Gout flare: how to recognize it and what helps

Primary Care / Joint Pain / Gout

What is gout?

Gout happens when there's too much uric acid in your blood. Uric acid is a normal waste product, made when your body breaks down substances called purines. When levels stay high, uric acid can form tiny, needle-like crystals in and around a joint.

Your immune system reacts to those crystals, and the result is a flare: sudden, intense inflammation. Between flares, many people feel completely normal. Without treatment, flares can become more frequent and affect more joints over time.

What does a gout flare feel like?

Compare what you're feeling to this list:

• Sudden, severe pain in one joint, often starting at night or early morning
• The big toe is the most common spot, but gout can also affect the ankle, the top of the foot, the knee, the wrist, the fingers or the elbow
• The joint is swollen, red or purplish, and warm to the touch
• The joint is so tender that even a sheet or a sock is hard to bear
• Pain that builds quickly and is often worst within the first day
• After the flare passes, the skin over the joint may peel or itch

Some people have had a similar episode before and recognize the feeling right away. If this is your first time, it's important to be checked, because a few other problems, including a joint infection, can look similar.

Who gets gout, and what triggers a flare?

Gout is more common in men, and in women after menopause. It also becomes more common with age. Your risk is higher if you have:

• High blood pressure, heart disease or kidney disease
• Extra body weight, diabetes or metabolic syndrome
• A family history of gout
• Certain medicines, such as some water pills (diuretics)

Common flare triggers include:

• Alcohol, especially beer and liquor
• Sugary drinks sweetened with fructose
• Large servings of red meat, organ meats and some seafood, such as shellfish
• Dehydration, which is easy to come by in a Florida summer
• An illness, surgery or a sudden change in some of your medications

Don't stop any medication you've been prescribed because you think it may affect gout. Ask your clinician first.

What can you do at home during a flare?

• Rest the joint and avoid putting weight on it if you can
• Raise it on a pillow
• Apply a cold pack wrapped in a thin towel, about 20 minutes at a time
• Drink plenty of water, unless you've been told to limit fluids
• Skip alcohol and sugary drinks until the flare settles
• Keep heavy blankets and tight shoes off the joint

Over-the-counter anti-inflammatory pain relievers help some people. They aren't safe for everyone, especially if you have kidney disease, heart failure or stomach ulcers, or take a blood thinner. Ask a clinician or pharmacist before you take them.

How is gout treated?

Gout treatment usually has two parts. Your clinician decides what's appropriate based on your health, your kidneys and the other medicines you take.

Calming the flare. If appropriate, your clinician may recommend or prescribe:

• Anti-inflammatory pain medicine
• An anti-inflammatory medicine used specifically for gout
• A short course of steroid medicine, by mouth, or as an injection at an in-person visit

Preventing future flares. If you have frequent flares, gout lumps under the skin (called tophi), kidney stones or joint damage, your clinician may talk with you about medicines that lower uric acid. These are taken every day, long term, and are adjusted based on blood tests. Your clinician may also order blood work to check your uric acid level and kidney function.

Lifestyle changes, like limiting alcohol, cutting back on sugary drinks, staying hydrated and reaching a healthy weight, can help too. For many people, though, diet alone isn't enough to control gout, and that's not a personal failure.

What does a video visit at MD Care look like for gout?

Gout is often diagnosed from your story and what the joint looks like. On a video visit, your clinician will:

• Ask when the pain started, how fast it came on and whether you've had flares before
• Look closely at the joint on camera, comparing it with the other side
• Ask about fever, chills, recent injuries and how you're feeling overall
• Review your medications, kidney health and other conditions before recommending treatment
• Order lab work if it's needed, and plan follow-up care with you

Good light helps. Have your medication list ready, including over-the-counter pills.

A video visit is $50 without insurance, with no membership. A $20 message visit may work for a quick follow-up, when your clinician agrees it's appropriate. If you have Medicare, we confirm your coverage before your visit, and you pay your plan's share. Most patients are seen within three hours, and you need to be in Florida at the time of your visit. See pricing and Medicare.

For ongoing gout care, including uric acid monitoring, our primary care clinicians can follow you over time.

When should you be seen in person?

Go to an in-person urgent care or emergency room today if:

• You have a hot, swollen joint with a fever or chills, or you feel generally unwell. A joint infection can look like gout and needs urgent treatment.
• The joint became painful after an injury or a fall
• Several joints are swollen at once
• You have a joint replacement and the painful joint is the replaced one
• You have a weakened immune system and a new hot, swollen joint
• The redness is spreading up the leg or arm