If you have gout, you know the signs that a flare-up is on the way. There's nothing you can do to stop an attack once it starts, but you can ease some of the symptoms at home.
Warning Signs of a Gout Flare-Up
Some people with gout, also known as gouty arthritis, say an attack begins with a burning, itching, or tingling feeling in a joint maybe an hour or two before the flare-up starts. The joint may feel a little stiff or a bit sore. Not long after, the telltale signs of gout begin. If you get repeated attacks, you'll learn your body's signals that one is about to begin.
Sometimes, people with gout have no early signs that a flare is about to start. They may just wake up in the middle of the night with a very painful joint.
When the flare starts, most people have redness, swelling, and severe pain, usually in one joint. The most common place for gout is the base of the big toe, but it can happen in other joints such as the elbow, knee, wrist, ankle, and instep.
Home Care for a Gout Flare-Up
If your doctor has diagnosed you with gout and given you medicine for a flare-up, take the medicine as directed when you know you’re having one. In most cases, that will probably be as soon as the first signs begin.
Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) such as celecoxib, indomethacin, meloxicam, or sulindac or suggest you take over-the-counter NSAIDs, like naproxen or ibuprofen. Depending on your medical history, your doctor may prescribe steroids or other medicines to reduce inflammation, such as colchicine (Colcrys).
In some cases, you already may be taking medicine like colchicine to prevent gout flare-ups. Your doctor may have also suggested:
- Allopurinol (Aloprim, Lopurin, Zyloprim)
- Canakinumab (Ilaris Ilaris Ilaris)
- Lesinurad (Zurampic)
- Pegloticase (Krystexxa)
- Probenecid (Probalan)
- Rasburicase (Elitek)
If you can’t take allopurinol or it is not effective, your doctor may prescribe febuxostat (Uloric). It should be used with caution, however, because it has been linked to increased risk of death from heart disease and from other causes.
Just because you have a flare doesn't mean these medicines aren't working. In the first few months that you take them, you may have an attack as your body adjusts to the drug. Your doctor will likely have given you something to take if this happens, too.
If you’ve been taking preventive gout medicine for a long time and you’re having flares for the first time in a while, call your doctor. They may talk to you about changing your dosage or your medicine.
Pain Relief Without Medicine
Use cold. If your pain isn't too bad, try cold packs or compresses on the joint to lower inflammation and soothe the ache. Wrap ice in a thin towel and apply it to the joint for up to 20 minutes several times a day. Do not apply ice to your hands or feet if you have nerve problems from diabetes or other causes.
Rest the joint. It's a good idea to rest it until the pain eases up. You probably won't want to move it much anyway. If you can, raise the joint on a pillow or other soft object.
Drink water. When your body doesn’t have enough water, your uric acid levels rise even higher. Stay hydrated to help keep those levels normal.
Watch what you eat and drink. Foods that are high in substances called purines, such as some seafood, organ meats like liver, and fatty foods, can raise the uric acid in your blood even more. So can fructose-sweetened drinks and alcohol -- especially beer.
When to Get Help for a Gout Flare
It's always a good idea to let your doctor know that you are having a flare. Sometimes, you may need to follow up to make sure your treatment plan is working or if your symptoms don't improve. Call your doctor if:
This is your first flare-up. There are several other conditions, such as a joint infection, that have some of the same symptoms as gout attacks.
You have a high fever and chills . Gout attack symptoms may include a mild fever, but a higher temperature may be a sign of an infection.
Your symptoms don't get any better after 48 hours or don't end after about a week. If you don't start to feel somewhat better after a few days, call your doctor. She may suggest a different treatment. Most gout attacks will go away by themselves in several weeks, even without treatment.