategies as early as possible can significantly shorten the duration of the attack and accelerate your return to normal activities.

2. Take the Right Anti-Inflammatory Medications

Effective management of acute gout attacks often involves the targeted use of anti-inflammatory medications, with three primary types demonstrating significant efficacy. These include over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil), aspirin (Vazalore), or naproxen sodium (Aleve), which work by reducing inflammation and pain. Additionally, prescription-strength steroids are highly effective in rapidly curbing inflammation. A third option is colchicine (Colcrys), a prescription anti-inflammatory medication that uniquely influences the body's response to uric acid crystals. Dr. FitzGerald notes that selecting the most appropriate medication requires careful consideration of your individual health profile, as certain drugs may not be suitable for specific conditions, such as NSAIDs for renal disease or steroids for individuals with diabetes.

3. Free the Joint!

During a gout attack, the affected joint can be exquisitely sensitive, making even the slightest pressure unbearable. Patients frequently report that they cannot tolerate the weight of a bedsheet or even light clothing touching the inflamed area. To alleviate this intense discomfort, it is crucial to ensure that there are absolutely no constraints or pressure on the flaring joint. This might involve carefully positioning pillows to support the limb in a way that suspends the sheet or blanket above the affected area, effectively creating a protective space around the tender joint. Ensuring the joint is free from any external pressure is a simple yet profoundly impactful step in managing the acute pain of a gout attack.

4. Rest and Elevate

Beyond simply freeing the joint from pressure, prioritizing rest and elevation are fundamental components of managing a gout flare-up. When a joint is inflamed and painful, any movement or weight-bearing can exacerbate the discomfort and potentially prolong the attack. Therefore, staying off the affected joint as much as possible is highly recommended. Concurrent with rest, elevating the affected limb above the level of your heart can significantly help. This elevation leverages gravity to reduce blood flow and fluid accumulation in the inflamed area, thereby helping to decrease swelling and alleviate pain. Integrating rest and elevation into your management plan provides crucial support to the healing process.

5. Apply Ice — if You Can Bear It

Applying ice to the inflamed joint can be a highly effective method for reducing swelling and numbing the pain during a gout attack. The cold temperature helps to constrict blood vessels, thereby decreasing blood flow to the area, which in turn reduces inflammation and localized discomfort. However, it is essential to approach ice application with caution and personal judgment. As Dr. FitzGerald advises, "Apply ice if you can do so comfortably without creating pain." For some individuals, the intense cold might be too painful or uncomfortable on an already hypersensitive joint. In such cases, a warm compress or heating pad might offer more relief, as heat can also help to relax muscles and increase blood flow, promoting comfort, though it may not reduce swelling as effectively as ice.

6. Watch Your Diet

While gout is primarily a genetic condition, dietary choices can significantly influence uric acid levels in the body and, consequently, the frequency and severity of gout attacks. A key strategy for managing gout involves adopting a dietary approach that limits the intake of purine-rich foods. Purines are natural compounds found in certain foods that the body breaks down into uric acid. High-purine foods include red meats, organ meats such as liver and kidney, and certain types of seafood like anchovies, sardines, and shellfish. Additionally, alcohol consumption, particularly beer and hard liquor, has been strongly linked to increased uric acid levels and gout flares. By carefully monitoring and moderating the intake of these specific items, individuals can effectively contribute to lowering their uric acid levels and potentially reducing the likelihood of future attacks.

7. Stay Hydrated

Maintaining adequate hydration is a deceptively simple yet highly effective strategy in the management of gout. Water plays a crucial role in the body's natural processes, including the excretion of waste products like uric acid. When you drink sufficient amounts of water, it helps your kidneys to efficiently flush out the excess uric acid crystals that are the primary culprits behind gout attacks. Dr. Shakouri emphasizes this point, stating, "A well-hydrated patient should drink enough to urinate every two to three hours." This frequent urination helps prevent the accumulation and crystallization of uric acid in the joints. Therefore, making a conscious effort to consume plenty of water throughout the day can actively contribute to reducing uric acid levels and preventing future gout flares.

8. Practice Mindfulness and Meditation

Living with the acute pain of a gout attack can be incredibly distressing and mentally taxing. While the physical discomfort is undeniable, incorporating mindfulness and meditation practices can significantly aid in managing the experience of pain. The good news is that a gout attack is typically self-limited, meaning it will eventually subside. In the interim, techniques such as meditation, yoga breathing, and guided imagery can help individuals cope more effectively with the pain, as noted by the Arthritis Foundation. These practices promote a sense of calm, shift focus away from the pain, and can help to elicit the body's natural relaxation response. By engaging in these mind-body practices, patients can develop greater resilience and reduce the psychological impact of a flare.

9. Create a Support Network

The stigma surrounding gout, often perpetuated by outdated stereotypes linking it solely to overindulgence, can lead many patients to suffer in silence. This societal perception can make individuals feel embarrassed or ashamed, preventing them from openly discussing their condition and seeking the understanding and assistance they need. Overcoming this isolation is a vital step in managing the disease holistically. It is important to confide in trusted friends and family members, informing them about your diagnosis and the challenges associated with gout. Establishing a supportive network allows you to reach out for practical help or emotional comfort when you are experiencing a flare, fostering a sense of community and reducing the burden of managing the condition alone.

10. If You Are Having Repeated Attacks, See Your Doctor

While some individuals may experience long intervals between gout attacks, with research indicating that for about 60 percent of patients, the next attack may be more than a year away and some may not experience another for a decade, it is crucial to recognize when more aggressive treatment is necessary. If you begin to experience more frequent gout attacks, it is a clear signal to consult your doctor about escalating your treatment strategy. Dr. Shakouri highlights that repeated flares are not merely a 'normal' part of living with gout; they indicate persistently high uric acid levels that can lead to permanent joint damage. In such cases, your doctor may recommend medications like allopurinol (Zyloprim). While allopurinol does not alleviate an acute attack, it is highly effective in preventing future flares by significantly reducing the body's production of uric acid, thereby addressing the root cause of the condition.

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Samir Dalvi, MD

Medical Reviewer

Castle Connolly Top Doctor
Samir Dalvi, MD, is a board-certified rheumatologist. He has over 14 years of experience in caring for patients with rheumatologic diseases, including osteoarthritis, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, lupus, and gout.
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Beth Levine

Author

Beth Levine is an award-winning health writer whose work has appeared in The Washington Post, The New York Times, O: The Oprah Magazine , Woman's Day , Good Housekeeping , Reader's Digest , AARP Bulletin , AARP The Magazine , Considerable.com, and NextTribe.com. She has also written custom content for the Yale New Haven Hospital and the March of Dimes. Levine's work has won awards from the American Academy of Orthopaedic Surgeons, the Connecticut Press Club, and the Public Relations Society of America. She is the author of Playgroups: From 18 Months to Kindergarten a Complete Guide for Parents and Divorce: Young People Caught in the Middle. She is also a humor writer and in addition to her editorial work, she coaches high school students on their college application essays.
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EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Sources
Additional Sources

• FitzGerald JD, Abeles AM, Dalbeth N, et al. 2020 American College of Rheumatology Guideline for the Management of Gout [PDF]. Arthritis Care & Research. June 2020.
• What Is Gout? Alliance for Gout Awareness.
• Types of Meditation for Arthritis. Arthritis Foundation.
• Harris MD, Siegel LB, Alloway JA. Gout and Hyperuricemia. American Family Physician. February 15, 1999.

Original article: https://www.everydayhealth.com/gout/10-steps-to-ease-gout-attack.aspx