How to Manage a Sudden Gout Flare-up

Gout is a form of arthritis once called the disease of kings, because people associated it with the rich meats and wine only the wealthy could afford. 

Like all other forms of arthritis, gout causes inflammation in the joints, but the cause is different from the more common forms, osteoarthritis (wear-and-tear of joint cartilage) and rheumatoid arthritis (an autoimmune response). 

Gout results from the build-up of uric acid crystals in the joint space, causing painful inflammation that usually starts in the big toe.

At Chicagoland Foot and Ankle, our team of board-certified foot and ankle specialists offer safe and effective treatments for gout and other podiatric conditions. 

Because gout isn’t as well known as other forms of arthritis, we’ve put together this guide to help you learn how to manage a sudden gout flare-up.

The causes of gout

Uric acid is created when your body breaks down purines — compounds found naturally in the body as well as in some foods. Normally your kidneys filter uric acid out of your blood, flushing it from your system through urine. 

But if you have a high level of purines in your diet or if your kidneys can’t remove the uric acid effectively, the waste builds up and deposits needle-like crystals in the joint space.

Any joint can be affected by this process, but some 50% of first-time attacks affect the big toe.

A number of foods, drinks, and medications can raise your body’s uric acid levels, leading to gout flare-ups. These include:

• Red meat and organ meats
• Shellfish
• Excessive alcohol
• Sugary drinks
• Fructose-high foods
• Low-dose aspirin
• Some diuretics (water pills)
• Immunosuppressants used in organ transplants 

You’re also at higher risk for gout if you’re obese or have hypertension, diabetes, and/or are subjected to chronic stress.

Once the crystals build up in the joint, they attract white blood cells to the area, leading to inflammation, severe pain, and chronic disease. Uric acid crystals can also collect in the urinary tract, causing kidney stones.

Gout flare-ups

Gout causes sudden flare-ups of symptoms, frequently in the middle of the night. They include:

• Intense joint pain, especially for first 4-12 hours
• Joint inflammation
• Swelling and tenderness
• Redness around the joint
• Warmth in the joint
• Limited range of motion

The pain can be so intense that even a light breeze feels intolerable. For some people, symptoms last for days or weeks after a flare-up. 

Managing a gout flare-up

Flare-ups are generally managed with medication. When you have an acute attack, we may recommend some combination of three types of drugs:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce pain and inflammation
• Colchicine, which reduces pain 
• Corticosteroids, which have strong anti-inflammatory properties

Once the attack has passed, we may prescribe medication to lower the level of uric acid in your blood, preventing, or at least lessening the severity of, attacks.

In addition, we may recommend lifestyle changes, including losing weight, limiting alcohol consumption, and limiting meats and fish that are high in purine content.

If you’re dealing with gout but are having trouble managing flare-ups, it’s time to come into Chicagoland Foot and Ankle for an evaluation and treatment. 

To get started, book online or call us at any of our locations — the Mount Greenwood and Portage Park areas of Chicago, Orland Park, and New Lenox, Illinois.