Why Do I Keep Getting Gout Flares When I’m Doing Everything Right?

Why Do I Keep Getting Gout Flares?

If you keep getting gout flares, it’s usually not what you’re eating. The real cause often goes untreated, so let’s talk about it.

If you’ve landed on this article you’ve probably tried quite a bit to stop flaring. Watching what you’re eating, taking the pills your doctor gave you during your last gout attack, maybe even given up some favorites, like beer, red meat, shrimp, etc, and the flares are still showing up.

But when flares keep coming back, it’s almost always a sign that the actual cause has not been treated. Not that you are cheating or failing, simply that the root cause of gout has not been addressed. I blame decades of stigma and phrasing like “king’s disease” but that’s hard to quiet. So let’s set that aside today, and get into the actual possible causes of why you keep getting gout flares, even when you are following all of the “gout rules” perfectly.

How many gout flares a year is “normal”?

Short answer, none is the goal. And a few a year is not “just how gout goes.”

A lot of us (because of that stigma I mentioned above) believe a flare or two a year is the price of having gout. You wait it out, take something for the pain, get back to your life until the next one. That belief is common. But it’s also very wrong, and it keeps people stuck for years.

If you’re flaring regularly, your gout is active. Not bad luck, not you cheating on the rules, active! Uncontrolled is the term I like to use though, I think because it gives just a little more hope to the phase you’re in, it implies it can be controlled, and it can.

The real reason flares keep coming back

Gout comes from uric acid. When there’s too much of it in your blood for too long, it forms tiny crystals in your joints. Those crystals are what your body reacts to when a flare hits.

But theres a big problem in this phase (aside from the part where you want to cut your foot off), you are prescribed medication, and without a full understanding of gout, you figure this medication will help your gout. But things like colchicine, NSAIDs, and steroids only treat the pain. They calm the fire, you start to feel a bit better, and you move on. But they have done absolutely nothing to lower the uric acid buildup that started this whole thing.

So if pain relief is the only treatment you’ve ever been given, the crystals are still there, waiting. When your body “sees” them again, it will react with inflammation and pain, and your flares will just keep coming, because that root cause was never addressed.

“But I feel fine between flares”

That’s exactly the trap.

Feeling okay between attacks doesn’t mean the gout is under control. If your uric acid is still high, the crystals are still building, even on your good days! Gout is one of those conditions where “no pain right now” and “gout controlled” are not the same thing.

You need proactive gout care, something to actually lower your uric acid levels in your blood so that crystals dissolve and new crystals can’t form. It’s also called “treating to target” and your target uric acid level should be >6mg/dL. When you are getting this proactive gout care, you are addressing that root cause of your flares, and keeping your uric acid under 6mg/dL where those crystals don’t form in the first place.

Why do I still get flares even on allopurinol?

This one comes up a lot, and it’s totally fair to be frustrated by it. Because now you are doing the correct step of proactively treating gout, but yet again, still flaring.

This is basically where treat to target needs to come in and be your “true north”. Allopurinol and similar medicines do lower uric acid, but only if the dose is high enough to get you to a target level. Plenty of people get started on a low dose and then don’t even know to keep following up. The dose never gets raised. The labs never get rechecked. So they’re technically “on a medication” but never actually treated to the level that stops flares.

Being on a pill and being treated to target are two different things. If you’ve been on allopurinol a while and are still flaring, it’s time for a new conversation with your doctor, about your dose and your most recent uric acid number.

Wait, my flares got worse after I started treatment

I know, this part feels like a double edge sword, and let’s be honest, really sucks. But ff this happened to you, please read this part twice, it’s very important.

When uric acid first starts dropping, old crystals begin to dissolve, and that process can actually trigger more flares for a while. I know, it feels backwards and it feels like the medicine is making things worse.

But, it isn’t. It’s a sign the treatment is doing its job. This stretch is temporary, and there are ways to cover you through it. A lot of people quit right here, days before things would’ve gotten dramatically better. Don’t be one of them without talking to your doctor first, ask about flare treatment when you start lowering your uric acid.

Can gout go away on its own?

Not really. Left alone, high uric acid tends to do the opposite, more frequent flares over time, and slow joint damage you can’t always feel happening. The upside is that it responds well when the treatment is aimed at the actual cause. “Controllable” is the honest word, not “curable”, but controllable is a life where you begin to unclench while always waiting for the next flare, and slowly start to live without even thinking about gout.

A few other things that can feed your flares

None of these are about blame, they’re just worth knowing:

• Dehydration
• Certain blood pressure medicines, especially water pills (diuretics)
• Reduced kidney function
• Genetics, how your body handles uric acid is largely inherited

If anyone ever told you that you “did this to yourself,” they were wrong. Plenty of people who eat carefully still get gout, because the biggest driver was never on their plate.

What “under control” gout actually looks like

It’s not a life of never eating what you love and bracing for the next attack.

It looks like flaring very rarely, or usually not at all. Knowing your uric acid number and where it should be. Having a plan that’s actually working, not just a bottle of pain pills for emergencies. Sleeping, walking, and traveling without wondering if a joint is about to turn on you.

Because of that *lovely* stigma we mention so often around here, too many people don’t even understand that this version of life is even on the table. It is.

Where to start

Well, first, you’re already in a great place. We’re a 100% patient lead nonprofit, so we have all been exactly where you are, and we all have our gout under control now, and we all want you to get here too.

So, if you have gout, and are wondering “why do I keep getting gout flares, when I am doing everything right?!” stick around our site for a little bit. Learn what uncontrolled gout actually looks like, that options exist beyond flare pain relief, and what to bring up at your next appointment.

This is our favorite place to start > Our Gout Roadmap < It meets you exactly where you are, and gives you the information you need to help you take the next step.

This is patient-to-patient education, not medical advice. We’re not here to tell you what to do, we’re here so you know what’s possible, and can walk in with the right questions for the doctor who can.