Gout in the knee is treated with a combination of anti-inflammatory medication to stop the immediate flare and, for recurring attacks, long-term therapy to lower uric acid levels and prevent future episodes. Most flares respond well to treatment started within the first 24 hours, with significant pain relief within a few days. Left untreated, a flare can drag on for days to weeks and, over time, cause permanent joint damage.
Treating an Acute Knee Gout Flare
The priority during a flare is reducing inflammation fast. Three main medication options work as first-line treatment: corticosteroids (like prednisone), NSAIDs (like naproxen or ibuprofen), and colchicine. Corticosteroids are increasingly favored by expert guidelines as the go-to choice, particularly for people who can’t tolerate NSAIDs due to kidney problems, stomach ulcers, or heart disease.
In a trial comparing naproxen with low-dose colchicine in nearly 400 people with gout flares, pain relief at seven days was equivalent, but naproxen caused fewer side effects like diarrhea and headaches. Your doctor will choose based on your other health conditions, medications, and how quickly you can start treatment. The earlier you begin, the faster the flare resolves.
Because the knee is a large, accessible joint, a corticosteroid injection directly into the knee is another option. This can rapidly reduce swelling when only one or two joints are involved. Despite being widely used in clinical practice, there are no randomized controlled trials evaluating this approach specifically for gout, so the evidence supporting it comes from clinical experience rather than formal studies.
What to Do at Home During a Flare
While medication does the heavy lifting, a few things can meaningfully ease your discomfort. Apply an ice pack wrapped in a cloth to your knee for 20 to 30 minutes at a time, several times a day. A bag of frozen peas works fine. Ice helps blunt both the pain and the swelling.
Keep weight off the knee as much as possible. Elevate your leg when sitting or lying down. Avoid alcohol during a flare, since it interferes with your kidneys’ ability to clear uric acid, effectively pulling it back into your bloodstream. Stay well hydrated with water instead.
How Long a Flare Lasts
With treatment, the worst pain typically peaks within the first day or two and then starts to subside. You can expect severe pain to last up to a few days, tapering to moderate discomfort that may linger for days or even a couple of weeks. Without treatment, flares follow the same general arc but take longer. They eventually resolve on their own, but the prolonged inflammation is both miserable and harmful to the joint.
Preventing Future Attacks
If you’ve had two or more gout flares per year, have visible lumps called tophi under your skin, or show signs of joint damage on imaging, current American College of Rheumatology guidelines strongly recommend starting urate-lowering therapy. This is the cornerstone of long-term gout management. The goal is to bring your serum uric acid below 6.0 mg/dL, the threshold at which existing uric acid crystals begin to dissolve and new ones stop forming.
For a first gout flare with no complications, guidelines recommend against jumping straight to long-term therapy. The exception is if you also have moderate-to-severe kidney disease, a uric acid level above 9 mg/dL, or kidney stones. In those cases, starting sooner makes sense.
Urate-lowering medications work by either reducing how much uric acid your body produces or helping your kidneys excrete more of it. Treatment is gradual: doses are increased slowly over weeks to months, with the target confirmed by blood tests. It’s common for flares to temporarily increase when starting these medications, which is why low-dose colchicine is often prescribed alongside them as a preventive buffer during the first several months.
Dietary Changes That Help
Diet alone rarely controls gout, but it makes a real difference alongside medication. The biggest culprits are foods high in purines (which break down into uric acid) and anything that slows your kidneys’ ability to clear it. The top triggers to limit or avoid:
- Organ meats like liver, kidney, and sweetbreads
- Certain seafood including herring, mussels, scallops, tuna, trout, and haddock
- Red meat including beef, lamb, pork, and bacon
- Sugary drinks and foods with high-fructose corn syrup, since fructose breaks down directly into uric acid
- Alcohol, especially beer, which is both high in purines and blocks uric acid excretion
- Turkey, particularly processed deli turkey
- Gravy, meat sauces, and yeast extract
On the other side, a few foods show genuine promise. Skim milk appears to speed up uric acid excretion through urine and may dampen the inflammatory response to crystals in joints. Cherries and cherry juice have known anti-inflammatory properties and early research suggests they help reduce uric acid levels. Coffee, despite being acidic, contains a different type of acid than uric acid and is associated with lower gout risk.
What Happens if Gout Goes Untreated
Gout that goes unmanaged for years can lead to tophi: lumps of uric acid crystals that form in and around joints, including in cartilage. Tophi erode the tissues they grow in, including bone. This damage is often irreversible. A tophus can displace or obstruct a joint, preventing it from moving properly. In severe cases, the knee joint becomes so damaged that joint replacement surgery is the only option.
There’s also a safety concern that’s easy to overlook. A hot, swollen knee from gout can look identical to a joint infection (septic arthritis), and the two conditions can even occur at the same time. People with gout are actually at higher risk for infected joints. The only reliable way to tell them apart is by testing the joint fluid for bacteria. If your knee flare comes with a fever, feels different from past episodes, or doesn’t respond to your usual gout treatment, getting the joint fluid tested is important because a missed joint infection can cause rapid, permanent damage.
Confirming the Diagnosis
If you’ve never had your knee gout formally confirmed, the gold standard is synovial fluid analysis. A needle is used to draw a small amount of fluid from the knee, and a lab technician examines it under a polarizing microscope. Uric acid crystals have a distinctive appearance: bright, needle-shaped, and they turn yellow when oriented in a specific direction under polarized light. This test is definitive. It also rules out infection and other crystal-related conditions that can mimic gout, like pseudogout, which is caused by a different type of crystal entirely.