Your first painful flare of gout can be a shock. But while it may seem like it came out of nowhere, it didn’t.
The process that caused it has been going on in your body for a while, says Jemima Albayda, MD, director of the Rapid Arthritis Care and Evaluation Clinic at Johns Hopkins Medicine in Baltimore. And no matter how long you’ve had gout, your overall health, the foods you eat, the medicines you take, and more can play a role.
Right now, you have a chance to hit the reset button -- to change your habits and improve your health so another attack is a lot less likely. “Gout is so easy to treat but so often mistreated,” Albayda says. “People just don’t know what they’re supposed to do.”
Watch What You Eat
Gout is caused by a high level of uric acid in your blood. It builds up in your joints and leads to a flare. So you need to cut out foods that raise it.
Watch out for trigger foods like:
- Red meat, especially organ meats like liver, tongue, and sweetbreads
- Seafood, like fish and shellfish
- High-fat meals
- Alcohol, especially beer and liquor
- Sugary foods and drinks, like sodas
That list might seem hard to swallow. No more beer? No more steak? But you may not need to cut them out completely. It may be enough to just limit these foods, says Shailendra Singh, MD, rheumatology medical director at the White River Medical Center in Batesville, AR.
“Some people can eat steak but not crab,” Singh says. “Some can have a beer without a problem, others can’t. You have to figure out what your own triggers are.”
It’s not just about cutting back -- you need to add some healthier foods, too. In general, Albayda recommends a heart-healthy diet for people with gout, with lots of vegetables and whole grains and few processed foods. For proteins, choose options that protect against gout like:
- Low-fat dairy, like skim milk, cheese, and yogurt
- Beans, soy, and other plant proteins
While we don’t know for sure, other foods and supplements could help lower uric acid and possibly your chances of a flare. They include:
- Cherries (or cherry juice or extract)
- Coffee
- Vitamin C supplements
Just ask your doctor before you start to use any of these foods or supplements to control gout.
Finally, don’t try fad diets. Fasting or losing weight too quickly can boost uric acid levels and trigger a flare.
Understand Your Medication
Your doctor may have already prescribed medicine. There are two basic types:
Short-term medication for flares. Drugs like colchicine (Colcrys, Mitigare) and nonsteroidal anti-inflammatory drugs (NSAIDs) can help with pain when you have an attack. Your doctor may also recommend steroid pills or shots.
Long-term medication to lower uric acid levels. These daily medicines -- like allopurinol (Aloprim, Lopurin, Zyloprim), febuxostat (Uloric), lesinurad (Zurampic), pegloticase (Krystexxa), probenecid (Probalan), and rasburicase (Elitek) -- treat the underlying cause of gout.
Your doctor will probably start by prescribing short-term medication and lifestyle changes to see how it affects your symptoms. But in the long run, most people need to add daily long-term medicine, too.
Make sure you know what each of your medicines does and when to take them. And if you do need long-term medication, don’t skip doses. That can make the level of uric acid in your blood go up and down, which can trigger a flare.
Take Care of Yourself
Get regular exercise and stay at a healthy weight. If you're overweight or obese, your body has more uric acid. Weight loss may help lower it.
Get other health conditions under control. Gout is linked with high blood pressure, diabetes, metabolic syndrome, heart disease, and kidney disease. If you have any of those problems, get treatment.
Ask your doctor if you need to make changes to the medications you take. Aspirin, diuretics for high blood pressure, and drugs for people who’ve had an organ transplant can trigger gout. Your doctor can help you find other alternatives.
Drink more fluids. You may lower your odds of gout if you drink at least eight glasses of fluids a day. Make sure that at least half of that is water.
What to Expect
Albayda says that a first flare can be a wake-up call -- a sign you need to adopt a healthier lifestyle in general.
If you don’t deal with it, your gout will probably get worse. That means more painful attacks and, eventually, lasting damage to your joints. You may also have higher chances of related problems, like heart disease, Albayda says.
It can take time to get your gout fully under control. Your doctor may need to adjust your medications from time to time, and you’ll need to figure out your personal triggers, which can involve trial and error. It can also take years for your body to get all the uric acid out of your joints, Albayda says.
But if you commit to changes and work closely with your doctor, you can control it.
“Gout is easy to manage once you know how,” Albayda says.
