Gout – stopping the attacks, not just treating them
An excruciating attack is the visible part. The treatment that prevents the next one is a different medicine, taken daily, and it is where most people go wrong.
What is happening
Gout is caused by uric acid crystallising inside a joint. The classic attack is sudden, often overnight, in the base of the big toe: exquisitely painful, red, hot and swollen, so tender that a bedsheet is unbearable. It can also hit the ankle, knee, wrist or fingers.
It is not a trivial condition. Repeated attacks damage joints permanently, and gout is associated with high blood pressure, kidney disease, diabetes and heart disease — so a diagnosis is a prompt to check those too.
Two different treatments, and the confusion between them
This is the single most important thing to understand about gout, and it is where most people go wrong.
- Attack treatment settles the inflammation now: an anti-inflammatory, colchicine, or a steroid. Started early, within hours, it works far better.
- Preventive treatment lowers uric acid over months so crystals stop forming and existing ones dissolve. It is taken every day, indefinitely, including when you feel completely well.
Used for attacks and for prevention respectively:
Colchicine — Colchicine Lennon
Acute gout attack; gout flare prophylaxis (when starting allopurinol); familial Mediterranean fever
Indomethacin — Indocid, Adco-Indomethacin
Acute gout; moderate to severe inflammatory conditions; post-operative pain
Prednisone — Trolic, Meticorten, Adco-Prednisone, Panafcort
Asthma exacerbations; COPD exacerbations; inflammatory and autoimmune conditions
Allopurinol — Zyloprim, Puricos, Adco-Allopurinol
Gout (long-term urate-lowering therapy); hyperuricaemia; prevention of tumour lysis syndrome
Diet matters, but less than people think
Gout has a long history of being blamed on indulgence, and that framing causes real harm — people feel judged, and they also believe diet alone should fix it. Most uric acid is produced by the body rather than eaten, so diet changes typically shift levels modestly.
- Beer and spirits raise risk substantially; beer more than most.
- Sugary drinks and anything sweetened with fructose are strongly associated.
- Organ meats, red meat and some shellfish contribute.
- Dehydration precipitates attacks — relevant in South African heat and after heavy drinking.
- Low-fat dairy and coffee are associated with lower risk.
- Vegetables containing purines, long avoided, do not meaningfully raise risk.
- Some medicines raise uric acid, particularly water tablets and low-dose aspirin. Do not stop them — mention them.
Getting on top of it
- Treat the attack early — keep a supply and a plan agreed with your clinician so you are not waiting for an appointment while in agony.
- Rest and elevate the joint; ice helps.
- Once settled, discuss preventive treatment if you have had more than one attack, any joint damage, kidney stones or kidney disease.
- Take it daily and have uric acid rechecked — the dose is adjusted to a target level, not just prescribed and forgotten.
- Get blood pressure, kidney function, glucose and cholesterol checked, since gout travels with them.
- Keep hydrated, particularly in hot weather.
Common questions
- Can I stop the daily tablet once attacks stop?
- No — attacks stopping is the medicine working. Uric acid rises again within weeks of stopping and the attacks return, often worse. It is a long-term treatment, like blood pressure medication.
- Is gout caused by eating too well?
- Largely no. Most uric acid is made by the body, and genetics, kidney function and certain medicines matter more than diet. Alcohol and sugary drinks are the dietary factors with the clearest effect.
- Should I take an anti-inflammatory during an attack if I have kidney problems?
- Ask first. Anti-inflammatories can worsen kidney function, and colchicine doses also need adjusting in kidney disease. There are alternatives, so this is a conversation rather than a reason to go untreated.
Sources
- Primary Healthcare Standard Treatment Guidelines and Essential Medicines ListNational Department of Health, South Africa
- Adult Primary Care guideNational Department of Health, South Africa
Last reviewed 4 August 2026.