Between flares
Staying well
A flare is the part that hurts today. The longer project is the urate that can feed the next one. For repeated flares, tophi, or ongoing gout, lifestyle changes alone are not enough.
Last reviewed
Urate-lowering medicine, as a long-term idea
For people with repeated flares, tophi, or ongoing gout, NIAMS is direct: lifestyle changes alone are not enough. Medicines that lower urate are the mainstay when a clinician has said they are needed, taken the way they were prescribed. Weight and diet still matter, including for the heart and kidneys, which often travel with gout. They are not a substitute for that medicine.
The aim, over time, is fewer flares and less chance of tophi and of joint damage. It is not a weekend project. It is not a remedy that dissolves crystals at home. It is usually a long-term medicine. The 2020 ACR guideline conditionally recommends continuing urate-lowering medicine indefinitely over stopping it, as a long-term plan. A month that felt normal is a reason to ask the clinician who knows you, not a reason to change it on your own.
The ACR’s 2020 guideline supports urate-lowering medicine when gout is ongoing, including when flares keep returning, when tophi are present, or when gout has damaged a joint. Whether that describes you is a clinician’s judgment, not a checklist to finish at the kitchen table.
Allopurinol is the usual first medicine
ACR’s 2020 guideline names allopurinol as the usual first urate-lowering medicine, including when chronic kidney disease is also present. Usual, in a guideline, is not a prescription with your name on it. Kidney function, other medicines, and a history of reactions belong in that conversation.
Other urate-lowering medicines exist. This page will not rank them. It will not describe a starting amount, a titration, or a reason to switch.
Do not start allopurinol, or any other urate-lowering medicine, from a bottle in a drawer. Do not stop one because a lab number moved or a website ranked the drugs. Starting, stopping, and switching are clinician decisions.
Flare medicine
For the inflamed joint. Chosen with you. Not everyone can take each one.
- Colchicine
- An NSAID a nonsteroidal anti-inflammatory
- A steroid
Long-term urate-lowering
The longer project, when a clinician has said it applies.
- Allopurinol the usual first
Other urate-lowering medicines exist. This is not a full list and not a ranking.
Treat-to-target
Flares can still happen early
Starting or changing urate-lowering medicine can be followed by flares. That is a known pattern, not proof that the medicine has failed. Call the clinician. Ask what they want you to do. Do not invent a stop date. The 2020 ACR guideline conditionally recommends continuing urate-lowering medicine indefinitely over stopping it, as a long-term plan; ask your clinician before changing anything, including in the middle of a flare.
- The plan starts A clinician prescribes a urate-lowering medicine. They often pair it with an anti-inflammatory for a time. The drug and the length are theirs. No schedule here.
- A flare can still happen Especially early. Call, rather than quit. A flare is a reason to get advice.
- Blood tests The plan is checked against the goal you set together, and adjusted with the clinician.
- The long run Fewer flares, and less room for tophi and joint damage. One quiet week does not finish it. One bad week does not cancel it.
Do and don’t
Do
- Ask the clinician before changing urate-lowering medicine, including if a flare starts. As a long-term plan, the 2020 ACR guideline favors continuing it indefinitely over stopping it.
- Keep the blood-test appointments. Bring questions.
- Call if flares show up after a start or a change.
- Treat food changes as an adjunct, not as the whole plan.
Don’t
- Start a urate-lowering medicine from a drawer.
- Stop it because you feel better, or because a flare started.
- Treat a number you found online as your target or your dose.
- Replace the medicine with a diet, a supplement, or a flush.
Diet is an adjunct
What you eat and drink can push urate up or down, and it is worth changing the things that reliably matter. The food and drink page covers those. NIAMS also describes the DASH eating pattern, especially for people who also have high blood pressure, as an ordinary healthy pattern that may help lower urate. It is not a substitute for urate-lowering medicine when that medicine is needed.
There is no food plan here that cures gout, reverses it, or dissolves crystals. Anyone who promises that is selling something this site will not back.
The rest of your health
High blood pressure, kidney disease, and heart disease show up more often alongside gout. So can kidney stones when urate is high. Those are reasons for regular care, not a list this site can manage for you.
Some prescribed medicines are tied to higher urate. NIAMS names certain diuretics and low-dose aspirin among them. That is not a reason to stop them. They are often there for blood pressure, the heart, or the kidneys. Any change belongs with the clinician who prescribed them. The same warning is on the food and drink page, because that is where people go looking for something to quit.
Clinical claims on this page follow the sources.