© Tashatuvango | Dreamstime.com
A gout attack can cause sudden and very severe joint pain. It frequently starts in the joint of a big toe and may wake you up at night. Even having a sheet resting on your toe can be painful. A gout attack can make you miserable. It may last from three days to up to two weeks. [1,2] Taking medication usually helps reduce the pain and may shorten the attack. Even without medication, a gout attack usually goes away within ten days. 
Once you have had an attack of gout, you need to start treatment to prevent another attack, because gout often comes back. Without treatment, you can expect another attack within two years. People with frequent attacks can develop a type of long-term gout that does not go away. It can cause painful lumps in or near joints and can cause damaging deformity of a joint. The good news is that treatment works well. Gout is very controllable for most people. 
What Causes Gout?
Gout occurs when you have too much uric acid. Uric acid is formed when your body breaks down a type of building-block molecule called a purine. Purines are naturally found in your body and they also come from certain types of food. It’s normal to have some uric acid in your blood, but if you have too much, uric acid can travel from your blood to your joints. Inside your joints, uric acid forms needle-shaped crystals. 
Your body’s defense system reacts to the crystals and tries to get rid of them. This reaction causes swelling and irritation called inflammation. Inflammation makes your joint red, swollen, hot, and tender. That is the gout attack. About two percent of people will have a gout attack at some time. Why this happens remains a mystery, because most people can have high levels of uric acid in their blood without having an attack. [1,2]
You may be at higher risk for gout if: [1,2]
- You are a man aged 30 to 45.
- You are woman over age 55.
- You have a family history of gout.
- You have high blood pressure, diabetes, or kidney disease.
- You are overweight.
- You drink alcohol.
- You eat foods high in purines or drink beverages sweetened with high-fructose corn syrup, like sodas.
What to Do for A Gout Attack
Medication may shorten a gout attack. Your doctor may prescribe medication that blocks inflammation called a nonsteroidal anti-inflammatory drug (NSAID), you may also take a drug called colchicine or a strong anti-inflammatory steroid drug. Over-the-counter NSAIDs include ibuprofen and naproxen. [1,2]
These drugs will reduce the pain and inflammation, but there are also home treatments that will help. Home treatment includes resting your joint, elevating your joint above the level of your heart, and using ice packs to reduce pain and swelling. [1,2]
How to Prevent Future Gout Attacks
Although gout usually starts in your big toe it can also affect your fingers, knees, or hips.  Gout can lead to kidney stones and can cause permanent damage to joints and tissues that surround joints. Medication and home treatments do a good job of preventing future attacks and long-term damage. 
If your doctor does a blood test that shows you have high uric acid levels after a gout attack, you may be started on a medication to lower uric acid. Medications to prevent gout attacks may be used for people who have more than three attacks per year, have severe gout, or kidney stones from gout. 
Lifestyle changes for gout prevention are an important part of treatment. They include: [1,2]
- Losing weight if you are overweight
- Getting regular exercise
- Limiting alcohol
- Drinking lots of water to help your kidneys flush out uric acid
- Limiting fructose-sweetened drinks
- Limiting foods high in purines like red meats, organ meats (kidney and liver), shellfish, sardines, and anchovies
- Eating a diet low in salt and saturated fat.
- Including lots of fruits vegetables and whole grains in your diet
For more discussions of foods that work as part of a gout diet, see these posts:
For more information on gout in general, please visit these posts:
- What Is Gout?
- What Could Be Causing Your Gout Symptoms?
- Gout in Ankles, Knees, and Feet: More Common Among Men
- NIH, Overview of Gout, https://www.niams.nih.gov/health-topics/gout/advanced
- AAOS, Gout, https://www.orthoinfo.org/en/diseases–conditions/gout/