Private gout clinic in London, same-day physiotherapy.

Treating an attack

• Start treatment as early as possible — within hours of the first twinge. Attacks treated early settle far faster.
• An anti-inflammatory at full dose, colchicine, or a short course of steroid — all three work, and the choice depends on your kidneys, stomach and other medicines.
• Rest and elevate the joint. Ice packs wrapped in a towel genuinely help.
• Keep bedclothes off the joint — a frame or a cushion works.
• Drink plenty of water.
• If you already take allopurinol or febuxostat, do not stop it during an attack. Stopping makes things worse.

The part that gets missed

Treating each attack does nothing to prevent the next one. Urate-lowering treatment — usually allopurinol — dissolves the crystal deposits over time and stops attacks altogether. It is under-prescribed, under-dosed, and stopped too early, which is why so many people believe gout is simply something they have.

• It is offered after a second attack, or after a first if you have tophi, kidney stones, kidney disease, or need diuretics.
• The dose is increased gradually until a blood test shows urate below target. A fixed starting dose that was never titrated is the commonest reason it fails.
• Attacks can increase during the first months as deposits dissolve. This is expected, is not failure, and is covered by taking a low dose of colchicine or an anti-inflammatory alongside for the first six months.
• Once established, it is normally continued indefinitely. Stopping means the crystals reform.

Diet and lifestyle

Diet matters, but far less than most people are led to believe — it typically shifts urate levels by a modest amount, whereas medication reaches target. Blaming diet alone leads to years of unnecessary restriction and continuing attacks.