Gout

Gout causes sudden and severe joint pain that usually starts in the big toe. But other joints and areas around the joints can be affected, such as the ankle, knee and foot. It’s the most common type of inflammatory arthritis. Men are three times more likely than women to develop gout. It tends to affect men after age 40 and women after menopause. Gout symptoms can be confused with another type of arthritis called calcium pyrophosphate deposition (CPPD). However, the crystals that irritate the joint in this condition are calcium phosphate crystals, not uric acid. 

A medical history, physical examination and blood tests are used to diagnose gout. The doctor needs to know:

• How severe the pain is.
• How quickly it started.
• How long it has been happening.
• Which joints are affected. 

The doctor will need to rule out other reasons for the joint pain and inflammation such as an infection, injury or other type of arthritis. The doctor may also take an X-ray, do an ultrasound or order a magnetic resonance imaging scan (MRI) to examine soft tissue and bone. The doctor might also remove fluid from the painful joint and examine it under a microscope for uric acid crystals or bacteria indicating an infection.

Treating an Acute Gout Attack

Here are the steps for getting the pain and swelling of a gout attack under control as quickly as possible:

• Call your doctor and make an appointment.
• Ice and elevate the joint.
• Drink plenty of fluids (no alcohol or sweet sodas).
• Reduce stress, which can worsen the attack.
• Ask friends and family to help you with daily tasks to ease stress on joints.

Medications for Acute Gout Attack 

Here are the medications that your doctor may prescribe at the first sign of an attack:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to relieve the pain and swelling of an acute gout episode. They  can shorten the attack, especially if taken in the first 24 hours.
• Corticosteroids – These drugs can be taken by mouth or injected into an inflamed joint to quickly relieve the pain and swelling of an acute attack. Corticosteroids usually start working within 24 hours after they are taken. 
• Colchicine - This anti-inflammatory medicine works best if taken within the first 24 hours of a gout attack.

Reducing Uric Acid Levels

The doctor will wait until the acute attack ends before starting medications to reduce your uric acid levels. Sometimes, these drugs can cause an attack at first because uric acid levels drop and crystals in the joints shift. But sticking with the treatment plan is the best way to prevent future attacks. The doctor may prescribe a low, but regular dose of colchicine along with one of the medications below to prevent attacks. 

Medications for Reducing Uric Acid Levels

The doctor will wait until the acute attack ends before starting medications to reduce your uric acid levels. Sometimes, these drugs can cause an attack at first because uric acid levels drop and crystals in the joints shift. But sticking with the treatment plan is the best way to prevent future attacks. The doctor may prescribe a low, but regular dose of colchicine along with one of the medications below to prevent attacks.

• Allopurinol (Zyloprim) reduces how much uric acid the body produces. It is often prescribed at a low daily dose at first, with the which is increased slowly over time if uric acid levels remain high. This drug comes in pill form.
• Febuxostat (Uloric) reduces how much uric acid the body produces. Like allopurinol, it’s started at a lower dose, which may be increased if uric acid levels remain high. This drug comes in pill form.
• Probenecid acts on the kidneys to help the body eliminate uric acid. The medication is taken twice daily and may be combined with febuxostat to boost effectiveness. This drug comes in pill form.
• Pegloticase (Krystexxa) is used when standard medications are unable to lower the uric acid level. It reduces uric acid quickly and to lower levels than other medications. The drug is administered every two weeks by intravenous (IV) infusion.

All drugs come with risks. To learn more about these drugs and their side effects, visit  the drug guide.

Diet

Drink lots of water and avoid alcohol, beer, high-purine foods and sugary drinks to help reduce uric acid buildup.

Adopting healthy lifestyle habits is a key part of an effective gout treatment plan. Eat a healthy diet, avoid or limit high-purine foods, do regular exercise and lose excess weight to lower your risk of repeated gout attacks.