Treatment of Gout
It is important to talk to your doctor about the symptoms of gout and their cause. Understanding the mechanisms responsible for gout is the first step in good management of this disease.
Learn more about what causes gout, including how uric acid crystals cause acute attacks of gout.
Treatment of gout, also known as gouty arthritis, should include both pain management and uric acid-lowering medications. It is important to distinguish these two classes of drugs for treating gout.
How to Relieve Gout Pain
As the most common form of inflammatory arthritis, gout flares are typically accompanied by severe pain at the site of the affected joint where gout symptoms cause it to be red, swollen and very tender to the touch. During these flares, the anti-inflammatory medications used to lessen the pain and swelling are most effective if started as soon as possible after the onset of the flare or attack.
gout flares usually last three to seven days.
When tolerable, use cool/ice compresses to help with pain and inflammation in addition to the medication.
Anti-Inflammatory Therapy
The medications commonly used to lessen the pain and suffering of a gout flare are: colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.
Colchicine is a medication that has literally been around for centuries for the treatment of gout. It can be used to prevent flares from occurring or used to stop a flare after it has started.
Similarly, NSAIDs (ibuprofen, Motrin, naproxen) can be used to control the frequency of gout flares or, in higher doses, to treat the pain and suffering of an active flare.
Corticosteroids in the form of prednisone or Medrol are occasionally used to treat gout attacks when patients don’t tolerate colchicine or NSAIDs.
All three of these anti-inflammatory medications are most effective when started within the first six to 12 hours of a gout flare. None of these medications have any beneficial effects on lowering uric acid in the blood, which is the primary goal in the treatment of gout.
A plant and grain-based diet is good for overall health.
It’s also good for a healthy cardiovascular and gastrointestinal system. It works to help reduce gout flares, too! Keep these foods in your diet: low-fat or non-fat dairy products; fresh vegetables and fresh fruit; and nuts and grains.
What to Do During a Gout Attack
Most people with gout don’t need to be told to keep the affected joint as still as possible and not to do anything that requires movement or weight-bearing on that joint. Another helpful approach endorsed by many gout sufferers is the use of ice (wrapped in a cloth) over the inflamed joint.
Treat Gout with Medication
What is a Xanthine Oxidase Inhibitor?
Once you have been diagnosed with gout, you will likely be given urate-lowering medications to treat your disease and prevent future attacks. The two most commonly used forms of this class are allopurinol (known as Lopruin® or Zyloprim®) and febuxostat (known as Uloric®). These are both xanthine oxidase inhibitors, which lowering uric acid levels by blocking the conversion of purines into uric acid. This prevents the formation of uric acid crystals and, over time, will prevent flares.
Without these medications, it is unlikely that your blood uric acid level can be lowered to the target of 6.0 mg/dL or less and gouty arthritis will continue to be a problem.
Other Uric Acid-lowering Medications
The other forms of uric acid-lowering medications are probenecid (Benemid or Probalan) and pegloticase (Krystexxa). Probenecid is a medication that helps the kidneys remove more uric acid from the blood. This drug is frequently used in combination with one of the xanthine oxidase inhibitors in order to help reduce the blood uric acid level even further.
Pegloticase is a medication used to treat advanced gout or gout that hasn’t responded well to other therapies. Its mechanism of action is very different than either the xanthine oxidase inhibitors or probenecid. Pegloticase works by breaking down already formed uric acid into a compound that is much easier for the body to eliminate. It is given as an intravenous infusion every two weeks and a complete course of therapy is usually six to 12 months.
Like many other medications for blood pressure or high cholesterol, uric acid-lowering medicines—also known as urate-lowering medicines—are meant to be taken daily for life in order to lower uric acid levels and manage them in order to prevent gout attacks. They should not be discontinued—even when a gout attack is over—to continue helping your body to remove uric acid from your blood.
Though it seems like your health is back to normal once the gout attack ends, the underlying cause of the disease—an elevated serum uric acid level—needs to be controlled. Medications for pain and inflammation can be stopped, as directed after pain and inflammation subside, but urate-lowering therapy must be continued for life. Otherwise, more gout attacks could occur while your serum uric acid level is still out of control.
Lifelong Gout Management
Like many other medications used for treating chronic conditions such as high blood pressure or high cholesterol, uric acid-lowering medicines are meant to be taken daily for life in order to lower uric acid levels and prevent the progression of the disease. They should not be discontinued, even if a gout flare occurs.
While gout is a lifelong condition, it can be managed – or even completely controlled – by sticking with a proper treatment plan. The combination of the right medications and lifestyle changes for lowering uric acid will stop the build-up of more uric acid crystals, which cause the excruciating pain of gout attacks and the crippling arthritis associated with uncontrolled gout over years and decades.
How Diet Affects Gout Treatment
If you’re not already seeing your doctor regularly for your gout, it is important to schedule check-ups every six months and get your uric acid levels checked at each visit. A healthy uric acid level is 6.0 mg/dL—so your doctor should be working to get your number within this range or lower.
Medication adherence is essential, but diet modification and exercise are still recommended.
Your doctor may ask you to keep a journal, to see whether anything—food or lifestyle activity—is triggering gout flares. This needs to be an honest journal that includes five pieces of critical information:
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Timing and duration of the gout flare
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The joint that is affected
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Whether medication is taken daily
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Foods and beverages consumed each day
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Type and length of exercise regimen
Looking For Triggers
Many gout sufferers recognize that the consumption of certain foods or drinks can trigger a gout attack in the following eight to 12 hours. These items frequently include one or more of the following:
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Red meat
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Shellfish
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High fructose corn syrup (often in drinks and in processed foods)
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Alcohol (especially beer)
These foods and beverages do not cause a person to have gout, but if consumed in excess, can certainly lead to gout flares. Having gout does not mean that you need to totally avoid these foods, but using them in moderation is important.
Find out more on the Diet & Lifestyle page.
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