The pain of a gout flare can settle while monosodium urate crystals remain in and around the joint. Long-term gout treatment is about changing the urate environment so crystal deposits can gradually reduce.
Pain gone does not necessarily mean crystals gone
A flare is an inflammatory reaction around urate crystals. The inflammation can settle much faster than the underlying crystal burden changes.
Can deposits shrink?
Yes. Sustained urate lowering can reduce crystal burden and shrink tophi over time. NICE recommends a treat-to-target approach to urate-lowering therapy, usually aiming below 360 µmol/L, and considering below 300 µmol/L for people with tophi, chronic gouty arthritis or continuing frequent flares despite being below 360 µmol/L.
Will the joint look completely normal again?
It depends what is causing the enlargement. Urate deposits and inflammation can reduce, but established cartilage loss, bone erosion or other structural joint change may not fully reverse.
How can clinicians tell what is there?
Clinical examination and serum urate history are useful. Imaging such as ultrasound can sometimes help when the diagnosis or extent of crystal deposition is uncertain.
NICE: Gout — diagnosis and management →
General information only; not a diagnosis or instruction to start, stop or change treatment.