Gout is an inflammatory joint disease commonly affecting men in their 40s and 50s but sometimes younger. It causes severe pain and swelling. Most people want immediate pain relief from gout. What stops gout pain immediately, and is a cortisone injection an option to help eliminate gout?

What does gout look like? 

Too much uric acid in the blood causes gout. Uric acid is a byproduct of the breakdown of purines. Generally, purines are produced by the body, but we also get purines from our diet. As purines are broken down, uric acid crystals are made. These tiny uric acid crystals build up in joints. The big toe is affected, but other joints, such as the ankle, knee, and patella, can also be affected.

Can you get gout in your shoulder? 

While most gout occurs in the big toe or foot, severe gout can affect the upper limb, such as the shoulder, wrist, and finger. However, uric acid levels must be high, and other inflammatory arthritis should be ruled out.

gout attack

Main causes of gout  

Generally, the higher the uric acid in the blood, the greater the risk of acute gout. Important genetic and lifestyle factors that increase uric acid levels include:

  • Family history – High uric acid levels are often genetic
  • gender – males are at higher risk
  • Diet – Certain foods high in a compound called purine increase uric acid. Examples include red meat, prawns, broad beans, cakes, and pastries.
  • alcohol
  • certain medications such as diuretics
  • weight gain

A gout attack is often triggered by an event such as a high intake of purine-rich foods or alcohol intake. Also, an acute injury, such as rolling your ankle, can cause an attack.

What does gout look like? 

Typically, we recommend you see a doctor if you think you have acute gout. Gout can be difficult to diagnose as some signs are similar to other conditions.

In most cases, people present with acute pain and swelling of a joint, more commonly the big toe joint or foot gout. Also, the ankle, knee, or patella can be affected. It is essential to rule out other reasons for joint pain, such as infection, trauma, or other joint arthritis. Imaging, such as X-rays or ultrasound, may be needed to confirm the diagnosis. Also, we may need to take some fluid from your joint and test it for crystals. Finally, blood tests may also be done to check uric acid levels, inflammatory markers, and other causes of inflammatory arthritis.

Gout vs. pseudogout: How can we tell?

Pseudogout is inflammatory arthritis caused by the build-up of calcium crystals in joints. As the name suggests, pseudogout looks like gout.

Generally, it can be challenging to differentiate between the two. However, there are clues as to whether symptoms are pseudogout or gout.

First, pseudogout tends to affect older people in their 60s and 70s, unlike gout. Second, pseudogout affects the knees, ankles, and wrists rather than the toes. Finally, attacks of pseudogout can last for many weeks and sometimes months rather than days in gout.

Immediate gout pain relief: What stops gout pain immediately? 

Generally, you can take simple steps to stop gout pain immediately. Examples include ice, compression of the joint, and rest from the sport. Also, you need to keep well hydrated and avoid alcohol.

Medications from your doctor can help. For example, anti-inflammatory tablets such as ibuprofen can quickly stop an acute attack and eliminate gout. Similarly, colchicine can immediately stop gout pain in the first 24 hours. The colchicine dose is often one tablet three times a day, decreasing to twice a day after a week as the pain settles.

Can you take colchicine with ibuprofen together? 

Yes, both medications treat acute gout and have different actions. However, we favour colchicine for acute attacks as this drug is well tolerated and works quickly.

Is a cortisone shot for gout an option for immediate gout pain relief? 

Cortisone is a potent anti-inflammatory steroid drug that immediately stops gout pain. Cortisone can be taken by mouth, but side effects are common. A cortisone injection into an inflamed joint is very effective in some cases. For example, a big toe or foot gout injection can be effective if severe. Using ultrasound to guide a needle into the joint is essential to improve accuracy and effect.

Generally, a cortisone shot for gout, such as foot gout, often takes a few days to start working. However, if given early in an acute attack, it can stop it in its tracks.

What about PRP injections to stop gout pain immediately?

PRP injections for gout are only reserved for exceptional cases. Like cortisone injections, PRP injections are anti-inflammatory and will have a beneficial effect. This effect is probably better if the injected joint has underlying degenerative changes such as osteoarthritis. Nevertheless, the impact of PRP is less than cortisone. Overall, we would only consider PRP injection for gout if the risks of a cortisone injection are too significant.

How to get rid of gout and prevent gout flare-ups

foods to avoid in gout

Generally, we need to lower uric acid levels to prevent gout flare-ups and help eliminate gout.

Firstly, you need to treat lifestyle factors. Examples include losing weight, reducing alcohol intake, and eating a healthy diet. Secondly, your doctor may prescribe medications to lower uric acid. The most common drug is Allopurinol. Waiting until an acute attack has settled before starting this drug is essential. Speak to your doctor about whether you should consider this drug. In general, preventative medication such as Alluprinol is helpful if uric acid levels are high (usually above a level of 500).

When taking Allopurinol, you should take another tablet, such as colchicine (1 tablet twice a day), for about four weeks to prevent another attack.

Typically, a lifestyle change can reduce uric acid levels. Foods that increase purine and should be avoided include organ meats, sardines, anchovies, prawns, board beans, and foods containing high fructose corn sugar concentrations. In addition, yeast and yeast-based foods such as frozen and canned foods can cause problems. Also, sugar-sweetened beverages and alcoholic drinks increase acid levels. Generally, wine is better than hard liquor or beer.

On the contrary, foods that reduce uric acid include cherries, fruit and vegetables high in vitamin C, low-fat dairy products, and a vegetarian diet. Also, keeping well hydrated can prevent and treat an attack. Also, vitamin C supplementation of 1gm daily is associated with reduced uric acid levels.

Keeping well hydrated (8 drinks/day) will reduce the frequency of acute attacks.

Which lifestyle factor is the most important in preventing gout attacks?  

A recent study suggested weight loss is the most critical lifestyle factor in preventing future attacks. Moreover, modifications of other lifestyle factors, such as diet and alcohol, did not work unless excess weight was addressed. So, in other words, losing weight must be your priority if you want to prevent future gout attacks.

Glucosamine and gout: New study suggests that glucosamine supplements reduce gout attacks 

A recent study suggests that regular glucosamine supplements reduce gout attacks but only in women and not men. Researchers estimated that the attacks were reduced by 20% over the 12-year study. So, glucosamine may help reduce gout attacks in women.

Dos and don’ts for immediate gout pain relief

  • Treat symptoms aggressively as soon as you feel an attack coming. For example, early big toe or foot gout treatment will mean a less painful episode.
  • Avoid alcohol and keep well hydrated during an acute attack
  • Avoid binging on foods that are high in purines, but a little in your diet is ok
  • Repeated episodes of gout should be treated with a preventative medication such as Allopurinol, especially if your uric acid levels are above 500

Final word from Sportdoctorlondon to stop gout pain immediately

Acute gout can mimic other common MSK disorders. Also, we must know that acute gout doesn’t just affect your big toe. It can also affect your ankles, knees, and sometimes upper limbs. Early diagnosis and treatment are critical, including a cortisone shot for acute gout.

Other related foot and ankle conditions:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.