Provoking factors for gout flares

Type of provocation	Specific examples
Physiologic alterations	Joint trauma Surgery Dehydration Starvation (eg, ketoacidosis)
Environmental alterations	High ambient temperature Extremes of humidity
Changes in medications affecting urate balance	Initiation and intensification of urate-lowering therapy^* Withdrawal of colchicine prophylaxis Vaccination Diuretics Low-dose aspirin
Intake of alcohol or other triggering foods	Alcohol (eg, beer, spirits, wine) Purine-rich foods (eg, red meat, shellfish)
Hospitalization^¶

To be used with UpToDate content on the clinical manifestations and diagnosis of gout.

* Although protective in the long term, initiating or intensifying urate-lowering therapy can precipitate gout flares, particularly in the early months of urate-lowering treatment. This risk can be reduced by using concurrent antiinflammatory prophylaxis. For more information, refer to UpToDate content on pharmacologic urate-lowering therapy in gout.

¶ Likely reflects a combination of physiologic alterations and medication changes.

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Provoking factors for gout flares