Through proper monitoring and treatment, gout patients can avoid painful attacks and prevent long-term joint damage and disability.
If you are diagnosed with gout, it is important to take your medications as directed, and to get your uric acid levels checked regularly – even if you have not experienced gout symptoms for years. Stopping your medications and poor lifestyle and diet choices can cause gout flares to return with a vengeance.
For a first-time flare, going to an emergency room or urgent care clinic may be the best option, unless an office visit with your own clinician is readily available. Seeking treatment when the symptoms first occur will help to resolve pain faster.
Medications to Lower Uric Acid Levels and Prevent Future Attacks
- Allopurinol – Taken orally, allopurinol decreases the body’s production of uric acid. This medication is the most commonly used urate-lowering drug, and the usual first choice for urate-lowering therapy. It is also recommended for patients with a history of kidney stones or tophi. Dose escalation is recommended. Examples: Lopurin, Zyloprim
- Lesinurad – Taken orally, this medication should be taken in combination with another drug, such as Allopurinol or Uloric. It treats high uric acid level in people with gout who are already taking a urate-lowering therapy. Example: Zurampic
- Lesinurad + Allopurinol Fixed-Dose Combination – Taken orally, this medication treats high uric acid level in people with gout who have not achieved target serum uric acid levels on allopurinol alone. Example: Duzallo
- Febuxostat – This medication is taken orally and decreases the body’s production of uric acid. It can be taken by people with mild to moderate kidney or liver disease. Example: Uloric
- Pegloticase – Pegloticase is an intravenous infusion of an enzyme used to dissolve gout crystals in advanced and difficult to control gout. Example: Krystexxa
- Probenecid – Taken orally, this medication increases the kidneys’ ability to remove uric acid from the body. It is not recommended if there is a history of kidney stones or renal impairment. Examples: Benemid, Probalan
Treatments to Relieve Pain and Reduce Swelling in Acute Attacks
- Colchicine – Taken orally, colchicine may be the most effective when taken within the first 12 hours of an acute flare; however, other medications may be needed for treating pain. A common dosing schedule is to take two 1.2 mg tablets together at once, then a third tablet one hour later, followed by one tablet 2-3 times per day over the next week. Occasionally, patients may have side effects such as nausea, vomiting, abdominal cramps or diarrhea. Example: Colcrys
- Glucocorticosteroids (Cortisone) – Taken orally or injected, cortisone quickly suppresses the inflammation of an acute attack. Examples: Medrol, Deltasone (prednisone), Kenalog
- Nonsteroidal anti-inflammatory drugs (NSAIDS) – Taken orally, NSAIDS reduce the inflammation caused by gout. Examples: Aleve, Advil, Celebrex, Indocin, Motrin, Naprosyn
Other Tips for Decreasing the Pain of an Acute Attack
Beyond medications, certain steps can be taken to help relieve pain caused by an acute gout attack.
- Rest the affected joint for 24 hours after the initial attack, or until the pain eases.
- Elevate painful joints.
- Apply cold packs wrapped in towels to the affected joints for 20-30 minutes, several times a day.
- Do not take high doses of aspirin, which may abruptly change uric acid levels and make symptoms worse.
- Avoid alcohol, high purine foods, and high-fructose foods and beverages. Learn more about a healthy gout diet.
- Ask if you have any questions about managing your gout or pain levels. Do not stop or start medications before consulting with your prescriber first.