Treating gout requires a two-pronged approach that combines medications and lifestyle changes.
Treating an Acute Gout Attack
Here are the steps for getting the pain and swelling of a gout attack under control:
- Take an anti-inflammatory medication as soon as possible
- Ice and elevate the joint
- Drink plenty of fluids (no alcohol or sweet sodas)
- Call your doctor and make an appointment
- Relax; stress can aggravate gout.
- Ask friends and family to help you with daily tasks.
Despite the sudden onset and intense pain, gout attacks usually peak and resolve within a week or 10 days and then disappear completely. The first 36 hours are typically the worst. However, it’s important that once you have an attack, you begin working with your doctor to control uric acid levels and prevent future gout attacks.
Medications for Treating An Acute Gout Attack
Here are the medications used to treat an acute gout attack.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are frequently used to quickly relieve the pain and swelling of an acute gout episode and can shorten the attack, especially if taken in the first 24 hours.
Corticosteroids (such as prednisone) can be taken by mouth or injected into an inflamed joint to relieve the pain and swelling of an acute gout attack. They can also be injected systemically if the attack doesn’t respond to other medications or if many joints are affected. Injection of adrenocorticotropic hormone (ACTH), a synthetic drug that stimulates the body to produce corticosteroids naturally, can help treat a gout attack. Corticosteroids and ACTH usually start working within 24 hours after you begin taking them.
Colchicine is derived from a plant that has been used to treat gout for more than 2,000 years. It helps to relieve the pain and swelling of acute attacks. Colchicine’s most common side effects are diarrhea, nausea and abdominal cramp, but more severe side attacks can occur. Like all gout medications, it has been shown to be most effective if taken at the first signs of a gout attack.
Reducing Uric Acid Levels
Medications that lower uric acid are intended to prevent gout attacks and keep the condition from becoming chronic. Your doctor will wait until your most recent gout attack is over before starting these medications, because taking them during an attack can worsen or prolong it. Taking these medications can be challenging – as uric acid levels drop, crystals in your joints may shift, triggering another attack. However, sticking with your treatment plan is the best way to prevent future attacks. Your doctor may prescribe an anti-inflammatory medication such as a low, but regular dose of colchicine or an NSAID, along with one of the medications below for the first six weeks to 12 months to prevent attacks.
Allopurinol reduces the production of uric acid. It is often prescribed at a low daily dose at first, with the dose gradually increasing over time. Occasional side effects include skin rash and stomach upset. Stomach problems usually go away as your body adjusts to the drug. In rare cases, allopurinol can cause a severe allergic reaction.
Febuxostat may be an option if you develop side effects from allopurinol or have kidney disease. Like allopurinol, febuxostat decreases the amount of uric acid made in the body. It’s also started at a lower dose, which may be increased if uric acid levels remain high. Side effects can include nausea and joint or muscle pain.
Probenecid acts on the kidneys to help the body eliminate uric acid. The medication is taken daily and may be combined with antibiotics to boost effectiveness. Common side effects include kidney stones, nausea, skin rash, stomach upset and headaches.
Lesinurad is an oral drug that helps the body eliminate uric acid. It’s used with a xanthine oxidase inhibitor (XOI), such as allopurinol or febuxostat, to enhance the effects for people whose gout is not controlled by optimally-dosed XOIs alone. Common side effects include headache, flu symptoms, increased blood creatinine, gastroesophageal reflux disease (GERD), kidney-related side effects and kidney stones. Lesinurad may also increase the risk of cardiovascular events. Patients should stay well hydrated to avoid formation of kidney stones.
Pegloticase is used when standard medications are unable to lower the uric acid level, a condition known as refractory chronic gout. Pegloticase reduces uric acid quickly and to lower levels than other medications. The drug is administered every two weeks by intravenous (IV) infusion. Side effects can include infusion reactions, gout flares, nausea, bruising, sore throat, constipation, chest pain and vomiting.
One of the best ways to take care of your health if you have gout is to take a proactive role in your own treatment – a process called self-management.
Here are some lifestyles changes you can make to help you manage gout.