How long do gout attacks last?

September 4, 2012 in Gout Remedies Forum For Gout Treatment

Most new gout sufferers want to know how long do gout attacks last?

Like many aspects of gout, there is no easy answer. There are so many factors involved, that we need much more personal information. Is it your first attack? How long have you had gout? What treatment are you taking?

Science tells us that a gout attack should last a few days. Let’s say a week at most. But, we have had several discussions about stubborn, or prolonged gout. I have summarized the key points about the duration of gout attacks in articles described below.

Stubborn gout is almost always due to inadequate treatment. In earlier discussions, we have seen people mention 14 days, and even 28 days. Most have described various medications they were taking, but in all cases these were inadequate.

If you are unsure if your treatment is OK, you can get personal gout help in the forum. Please describe your experience in full. Include dates when you were first diagnosed with gout, your test results and treatment history, as well as explaining why you believe your gout is lasting longer than usual.

Gout Flare Duration Articles

This topic has prompted several discussions about the length of gout attacks. I have summarized the key points in the following articles, and I will add to the list as we have more gout flare duration discussions:

How long does gout flare up last?
How long does gout flare up last? Anything from a few hours to permanent gout pain. Check 4 factors. See how you can control how long gout flare up lasts.
How Long Does a Gout Attack Last?
Are you wondering how long does a gout attack last? Less than a week, so why do some flares last longer? See how long gout should last and how to fix it fast.

My articles also link to a good pain relief package that should control gout pain in hours, not days. I call this Gout Pain Freedom, which will help you control how long gout attacks last.

The variety of questions about duration of gout attacks is amazing. Last year I counted 1060 different “how long” questions about gout. There are several current discussions that you might like to join. I’ve tagged these: how long does gout pain last.

Always remember: gout is personal!

There are no fixed rules to tell you how long gout attacks last. If you are new to GoutPal, please see why you need to make How To Treat Gout personal. If you are already an established member, then you will know that the real question is:

How long do Your gout attacks last, and what can we do to control them?

You’ll find your answers in the gout forum.


Find more (see gouty search hints).

 

12 responses to How long do gout attacks last?

  1. I have had the symptoms of gout for over 2 months and had it misdiagnosed several times as it wasn’t in my big toe YET but in my ankle. Finally got diagnosed with gout, as it finally took over my left foot into my toe, however they weren’t able to confirm it because the fluid sample they took out of my ankle wasn’t sufficient. Anyhow it has gone away about 60 to 70 percent but still hurts and makes me limp. The majority of the pain is in my ankle and Achilles but the toe hurts a little too. I have been trying to treat it without prescription drugs. I have gone all but vegetarian only eating eggs and light dairy and have tried several supplements. I read that it could be painful even as its getting better so I guess I am just hoping for some advice to fully get rid of the pain.
    Thanks,
    Justin

    • Yes, gout certainly can be painful as it gets better. That is why you absolutely must monitor uric acid levels when you are trying to control gout. Not doing so is like walking through town blindfolded. You might make it, but it will absolutely be good luck and poor judgment.

      Good judgment means controlling uric acid. The pain of gout is so complicated as to be almost random and I can assure you, despite what people claim, that there is very little direct link between daily diet changes and gout pain. It is all a question of long term lowering of uric acid to 5mg/dL or below.

      Though I am a committed allopurinol user, I do know that dietary changes can reduce uric acid by 1 or 2 mg/dL. However, this only works if you accept the rules.
      1. Uric acid blood tests are vital to tell you if 1 or 2 mg/dL is enough.
      2. Uric acid blood tests are vital to tell you if the dietary changes you make are achieving 1 or 2 mg/dL
      3. Analysis of complete diet is vital.
      4.Recording of diet changes mapped to uric acid changes is vital.

      Personally, I do not have the willpower and tenacity to control uric acid by dietary means, but I respect and support anyone who tries to do it. If you commit to the 4 points I have made, I will do everything I can to advise you on the best dietary changes you can make.

      As an aside, perhaps you can answer me one question that I never understood. Why put your trust in untested, uncontrolled, unreliable supplements, when you do not trust prescription drugs that have undergone extensive safety trials? Both routes involve one or more pills every day. One way is proven to control gout. The other isn’t.

      Why do people waste money on the untested choice?

      • Keith–your advice about using allopurinol is precisely the advice my M.D. gave me 2 weeks ago. I started on allopurinol but now 2 weeks later have had a flare-up of pain in my knee. It is very aggravating to say the least–but I was warned that I might have another attack. I am supposed to be able to eat anything I like within reason on allopurinol but am afraid to do so as a result of this latest attack. Doc echoed Keith’s comment about the long testing of allopurinol. He just shook his head when I mentioned alternative treatments. His retort was take the pill and live your life. I, for one, am hoping he is right!

        • Allopurinol stops uric acid forming from everything you eat. It stops about half the uric acid from natural tisue renewal. It does nothing to uric acid that is already in your system – i.e. all the deposits that built up before you started treatment. All that assumes that you are on the right dose.

          First thing to do is get a blood test immediately and see what the result is. If over 5mg/dL (0.30 mmol/L) then increase the dose.

          If under 5 then celebrate – that pain is a good sign that old crystals are dissolving.

  2. Justin, you are in for a rude awakening: Without knowing your uric acid level, and no gout controling drug, like Allopurinol or Uloric, you will never get your gout under control. Eating lots of eggs will jump your cholesterol to where you will need to fight that, too. That’s all I have to tell you, and I am speaking from experience.

  3. Thanks for all the comments. A couple things to update, when I went to the er and finally got diagnosed with gout they took a blood test and told me that the levels were normal but didn’t tell me an actual numb
    er. Second I am not against the use of a script I was just fed up with doctors, I should tell you I live in a somewhat rural part of Alaska and the level of healthcare can be frustrating. That being said I gave up and went back to the doc and she gave me a script for probenecid-colchine to treat the gout. However when I got it filled the pharmacists seemed less than confident and told me it is an old drug that she hasn’t seen used in a long time. So that is my current status if you have any info on this drug please let me know.
    Thanks,
    Justin

    • A wise man once talked of training his doctor. This was very early in my discoveries through GoutPal and I thought it was a tongue-in-cheek remark. Thousands of reviews, and five gout doctors later, I can see the truth of it.

      I do not wish to make excuses, but doctors see thousands of different health problems, so they cannot be experts on every disease. On the other hand, prescribing probenecid without a 24-hour urine test to assess uric acid excretion rates is just plain irresponsible. In the UK, we have standards boards to oversee medical practitioners. I wish I’d reported some of my bad gout doctors. I never got issued with a probenecid script, but I’ve certainly had the “normal” uric acid blood test “joke.” Somebody please tell the doctors – that joke aint funny no more.

      I bang on about normal uric acid test results with increasing frustration every month. I think it is time to take action, so my latest advice is to report the offending ER doctors. Its up to you whether you go to the hospital management team or a higher authority. This has to be stamped out. Normal on lab reports mean that the result is within a statistical range that covers a certain percentage of whatever test samples are used as a benchmark. I do not want to understand statistics enough to explain all the intricacies of a normal distribution, but it is simply inappropriate.

      My analogy today puts the same doctor in the field hospital of a war zone. Your gout attack leaves you crippled, and you feel just a little unworthy as you hobble through the ranks of minefield and artillery victims. Dr Statistics checks you out. His report says that your ankle count is outside the normal distribution for patients in this field hospital, so he chops your gouty foot off just above the ankle.

      For the avoidance of doubt, medical ranges for uric acid test results are:
      Any value over 6.5mg/dL is a strong indicator of gout, and other criteria should be used to confirm gout. The best test, currently, is crystals in joint fluid, but if this is not possible, professional rheumatologists publish other criteria.

      Any value between 6 – 6.5mg/dL is a warning, and should be retested two weeks hence.

      Once you have ever had a gout attack, then uric acid must be maintained at 5mg/dL or below.

      There is more on both these topics on the main website. You can find them via the search boxes near the top and bottom of every page. I suggest you search for probenecid, and for Normal Uric Acid, No Thanks.

      Just to clarify the probenecid issue. If you have been confirmed as an under-excreter, it can be a good choice. It is useful alone, or in combination with allopurinol or febuxostat to achieve the magic 5mg/dL. The combo with colchicine saves an extra pill during the first few months of treatment, but is unnecessary after that. Most doctors overlook probenecid, as allopurinol works both for under-excreters and over-producers. If it is prescribed after testing excretion rates, it’s a good sign of a doctor who understands gout. Prescribed without that test, probenecid is an indicator of a doctor’s need to be retired. I’m not saying that probenecid will not help you, just that it is a stupid way to see if you are a suitable candidate, when a straightforward urine test will assess you better.

      Finally, any doctor who prescribes uric acid lowering treatment without arranging monthly uric acid tests is past retirement. Once 5mg/dL is reached, test interval can be extended, but never beyond once a year. Uric acid tests should always be accompanied by kidney function and liver function tests.

      Thanks for the inspiration, Justin. I’ll go and write my “Signs that your gout doctor’s past retirement” article.

  4. Hi, i’ve had gout for 6 weeks continues. firstly i had it in the big toe but they weren’t sure it was gout until they confirmed it after a week with a blood test, i was told to rest as much as possible so i was signed of work for 2 weeks.The gout eventualy reduced alot about 80% so i returned to work. I was at work for 2 days when i got it again, in the ankle this time, so i again took time off work (reluctantly) for 2 more days.The gout was not as intense in the ankle so i managed to work on afterwards but not at full speed. Proplems kept arising when i kept aggrovating the ankle and toe by banging it or straining the foot ie in my sleep or kneeling down.
    I presumed that changing my diet and taking naproxen would eventually help the gout to dissapear it has not been the case. I got intouch with my GP again who has now perscribed some new tablets.
    Is this common for gout to go on for so long? and what would explain this happening? please can you give me some advise/help, thank you for your time.

    • I can’t give you a proper reply because, crucially, you haven’t given the uric acid number from your blood test results, or the name of the new tablets.

      General advice for all gout patients is to work with your doctor to get uric acid to 0.30mmol/L (5mg/dL) or lower. If you have had gout for over a year, your initial target should be as low as you can get it using the maximum dose of allopurinol, or other uric acid lowering medicine. Not only does this get the joint-destroying crystals dissolved ASAP, it also significantly reduces the length of time you are at risk from recurring gout attacks. You should find that, as the store of uric acid deposits shrinks, the intensity, frequency, and duration of gout attacks also reduces significantly.

      Speaking of pain, I understand how gout pain can interfere with the ability to work, and the ability to enjoy many aspects of life. What you have to understand is:
      (a) You cannot treat gout pain like a headache or stubbed toe.
      (b) Gout pain is controllable, and the quicker you act, the easier it is.

      On (a), Over The Counter (OTC) pain medicine is *not* gout medicine. Gout pain is a complex series of reactions, which I will touch on in (b). The part of that process that responds to naproxen (i.e. Aleve, and other NSAIDs such as ibuprofen), or other anti-inflammatory drugs, is not the simple ache or pain that OTC meds are marketed for. It’s gout! Respect it, then beat it. See your doctor for a prescription for gout strength anti-inflammatories. Often, it’s just the same OTC at higher dose, but do not self medicate – you have to do this through your doctor, or you will die *. At the same time, ask for advice on compatible analgesics just in case the anti-inflammatories need some support.

      On (b), Gout often needs a three-phase attack – i.e. start with phase 1 then, if you do not get full mobility in a couple of hours, move to the next phase. As I said, this works best at the first twinge of gout.:
      1. Two colchicine tabs ( or one if you get the 1mg variety).
      2. After an hour, if your joint is still immobile, one final colchicine, plus your prescription anti-inflammatory repeated as advised until pain subsides.
      3. After two hours, if your joint is still immobile, start your compatible analgesic, repeated as advised by your doctor or pharmacist.

      If that doesn’t work, you have more than gout, so get to hospital ASAP.

      The real problem with gout pain is, despite it’s awesome intensity, people do not take it seriously enough. Gout will only stop you from working, dancing, or any other aspect of life if you allow it (assuming that you do not have other health problems). For more information, please search for Pain Freedom in the search box near the top of each page, repeated bottom right.

      * Disclaimer: I’m not a doctor, so death might not be immediate, but will happen sooner or later. I’ll leave it to your doctor to consult your medical history and ascertain the best prescription to make the chances of that be later.

  5. My longest attack lasted just over a year, most of that time crippled and stuck in bed while the attacks kind of wheeled around my body. Two weeks in my left big toe then it would seamlessly move (no break in between) to the ankle for a week or three. Then it would move to either my other foot, either knee or elbow or my left wrist. Eventually I even got it in my right hip.

    I didn’t have insurance so I just lived with it until it finally sent me to the county hospital. Now I still have pains but haven’t had an attack in about two years.

  6. In a strange kind of way, although it must have been awful for you, I am slightly comforted by a year long attack. I have had an attack for nearly 4 months. It’s mainly left big toe but sometimes moves up to the ankle or top of the foot. My uric reading was 5 when I was first diagnosed about 8 years ago and this attack has a reading of 5.4. I’ve been thorugh all of the various NSAIDs, colchicine and steroids and the symptoms sometimes get better but don’t go away. It varies between being able to walk without a limp but getting pain if I stress it by walking for a long time or stretching the foot, through to the full blown attack I have at the moment. I’ve had blood tests and x rays and the various medical people involved have told me that it is definitely gout. They can’t give me allipurinol until they have cleared the attack for a few weeks for all the well publicised reasons of getting flare ups. The only NSAID which seems to obviously help is Diclofenac but apparently there have been some health scares with it and the doctors are reluctant to prescribe that particular NSAID unless all else fails. I have found through trial and error that alchohol causes it to get worse so beer and red wine are off my radar for a while.

    So, it would be great to have some advice as to what I do next as the current plan seems to be to tough it out and then get me on the allipurinol asap.

    Thanks

  7. This gout duration topic is now closed. Please see the following summaries:

    How long does gout flare up last?
    How long does gout flare up last? Anything from a few hours to permanent gout pain. Check 4 factors. See how you can control how long gout flare up lasts.

    How Long Does a Gout Attack Last?
    Are you wondering how long does a gout attack last? Less than a week, so why do some flares last longer? See how long gout should last and how to fix it fast.

    For current discussions about gout attack duration, please see How long does gout pain last?