How to Prevent the Next Gout Attack

If you’ve ever experienced a gout attack, you're not likely to forget it. The sudden, severe inflammatory pain may have woken you up in the middle of the night or even sent you to the ER.

You may be at high risk for another attack if you haven’t made any changes to your diet, lifestyle, or medication regimen. Taking precautions against future attacks can spare you from gout pain and limit long-term damage to your joints.

Gout can go away...or return again and again

Gout attacks almost always result in stabbing pain, redness, and swelling in a joint. In men, about 50% of first-time gout attacks involve a big toe joint.¹Efthimiou, Petros. (2020). Absolute Rheumatology Review. 10.1007/978-3-030-23022-7. Other commonly affected joints include the instep, heel, ankle, and knee.²Sidari A, Hill E. Diagnosis and Treatment of Gout and Pseudogout for Everyday Practice. Prim Care. 2018;45(2):213-236. doi:10.1016/j.pop.2018.02.004

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After the first gout attack, the condition can affect people differently:

• Some people will go months or even years without having another gout attack—or very rarely, they may never have another one again.
• Other people will begin to experience gout attacks regularly. Eventually, these flare-ups may become frequent and longer-lasting. Chronic gout can lead to permanent joint damage and result in disability. Thankfully, early and appropriate treatment of the underlying cause of gout—high levels of uric acid in the blood—can prevent joint damage.

Experts can’t predict who will have a one-time attack versus chronic gout. If you’ve had an attack, it’s worth your time and effort to make changes that can help you avoid another painful flare-up.

See Gout Causes and Risk Factors

5 steps you can take to prevent a gout flare-up

Making one or more of these lifestyle and dietary changes can reduce your risk of another gout attack and the joint damage it can cause. A doctor can help advise you based on your unique health circumstances.

1. Adjust your diet

A healthy diet to help prevent gout will include vegetables, fruits, low-fat dairy, and complex carbohydrates, such as whole grains and beans.

A gout prevention diet also involves avoiding certain foods, particularly:

• Meat, particularly organ meats, like liver, and game meats, like venison
• Seafood, including fish and shellfish
• Alcohol, including wine, spirits, and especially beer

These foods and drinks contain a high level of a substance called purines that increase the chances of a gout attack.

See a What Are Purines?

2. Swap soda for water (coffee and tea are okay in moderation)

Sugary foods and drinks, such as soda, increase purine intake and the risk of a gout attack.³Choi HK, Willett W, Curhan G. Fructose-rich beverages and risk of gout in women. JAMA. 2010;304(20):2270-8. doi: 10.1001/jama.2010.1638^,4Choi HK, Curhan G. Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ. 2008;336(7639):309-312. doi:10.1136/bmj.39449.819271.BE^,5Batt C, Phipps-Green AJ, Black MA, Cadzow M, Merriman ME, Topless R, Gow P, Harrison A, Highton J, Jones P, Stamp L, Dalbeth N, Merriman TR. Sugar-sweetened beverage consumption: a risk factor for prevalent gout with SLC2A9 genotype-specific effects on serum urate and risk of gout. Ann Rheum Dis. 2014 Dec;73(12):2101-6. PMCID: PMC4251167 DOI: 10.1136/annrheumdis-2013-203600 On the other hand, drinking plenty of water may lower your risk of gout flares.⁶Neogi T, Chen C, Niu J, et al. Relation of temperature and humidity to the risk of recurrent gout attacks. Am J Epidemiol. 2014;180(4):372-377. PMCID: PMC4184385 DOI: 10.1093/aje/kwu147 Experts typically recommend drinking 48 to 64 ounces of water (about 6 to 8 glasses), each day. Staying hydrated may help flush uric acid from the body.

Coffee and tea do not seem to increase the level of uric acid in the body, and coffee may even lower it.⁷Paul BJ, Anoopkumar K, Krishnan V. Asymptomatic hyperuricemia: is it time to intervene?. Clin Rheumatol. 2017;36(12):2637-2644. doi:10.1007/s10067-017-3851-y^,8Kakutani-Hatayama M, Kadoya M, Okazaki H, et al. Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle. Am J Lifestyle Med. 2015;11(4):321-329. Published 2015 Sep 2. doi: 10.1177/1559827615601973 However, I generally recommend my patients avoid excessive amounts of coffee or tea. While scientists don't know for sure, some evidence suggests that drinking several cups of coffee or tea can make you a little dehydrated.⁹Seal AD, Bardis CN, Gavrieli A, Grigorakis P, Adams JD, Arnaoutis G, Yannakoulia M, Kavouras SA. Coffee with High but Not Low Caffeine Content Augments Fluid and Electrolyte Excretion at Rest. Front Nutr. 2017 Aug 18;4:40. PMCID: PMC5563313 DOI: 10.3389/fnut.2017.00040

See Hyperuricemia - High Uric Acid Levels and Gout

3. Get moving

Most experts recommend losing excess weight, which is a risk factor for gout. What is less widely known is that avoiding a sedentary lifestyle and getting regular exercise—even if you don’t lose weight—may help reduce your risk of a gout attack.¹⁰Yuan S, Zhang ZW, Li ZL. Antacids' side effect hyperuricaemia could be alleviated by long-term aerobic exercise via accelerating ATP turnover rate. Biomed Pharmacother. 2018;99:18-24. doi:10.1016/j.biopha.2018.01.052^,11Park DY, Kim YS, Ryu SH, Jin YS. The association between sedentary behavior, physical activity and hyperuricemia. Vasc Health Risk Manag. 2019;15:291-299. Published 2019 Aug 13. doi:10.2147/VHRM.S200278

4. Get tested for sleep apnea

Untreated sleep apnea can increase the risk of gout.¹²Zhang Y, Peloquin CE, Dubreuil M, et al. Sleep Apnea and the Risk of Incident Gout: A Population-Based, Body Mass Index-Matched Cohort Study. Arthritis Rheumatol. 2015;67(12):3298-3302. PMCID: PMC4821424 DOI: 10.1002/art.39330^,13Abrams B. Sleep apnea and gout. Can Fam Physician. 2009;55(3):243-244. PMID: 19282526 Sleep apnea is a sleep disorder that causes the body to take in less oxygen while sleeping, which in turn causes the body to produce more purines.¹²Zhang Y, Peloquin CE, Dubreuil M, et al. Sleep Apnea and the Risk of Incident Gout: A Population-Based, Body Mass Index-Matched Cohort Study. Arthritis Rheumatol. 2015;67(12):3298-3302. PMCID: PMC4821424 DOI: 10.1002/art.39330^,14Choi HK, Niu J, Neogi T, et al. Nocturnal risk of gout attacks. Arthritis Rheumatol. 2015;67(2):555-562. PMID: 25504842 doi: 10.1002/art.38917 Sleep apnea is typically treated with a continuous positive airway pressure (CPAP) machine or other device that increases oxygen intake while sleeping.

5. Take your gout medication regularly

In addition to the strategies described above, a doctor will usually recommend taking a prescription medication, such as allopurinol, that is proven effective in preventing gout attacks.

Allopurinol and other medications that lower the uric acid can have several benefits, including reducing gout flares, improving function and quality of life, increasing productivity at work, decreasing sick-days from work, and reducing gout-associated cost. Like most drugs, the long-term use of prescription gout medications carries a small potential of side effects and health risks.⁹Seal AD, Bardis CN, Gavrieli A, Grigorakis P, Adams JD, Arnaoutis G, Yannakoulia M, Kavouras SA. Coffee with High but Not Low Caffeine Content Augments Fluid and Electrolyte Excretion at Rest. Front Nutr. 2017 Aug 18;4:40. PMCID: PMC5563313 DOI: 10.3389/fnut.2017.00040 You should discuss the potential benefits and risks with your provider.

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Learn more

Gout Prevention Diet

6 Ways to Deal with Painful Gout Attacks