Gout: Acute Crises and Long-Term Control
Lifestyle alone rarely suffices for recurrent disease.
Dr. Inès Da Costa
Rheumatologist
Sudden severe joint pain (often big toe), redness, swelling, exquisite tenderness. Resolves spontaneously in 7-10 days.
Acute treatment
NSAIDs, colchicine, or steroids depending on comorbidities. Start within 24 hours for best effect.
Long-term control
- Allopurinol or febuxostat to lower uric acid below 360 µmol/L (300 in tophaceous disease)
- Slowly titrate to target
- Continue indefinitely
- Co-prescribe colchicine prophylaxis during initiation
Lifestyle
Reduce alcohol (especially beer), sugary drinks, organ meats and shellfish; encourage low-fat dairy and coffee.
Stopping urate-lowering therapy after symptom resolution is a leading cause of recurrence.
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