Gout Treatment

For an acute flare, guidelines including NICE's gout guideline set out three main established options: NSAIDs, colchicine, and corticosteroids (given as tablets, or occasionally as an injection into or around the joint). There is no single medicine that's right for everyone — which one is used, or whether a combination approach is needed, depends on individual factors.

Because of this, the right choice for one person can be entirely wrong for another. This page explains what each option is and why it's used — it isn't a guide to which one you personally should take. That decision belongs with your doctor or pharmacist.

Colchicine is sometimes assumed to be a general painkiller — it isn't. It's an anti-inflammatory medicine that works specifically by reducing the inflammation urate crystals cause in the joint, which is what relieves the pain, rather than simply masking it the way an ordinary analgesic would.

Correct, prescribed use matters more with colchicine than with many medicines. It has a genuinely narrow margin between a helpful dose and a harmful one, and it interacts with a range of other medicines — including some antibiotics, antifungals, certain heart medicines, and drugs that affect the kidneys, liver or blood — as well as being unsuitable for some people with significant kidney, liver, blood or heart conditions.

It's worth separating two different things: relieving pain, and controlling the inflammatory attack itself. NSAIDs, colchicine and corticosteroids all work substantially by damping down the inflammation the crystals are causing — the pain relief follows as a result.

An ordinary painkiller such as paracetamol may take the edge off discomfort, but on its own it doesn't act on that underlying inflammation in the same way, so it isn't considered a substitute for the anti-inflammatory options above during a significant flare. And whichever medicine is used for pain, none of them lower uric acid or change the underlying gout — that's the job of long-term urate-lowering treatment, covered further down this page.

A hot, swollen, intensely painful joint usually does mean gout if you've had it before — but not always. The same picture can occasionally be caused by a joint infection (septic arthritis) or other conditions, which need urgent assessment and are treated very differently from gout. A previous gout diagnosis doesn't automatically mean every future swollen joint is gout again.

Not everyone who has had gout needs long-term medication — but guidelines are clear about who it should routinely be offered to. UK NICE guidance recommends offering ULT, using a treat-to-target approach, to people with:

For anyone with a first or subsequent flare who doesn't fall into those groups, guidelines recommend discussing the option of ULT with them rather than assuming it isn't needed or automatically starting it. This isn't a checklist for diagnosing yourself — it's context for a conversation with your GP or rheumatology team, who can weigh your individual circumstances.

Febuxostat is another xanthine oxidase inhibitor, working in broadly the same way as allopurinol to lower urate production. UK guidelines list it as an equally valid first-line option alongside allopurinol, and as an alternative if allopurinol isn't tolerated or doesn't bring urate to target.

One important difference: regulatory safety reviews found a higher rate of cardiovascular death in people with pre-existing major cardiovascular disease (such as a previous heart attack or stroke) taking febuxostat compared with allopurinol in a large trial. Because of this, guidelines favour allopurinol over febuxostat for people with significant cardiovascular disease, and febuxostat is generally reserved for people who can't take allopurinol or whose urate stays above target on it. This isn't a claim that either medicine is "better" in general — it's a specific, guideline-recognised safety consideration your prescriber will already factor in.

Successful long-term gout treatment isn't "take a tablet and see what happens" — it's an actively monitored process known as treat-to-target. The dose of ULT is adjusted, usually guided by monthly blood tests during this phase, until serum urate reaches a specific guideline-recommended target — and treatment continues at that dose afterwards, with less frequent monitoring, to keep urate below target long term.

These are the figures used in current UK NICE guidance; other national guidelines can phrase targets slightly differently, so if you're outside the UK, your own clinician will confirm the target that applies to you.

This comes up often, and the answer depends on which situation applies to you.

If you're already established on allopurinol or another ULT and you have a flare, current expert guidance generally supports continuing it as normal rather than stopping — the flare is treated separately with an acute medicine, while the long-term treatment carries on underneath. Stopping and restarting established ULT can itself cause urate levels to swing, which isn't helpful. Even so, this is a decision to confirm with your own prescriber if you're ever unsure, rather than assume applies to your situation without asking.

If ULT hasn't been started yet, and you're currently having a flare, guidelines generally suggest waiting until the flare has settled — commonly a couple of weeks or so — before starting, since it's usually easier to begin treatment once the acute inflammation has calmed down. Where flares are frequent, starting during a flare (alongside flare prophylaxis) can also be reasonable. Either way, this is a timing decision for your clinician to make with you, not something to decide alone.

For many people, sustained urate-lowering treatment leads to long periods without flares, and existing tophi can shrink or disappear entirely — which understandably gets described as gout being "in remission." That's a reasonable way to think about it, but it's different from a permanent cure.

Gout is driven by urate staying too high for too long; if urate-lowering treatment is stopped, urate levels generally rise back toward where they were, and crystals can start forming again. For most people who need ULT, staying flare-free depends on continuing to keep urate controlled — not on lifestyle changes alone, and not as a treatment course with a fixed end date.

You'll often see specific foods or supplements — tart cherry, vitamin C and others — promoted as gout treatments. The evidence behind most of these is limited, mixed, or based on small studies, and none is established as a replacement for medical treatment where medical treatment is needed. We've reviewed the evidence in more depth in our supplements for gout guide, if you'd like to look at what's actually been studied.