Gout — managing flare-ups and prevention
Reviewed by the My London Pharmacy clinical team, Zaynab Ali, Pharmacist Independent Prescriber
·29 July 2026
·7 min read
Quick answer
Gout is a form of arthritis caused by urate crystals forming in a joint, triggering sudden, intense pain and swelling. Flare-ups are treated to settle inflammation and ease pain, while longer-term prevention focuses on lowering urate levels through medication where appropriate and everyday lifestyle changes.
What gout is and why it happens
Gout is a common type of inflammatory arthritis that develops when uric acid builds up in the blood and forms tiny, needle-shaped crystals in and around a joint. These crystals provoke a sharp immune reaction, which is why a flare can come on quickly, often overnight, with severe pain, redness, heat and swelling. The base of the big toe is affected most often, but gout can involve the ankles, knees, fingers, wrists and other joints, and some people are affected in more than one place.
Uric acid is a normal waste product made when the body breaks down substances called purines. Levels can rise if the body produces too much or the kidneys clear too little. Family history, older age, being male, higher body weight, certain health conditions such as high blood pressure and kidney disease, some medicines including certain water tablets, and dietary factors can all contribute. Gout tends to come in episodes, with symptom-free periods in between, but without attention to the underlying urate level, attacks can become more frequent over time. Understanding your own triggers and risk factors is a useful part of keeping attacks infrequent.
Gout is one of the most common forms of inflammatory arthritis in the UK, and it is more than just a painful joint. Because it reflects the level of urate in the body, it is closely connected to overall health and to conditions such as high blood pressure, kidney function and metabolic health. Recognising gout for what it is, a manageable long-term condition rather than simply an occasional bout of pain, helps explain why both settling flares and addressing the underlying urate level matter, and why a longer-term view tends to serve people best.
Managing a flare-up
During an attack, the priority is to reduce inflammation and ease pain as early as possible, as flares often respond better when treated promptly rather than after a day or two. Anti-inflammatory medicines are a common choice, and a clinician can advise which is appropriate for you and how long to take it. Options such as Naproxen 250mg & 500mg Tablets or Etoricoxib 60mg Tablets may be considered for suitable people, alongside advice on protecting the joint and staying comfortable.
Simple measures help too: rest the affected joint, keep it raised where possible, and apply an ice pack wrapped in a cloth for short periods to ease the swelling. Try to keep bedclothes and tight footwear off a painful toe, as even light pressure can be intensely uncomfortable during a flare. Most flares settle within one to two weeks, though prompt treatment can shorten and soften them. Anti-inflammatory treatment is not right for everyone, so it should be used on clinical advice, particularly if you have stomach, kidney, heart or blood-pressure conditions, or take other regular medicines.
Preventing future attacks
If you have frequent flares, more than one joint involved, kidney stones, or complications such as urate deposits under the skin, NICE guidance supports considering long-term treatment to lower uric acid levels. This urate-lowering therapy is taken daily over the long term and works gradually to dissolve existing crystals and prevent new ones forming. It is usually started once a flare has settled and continued consistently, as stopping and starting can itself trigger attacks.
When urate-lowering treatment is first introduced, levels can shift and briefly make flares more likely, so a clinician may recommend cover with an anti-inflammatory for a period at the start. The aim is to bring your urate level down to a healthy target and keep it there, which over months significantly reduces how often attacks happen. Because prevention is a long-term commitment, it works best when reviewed regularly so the dose can be adjusted, blood levels checked, and any side effects discussed. Sticking with treatment, even during the symptom-free spells, is the key to lasting benefit.
It can take some months for the full benefit of urate-lowering treatment to show, as existing crystals gradually dissolve, so patience and consistency really pay off. During this settling-in period it is normal to still have the occasional flare, and this is not a sign that treatment is failing. Keeping in touch with your clinician, attending blood tests and not stopping the medicine when you feel well all help you reach the point where attacks become rare, which is the goal that makes the daily routine worthwhile.
Everyday steps that support prevention
Lifestyle changes will not replace medication for everyone, but they can help reduce how often attacks happen and support your overall health, including your heart and kidneys, which are linked to gout. Small, sustainable adjustments tend to work better than dramatic ones, and they complement any prescribed treatment rather than replacing it.
- Stay well hydrated with water across the day, which supports the kidneys in clearing urate.
- Moderate alcohol, particularly beer and spirits, which are strongly linked with flares.
- Cut back on sugary drinks and foods high in purines, such as red meat, offal and some seafood like mussels and anchovies.
- Aim for a balanced diet and a healthy weight, losing weight gradually rather than through crash dieting, which can raise urate temporarily.
- Include low-fat dairy and plenty of vegetables, which are associated with lower risk.
- Keep active with gentle exercise between flares to support your joints and general health.
Living well between flares
Between attacks, gout can be easy to forget, but this is exactly the time when steady prevention pays off. Keeping up with any urate-lowering treatment, attending reviews and maintaining your lifestyle changes all reduce the chance of the next flare arriving. It can help to keep a note of when attacks happen and what preceded them, so you and your clinician can spot patterns and fine-tune your plan.
Gout is also a reminder to look after your wider health. Because it is linked with conditions such as high blood pressure, raised cholesterol, diabetes and kidney problems, a review is a good opportunity to check these too. Being prepared for a flare, for example knowing your plan for early treatment and having discussed it with your clinician in advance, means you can act quickly if one starts. With consistent care, many people find their attacks become far less frequent and less severe over time.
When to seek clinical help
See a clinician if you think you are having your first attack of gout, if flares are becoming more frequent or severe, or if a joint becomes very hot, swollen and painful. It is important to rule out a joint infection, which can look similar but needs urgent treatment, so seek help promptly if you also feel feverish or generally unwell, as this combination should never be ignored.
A clinician can confirm the diagnosis, sometimes with a blood test or by examining fluid from the joint, and check for related conditions such as high blood pressure or kidney issues. They can also discuss whether long-term prevention may be suitable for you and help you manage a flare safely. If you already take urate-lowering treatment and are still getting flares, a review can help fine-tune your care so you get the most from it.
Getting help early in the course of gout tends to lead to better outcomes, because attacks that are treated promptly and urate levels that are brought under control cause less trouble over the years. If you are unsure whether your symptoms are gout, or how best to handle a flare, a pharmacist can offer initial advice and point you towards a consultation where needed. Taking gout seriously, rather than simply waiting for each attack to pass, gives you the best chance of keeping your joints comfortable and protecting your longer-term health.
Frequently asked questions
What triggers a gout attack?
Attacks are triggered when urate crystals irritate a joint. Common contributors include alcohol, purine-rich foods, dehydration, certain medicines and sudden changes in urate levels.
How long does a gout flare last?
Most flares ease within one to two weeks. Starting anti-inflammatory treatment early, on clinical advice, can shorten an attack and reduce its severity.
Can gout be prevented?
Frequent attacks can often be reduced with long-term urate-lowering treatment and lifestyle changes. A clinician can advise whether preventive medication is suitable for you.
Is gout linked to diet alone?
Diet plays a part, but genetics, kidney function, other health conditions and some medicines also affect urate levels. Diet changes help but do not always control gout on their own.
Should I keep taking prevention medicine between attacks?
Yes. Urate-lowering treatment works over the long term, and stopping and starting can trigger flares. Take it consistently and attend reviews so the dose can be adjusted.
When should I see a clinician urgently?
Seek prompt help if a joint is very hot, swollen and painful, especially with a fever, as this can indicate a joint infection that needs urgent assessment.