What triggers gout flares?

Updated: Jan 26, 2021
  • Author: Bruce M Rothschild, MD; Chief Editor: Herbert S Diamond, MD  more...
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Individual gout flares are often triggered by acute increases or decreases in urate levels that may lead to the production, exposure, or shedding of crystals. Changes in urate levels can result from acute alcohol ingestion, acute overindulgence in foods high in purines, rapid weight loss, dehydration, or trauma.

Similarly, flares can be precipitated by additions of or changes in dosage of medications that raise or lower uric acid levels. Medications that increase uric acid levels via effects on renal tubular transport include the following [35, 36] :

  • Loop and thiazide diuretics
  • Niacin
  • Low-dose aspirin
  • Cyclosporine [37]
  • Pembrolizumab [38]

​Agents that lower levels of uric acid include the following:

  • Radiocontrast dyes
  • Xanthine oxidase inhibitors (eg, allopurinol, febuxostat)
  • Uricosurics (eg, probenecid).

Vaccination has been associated with increased risk of gout flares. Elevated risk has been reportd with recombinant zoster vaccine and other vaccine, but not influenza vaccine. [39, 40]

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