Gout Flare Up Causes, Symptoms, and Treatments

By Terez Malka, MD
Medically reviewed checkmarkMedically reviewed
January 21, 2022

Gout is a common form of arthritis that, according to recent studies, is on the rise.

In 2017, it was found that there was a 7.2% increase of people diagnosed with gout over the last 27 years.

And in the period from 1990-2017, it’s estimated that 41.2 million cases of gout were found—making it the most common form of arthritis in the United States.

Gout is caused by excess uric acid in a person’s blood. Uric acid develops as purines are broken down in the body.

While purines are a chemical that naturally occurs in the body, they are also in the food or beverages we ingest.

When the body has too much uric acid, microscopic crystals may form and surround joints in the body, causing pain and inflammation.

Any joint can be affected by gout, but the most common one is the big toe. 

What is a Gout Flare Up?

Gout flares are sudden attacks that cause intense pain and discomfort in a joint.

The joint can become hot, swollen, tender, and irritated.

These flare ups can happen at any time, but are most likely to occur at night.

In fact, research has shown that gout flares are 2.4 times more likely to occur during the night time, though experts aren’t exactly sure why. 

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Symptoms of Gout Flares

The first affected joint in 75% of gout patients is the big toe, sometimes referred to as the bunion joint.

Over 90% of gout patients experience a flare up on the big toe joint.

Some experts believe that this joint is most affected by gout because it’s the joint that receives the greatest amount of pressure when walking or running. 

While generally affecting the big toe first, a gout flare may occur in a number of joints.

Along with the big or bunion toe, gout flare ups may occur in the ankles, knees, feet, wrists, elbows, or even fingers.

Below are the most common gout symptoms.

SymptomDetails
Intense joint painInitial joint pain may be severe in the first few hours after the initial flare, and may last from a few days to a few weeks if left untreated.
Swelling or tendernessGout patients may experience intense discomfort or pain from swelling. The affected area may be red and hot, and the weight of a comforter may seem unbearable.
Lasting or lingering painPain may last from a few days to a few weeks. If left untreated, the flare ups may become more frequent and the pain may worsen.
Limited range of motionGout patients may have trouble moving joints as usual.

Causes of Gout Flares

Gout flares are caused by a buildup of uric acid in the body, which can occur for a number of reasons.

Diet, lifestyle, some medications, obesity, and genetics are all factors that play a role in the amount of uric acid your body produces.

  • Diet: People who maintain a diet that is high in sugary drinks, alcohol, or anything that contains high fructose corn syrup are at greater risk of developing gout. A diet rich in certain foods with high purine content,  like organ meats and red meats, can also increase a person’s chance of developing gout.
  • Water intake: Dehydration is also another potential cause of gout flares, as your kidneys can’t function properly and rid the body of the excess uric acid without water. Taking diuretics and certain medications (like blood pressure medication) can cause dehydration. Alcoholic beverages, like beer or cocktails, are also dehydrating and should be limited or avoided if you are at risk for developing gout.
  • Weight: If you have obesity, your body will not only create more uric acid, but your kidneys may also have more trouble eliminating the uric acid. 
  • Medical conditions: High blood pressure and chronic conditions like diabetes and heart or kidney diseases can contribute to gout flare ups. 

Common Triggers

There are a plethora of triggers for gout flares, including certain medications, like aspirin or diuretics.

Aspirin raises the levels of uric acid in the body, while diuretics rid the body of excess water, and both of which may cause you to be dehydrated and unable to flush out excess uric acid. 

The types of food you eat and the amount of alcohol you drink can also trigger a gout attack.

Certain foods, such as game meats like duck, rabbit, and venison, should be avoided. Red meat, pork, seafood, and lamb are also correlated with gout flare ups. 

Alcohol is another common trigger because it increases uric acid levels and slows the rate at which it is secreted from the body. 

Treatment for Gout Flares

Gout flares can be incredibly painful and debilitating at times, but fortunately, they are very treatable.

The key to quick recovery is to not ignore the pain—by treating the flare up early, you’ll be on the road to a quicker recovery.

Home remedies

The tricky thing about gout flares is that they occur suddenly with virtually no warning.

And since they tend to occur in the middle of the night, gout patients suffering through a flare up will want immediate relief fast.

There are several steps you can take at home to help alleviate the pain and discomfort.

  • Over-the-counter medications: Take ibuprofen or naproxen for pain relief. Aspirin should be avoided, as it can actually worsen a flare. 
  • Apply ice: Icing the affected joint can help reduce inflammation and ease the pain. For best results, wrap an ice bag in a towel and ice the affected area in intervals of 20-30 minutes a few times daily.
  • Stay hydrated: Drinking enough fluids can help your body flush out excess uric acid. While this may not provide immediate relief, it’s important to stay hydrated during a gout attack as it will help clear uric acid and help prevent future attacks.
  • Avoid alcohol and trigger foods: Again, this may not provide immediate relief, but you should definitely steer clear of purine-rich foods and dehydrating alcoholic beverages if you are experiencing a flare up. While cutting back on your alcohol consumption and removing any trigger foods from your diet may not heal the current flare up, it will prevent the gout flare from worsening.
  • Elevate your foot: If you are experiencing a flare up on the big toe, you can help reduce swelling by elevating your foot. While laying down, prop your foot up on a few pillows so that your foot is higher than your chest.
  • Topical creams: arthritis or muscle pain creams like Icy Hot and Aspercreme have been shown to relieve joint pain due to all forms of arthritis

Prescription medication

If you are suffering from chronic gout, the first recommended course of action is typically by making changes to your diet and lifestyle.

If that alone doesn’t help prevent gout flare-ups, your doctor may prescribe medication to lower the uric acid levels in your blood to help prevent gout attacks.

There are also prescription medications that immediately reduce inflammation and can be used to help treat an acute flare of gout including indomethacin, prednisone, and colchicine.

Allopurinol and sulfinpyrazone are common medications prescribed for gout patients.

Packaged in pill form, these drugs are designed to help reduce the level of uric acid in your blood by increasing the amount of uric acid passed in your urine.

Because these medications increase the amount of uric acid in your urine, you may be at greater risk for developing kidney stones.

This is why it’s incredibly important to stay hydrated and drink plenty of water to help dilute the uric acid content in your urine.

Probenecid is another medication that is used to treat gout.

It comes in pill form and works by acting on the kidneys to help eliminate uric acid in the body.

This medication may increase the frequency of gout flares during the first 6-12 months of use but after that period, it’s an effective drug for preventing gout attacks.

During this period, you may want to employ healthy lifestyle changes to help lower the chances of gout flare up. 

Uric acid-lowering therapy with prescription medication is highly effective.

In fact, the biggest problem most gout patients experience with this treatment is sticking to the routine.

Many studies show that up to 80% of people who were prescribed allopurinol were taking it incorrectly or not at all.

This may be because with gout, unless you are experiencing symptoms or a flare up, you can quickly forget how important it is to stick to your daily prescribed regimen.

Invantraneous infusions

For people with severe cases of gout, your doctor may prescribe pegloticase, which is a drug administered through intravenous (IV) infusion.

When other prescriptions fail to lower uric acid levels, this powerful drug is an option that can quickly reduce uric acid levels.

Since there are some concerns about potential side-effects of pegloticase, it’s typically only used as a last resort.

Preventing Gout Flares

One of the best ways to prevent gout flares is understanding your triggers and making healthy lifestyle choices. 

Eat a gout-friendly diet

Since purine is broken down into uric acid, gout patients should avoid purine-rich foods to keep their uric acid levels low.

Below are several foods low in purine that you can incorporate into your diet.

  • Dairy: Research shows that the proteins found in dairy products can help lower uric acid levels. If you are trying to reduce the amount of fat in your diet, you can opt for low-fat dairy products.
  • Plant-based proteins: With gout, you may want to limit your consumption of meat. To replace this, you can incorporate plant-based proteins like tofu, lentils, and beans.
  • Vegetables: Recent studies show that purine-rich vegetables like asparagus, spinach, and cauliflower do not affect uric acid levels or increase the risk of a gout flare. These are nutrient-rich, low-calorie foods that can help you maintain a healthy weight, which is important to preventing future flare ups.
  • Cherries: Studies have shown that cherry consumption may lower uric acid levels and reduce the risk of gout flare-ups. More studies are needed to prove this benefit.

Avoid trigger foods

Some gout patients may also find that certain foods with low purine content will actually trigger a gout flare.

For example, some studies show that tomatoes, a low-purine food, are a commonly-reported trigger food for people with gout. 

Everyone’s biology is different, so you may discover that certain unexpected foods can bring on a flare-up.

Keeping a food journal is a good way of monitoring what may cause flare-ups for you.

Maintain a healthy weight

Obesity is a risk factor for gout, and along with a healthy diet, getting an adequate amount of exercise can help you reach and maintain a healthy weight.

Regular physical activity can also help lower blood pressure, cholesterol, and blood sugar levels—all potential factors in developing gout. 

Keeping up with a consistent exercise routine may also help prevent gout.

One study found that men who ran over 8 kilometers per day had 50-60% lower risk of gout than less active men.

The exercise you choose doesn’t have to be intense; you can incorporate low-impact movement into your routine, including walking, swimming, or biking.

Cut back on alcohol

Gout may be triggered by drinking alcoholic beverages, which are dehydrating and can also raise your uric acid levels.

Risk Factors of Gout Flares

If you fall into one of the following risk factor groups, you may be more likely to develop gout. 

  • Age: Older individuals are more likely to develop gout. Men over 40 and post-menopausal women are at greater risk, as well.
  • Sex: Men are three times more likely to develop gout than women. This is because women generally tend to have lower uric acid levels. However, those levels may increase after a person experiences menopause.
  • Family history: Genetics play a big role in gout because your biological basis determines how well your body can process uric acid. If other family members have had gout, you’re more likely to develop the condition.
  • Medical conditions: Certain diseases and medical conditions can increase your risk of developing gout. This includes high blood pressure, diabetes, insulin resistance, chronic kidney disease, and heart diseases.
  • Weight: People who are overweight may produce more uric acid, putting them at risk for developing gout.
  • Certain medications: Some medications, like aspirin, diuretics, and beta blockers, can increase uric acid levels—which in turn, increases the risk of developing gout.
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When to See a Doctor

If you are experiencing your first flare up, it is recommended to visit your doctor.

There are a few conditions that have the same symptoms as a gout flare, such as joint infections, so getting an accurate diagnosis is critical.

When you visit your doctor, they will help you manage your current gout flare and explain how to prevent flare ups from occuring in the future. 

If you have had gout before and symptoms persist longer than 14 days or are worsening, you should seek medical care.

How K Health Can Help

Did you know you can get affordable primary care with the K Health app?

Download K to check your symptoms, explore conditions and treatments, and if needed text with a doctor in minutes. K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data.

Frequently Asked Questions

What is the most effective way to calm a gout flare-up?
You can take nonsteroidal anti-inflammatory drugs (NSAIDs) to alleviate the pain.There are also prescription medications that can help relieve gout flare symptoms– so talk with your doctor or a health provider if your symptoms are not responding to over-the-counter treatments. You can also apply ice and joint pain cremes to the affected joint to help with inflammation and elevate the joint to reduce swelling. During a flare-up, make sure to stay hydrated to help flush out the excess uric acid in your system.
How long does a gout flare up last?
A gout flare-up will usually last 3 days with treatment, and up to 14 days without. The initial 4-12 hours of a flare-up are generally the most painful.
Can the COVID-19 vaccine cause gout to flare?
In certain people, receiving any vaccination may trigger a gout flare, but this isn’t a reason to avoid this important vaccination. Talk to your doctor if you’re concerned, and they’ll explain the risks as well as the benefits.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.

Terez Malka, MD

Dr. Terez Malka is a board-certified pediatrician and emergency medicine physician.