Gout treatment (Gout management (urate-lowering therapy))
Treatment to settle painful gout attacks and, over time, lower the uric acid in your blood so the attacks stop coming back.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Gout treatment has two parts: settling a painful attack, and lowering blood urate long-term so attacks stop.
- Daily urate-lowering tablets (such as allopurinol) take months to work fully and are usually meant for life — stopping them often brings gout back.
- Attacks can briefly get worse when you first start urate-lowering tablets, so a 'cover' medicine is usually given for the first few months.
- It is worth asking which medicines, water tablets or health conditions are pushing your urate up, and whether your kidneys need checking.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Settles the severe pain and swelling of an attack
Urgent anti-inflammatory tablets may be unsafe if you have significant kidney disease, stomach ulcers, heart failure or are on blood thinners — a...
Rest the joint, start your flare medicine early, and use ice and elevation. Most attacks ease over a few days to a couple of weeks with treatment.
A clear, written plan covering both flare treatment and the daily urate-lowering tablet, with the urate target stated.
Rest the joint, start your flare medicine early, and use ice and elevation. Most attacks ease over a few days to a...
You may notice more frequent flares at first. Keep taking the urate-lowering tablet and use the 'cover' medicine...
The dose is increased step by step until urate reaches target. Flares usually become less frequent as crystals...
Many people have far fewer or no attacks once urate has been at target for a while. Any tophi slowly shrink.
What is gout treatment?
Gout is a form of arthritis caused by too much urate (uric acid) in the blood. The urate can form sharp crystals in a joint, which triggers sudden, severe pain, swelling and redness — most often in the big toe, but also the foot, ankle, knee, hand or other joints.
Treatment has two separate jobs. The first is to settle a painful attack (a 'flare') with anti-inflammatory medicines. The second, longer-term job is to lower the urate in your blood with a daily tablet so the crystals slowly dissolve and the attacks stop happening. This is called urate-lowering therapy.
Lowering urate is the part that actually changes the disease. Treating each flare brings relief, but it does not stop the next one. A tablet such as allopurinol, taken every day and adjusted to reach a urate target, is what keeps gout away in the long run.
Gout is strongly linked to things like family history, kidney function, some water tablets (diuretics), alcohol and body weight. It is a treatable condition, not a sign of a 'bad diet' alone, and good treatment can make attacks a thing of the past.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Treating the attack vs lowering urate
| Treat the attack | Lower urate long-term | |
|---|---|---|
| What it does | Calms pain and swelling now | Stops future attacks |
| How fast | Days | Months to work fully |
| How long | A short course | Usually lifelong |
| Examples | NSAID, colchicine, steroid | Allopurinol, febuxostat |
The two are different jobs. Painkillers for an attack do not lower urate, and urate-lowering tablets are not painkillers for a sudden flare.
Preparing for your treatment
- Tell your clinician about all your medicines and supplements — water tablets (diuretics) and some other drugs can raise urate.
- Mention any kidney problems, heart disease, liver problems or past reactions to gout medicines, as these affect which tablet and dose are safe.
- Expect a blood test for urate and kidney function before, and during, urate-lowering treatment.
- Ask whether you should keep a short course of flare medicine at home so you can treat an attack early.
- Be honest about alcohol and any sugary drinks, as cutting back can help, though tablets do the main work.
- If you are of South-East Asian, Han Chinese or Thai background, ask whether a genetic blood test (HLA-B*5801) is needed before allopurinol, as it affects the risk of a serious skin reaction.
- Bring a note of how often you get attacks and which joints are affected.
What happens
For a flare, your clinician confirms it is gout (sometimes by drawing a little fluid from the joint to look for crystals, or by a blood test and examination) and starts an anti-inflammatory tablet, colchicine or a steroid to settle the pain. Treating early in an attack works better than waiting.
For long-term control, you start a low dose of a urate-lowering tablet, usually once the worst of a flare has settled. Your urate level is then checked by blood test, often monthly, and the dose is slowly increased until your urate reaches the target. This step-by-step approach reduces side effects and reduces the chance of triggering flares.
Once your urate is at target and steady, monitoring usually settles to around once a year. Your clinician also reviews anything that pushes urate up, such as certain water tablets, and checks your kidney function.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Urgent anti-inflammatory tablets may be unsafe if you have significant kidney disease, stomach ulcers, heart failure or are on blood thinners — a different flare treatment is needed.
- Colchicine needs caution or dose reduction with kidney or liver impairment and certain other medicines.
- Allopurinol may not be the first choice if you have had a serious reaction to it, or carry a high-risk gene without testing.
- Urate-lowering treatment is not a substitute for treating a hot, infected joint, which must be excluded first.
Delay or rearrange if…
- You are in the middle of a severe flare — long-term urate-lowering tablets are usually started once the worst has settled (though if you already take them, you keep going).
- A joint infection has not been ruled out in a hot, swollen, painful joint.
- Recent major changes in kidney function need checking before choosing a dose.
- You have an unexplained rash or are unwell shortly after starting allopurinol.
Alternatives to discuss
- Treating attacks only, accepting that they will keep returning (not recommended if attacks are frequent or joints are being damaged).
- Choosing febuxostat instead of allopurinol, or vice versa, if the first is not suitable.
- Lifestyle measures (alcohol, sugary drinks, weight) as support alongside tablets, not as a replacement.
- Reviewing and changing medicines, such as some water tablets, that raise urate where it is safe to do so.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Settles the severe pain and swelling of an attack
- Over months, can stop attacks coming back altogether
- Slowly dissolves urate crystals and any lumps (tophi) under the skin
- Protects joints from long-term damage caused by repeated attacks
- Reduces reliance on regular painkillers
Risks & complications
- A temporary increase in attacks when urate-lowering tablets are first started
- Stomach upset, loose stools or feeling sick (especially with colchicine or anti-inflammatories)
- Mild rash when starting allopurinol
- Anti-inflammatory tablets can upset the stomach or affect blood pressure and the kidneys
- Needing to switch tablets because the first one is not tolerated or does not reach target
- Interactions between gout medicines and other drugs (for example colchicine with some other medicines)
- Blood test changes affecting the liver or blood count, which is why monitoring is done
- A serious allergic skin reaction to allopurinol (more likely in certain genetic backgrounds), which needs the tablet stopped urgently
- Severe colchicine toxicity if the dose is too high or kidneys are impaired
- Serious anti-inflammatory side effects such as bleeding from the stomach
The most important early issue is that attacks can flare when urate-lowering treatment begins — this is expected and is not a reason to stop the tablet. The most serious, though rare, issue is a severe skin reaction to allopurinol; any widespread rash, blistering, mouth sores or fever after starting it needs urgent medical attention. Ask your clinician which medicine suits your kidneys and other conditions, and whether you need a genetic test before allopurinol.
Published figures to discuss
Gout treatment is generally well established and most side effects are manageable, but how quickly attacks stop depends on reaching and holding the urate target, which varies between people. Serious reactions to allopurinol are rare but important, and risk is higher in certain genetic backgrounds, with kidney impairment, and at higher doses.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Urate target for most people | Below 360 micromol/litre (below 300 if tophi, chronic gouty arthritis or frequent flares) | A treatment target from NICE NG219, not a complication rate. Reaching it is what stops attacks over time. | NICE — Gout: diagnosis and management (NG219)nice.org.ukSource-linked context |
| Flares when starting urate-lowering tablets | Common in the first weeks to months | Expected as crystals shift; a cover medicine is usually given for several months. Not a reason to stop. | Guide sourcesClinical context |
| Serious allergic skin reaction to allopurinol | Rare, but higher with certain HLA-B*5801 backgrounds, kidney impairment and high starting doses | Any widespread rash, blistering, mouth sores or fever needs the tablet stopped and urgent review. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery from the treatment itself. What matters is how your symptoms respond: an attack settles over days, while the long-term tablets quietly work over months to stop attacks returning.
- More frequent flares in the first weeks or months of urate-lowering treatment
- Needing several dose increases before urate reaches target
- A short period of stomach upset when starting colchicine or anti-inflammatories
- Gradual fading of attacks rather than an instant stop
Aftercare
- Keep taking your urate-lowering tablet every day, even when you feel completely well and have no attacks.
- Treat any flare early with your agreed flare medicine, and tell your clinician if attacks continue.
- Attend blood tests so your urate level and kidney function can be checked.
- Stay well hydrated and limit alcohol, especially beer and spirits, and sugary drinks.
- Tell any other prescriber that you take gout medicines, to avoid interactions.
- Report any new rash, mouth ulcers, blistering or fever after starting allopurinol straight away.
- Keep a simple record of attacks so your clinician can judge whether control is good enough.
- A written plan for what to take during a flare
- A supply of flare medicine kept at home
- Your next urate blood test booked
- A list of all your medicines to check for interactions
- Knowing the urate target you are aiming for
- The clinic or GP contact for advice if attacks continue
⚠ Get urgent help if…
- A widespread rash, blistering, peeling skin, mouth sores or fever after starting allopurinol — stop the tablet and seek urgent medical advice
- A hot, very painful, swollen joint with fever or feeling generally unwell — this can mean a joint infection, which is an emergency
- Severe vomiting or diarrhoea while taking colchicine
- Black or bloody stools, or vomiting blood, while taking anti-inflammatory tablets
- Passing much less urine, or new swelling, suggesting a kidney problem
- An attack that is not settling at all despite treatment
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result is fewer attacks, and eventually none, with your blood urate held below the target your clinician sets. Because crystals take time to dissolve, the benefit builds over months rather than appearing straight away.
Reaching and staying at the urate target is the key marker that treatment is working. A normal urate on a single test does not mean the job is done if you are still having attacks, and it does not mean you can stop the tablet — urate usually rises again if treatment stops.
Urate-lowering treatment works for as long as you take it. For most people it is a lifelong tablet, because stopping it allows urate to climb and attacks to return. The dose may need adjusting over time, particularly if your kidney function or other medicines change.
Related tests, treatments or support
Gout treatment often sits alongside management of related conditions such as high blood pressure, kidney disease, diabetes and heart disease, which commonly occur together with gout. Your clinician may review water tablets and other medicines as part of the bigger picture.
Follow-up & long-term care
After starting urate-lowering treatment, your urate is usually checked about every month while the dose is adjusted, then around once a year once it is steady and at target. Kidney function and other medicines are reviewed at the same time. If attacks continue despite treatment, the plan should be revisited rather than left unchanged.
- Daily urate-lowering tablet, continued long term
- Around yearly urate and kidney blood tests once stable
- Periodic review of diuretics and other medicines that raise urate
- Keeping flare medicine available to treat attacks early
- Attention to alcohol, sugary drinks and body weight as supportive measures
Repeat, follow-on and what comes next
- Many people need several dose increases, and sometimes a switch between allopurinol and febuxostat, before urate reaches target.
- If attacks continue despite a 'normal-looking' urate, the target may not be low enough or the dose may be too low.
- Stopping urate-lowering tablets usually leads to urate rising and attacks returning, so restarting is common after gaps.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear, written plan covering both flare treatment and the daily urate-lowering tablet, with the urate target stated.
- Regular blood tests for urate and kidney function, with the dose adjusted to target.
- A named contact for advice if attacks continue or side effects occur.
- Review of medicines and conditions that raise urate, and safety advice about the allopurinol skin reaction.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether you see a GP or a private rheumatologist, and how many follow-up appointments are needed
- Blood tests for urate and kidney function, and how often they are repeated while the dose is adjusted
- Whether joint fluid is sampled or imaging is used to confirm the diagnosis
- Any genetic testing (HLA-B*5801) before allopurinol in higher-risk groups
- The medicines themselves and the length of follow-up to reach the urate target
- Management of related conditions such as high blood pressure or kidney disease
- The consultation fee and how many follow-up visits are expected
- The cost of urate and kidney blood tests, and how often they are repeated
- Whether joint aspiration or imaging is included if needed
- Any genetic test fee before allopurinol
- What happens, and what it costs, if attacks continue and the plan needs changing
- Whether prescriptions are issued for you to dispense through a community pharmacy
On the NHS? Gout is commonly diagnosed and managed on the NHS, usually by a GP, with rheumatology referral when needed; private care is mainly used for faster access or a specialist opinion rather than because better medicines are private.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Being told to take a 'gout tablet' without it being explained that flare medicines and urate-lowering tablets are different jobs.
- Not being warned that attacks can worsen at first on urate-lowering treatment, leading people to stop.
- No clear urate target set, so it is impossible to tell whether treatment is working.
- Not being told about the rare but serious allopurinol skin reaction and what to watch for.
Marketing red flags
- Claims that a supplement, cherry product or special diet will 'cure' gout or replace urate-lowering tablets.
- Promising a permanent fix from a single course of treatment without long-term urate control.
- Offering urate-lowering treatment without blood-test monitoring of urate and kidneys.
- Treating gout purely as a 'lifestyle' problem and ignoring kidney function and medicines.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What urate target are we aiming for, and what is my level now?
- Which urate-lowering tablet suits my kidneys, heart and other medicines?
- Do I need a genetic blood test before starting allopurinol?
- What should I take, and how early, when I feel a flare starting?
- Which of my current medicines might be raising my urate?
- How often will my urate and kidney function be checked?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Can gout be treated on the NHS?
Why did my gout get worse when I started the tablets?
Do I have to take the tablets forever?
Will changing my diet cure my gout?
Is gout caused by what I eat?
How will I know the treatment is working?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NICE — Gout: diagnosis and management (NG219) NHS — Gout Versus Arthritis — Gout British Society for Rheumatology — Gout management guideline NICE — Gout overview
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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