How is gout treated?
Gout can be treated and controlled. Symptoms are often dramatically improved within 24 hours after treatment has begun. Attacks can be prevented with appropriate therapy to lower the blood uric acid levels and change in lifestyle by addressing the modifiable risk factors.
The goals of treatment are to:
- Relieve pain and inflammation
- Prevent future gout attacks that could lead to permanent joint damage and tophi
- Prevent the development of tophi
- Prevent kidney damage from chronically elevated urate levels
The type of treatment prescribed will depend on several factors, including the person's age, type of medicines he or she is taking, kidney function, overall health, other comorbidities (other medical problems), and other medications they are taking.
Medication used for the treatment of gout include those that treat the gout attack and those that prevent future gout attacks by lowering the uric acid.
Medications that treat gout attacks
Anti-inflammatory drugs will reduce the pain and swelling of attacks. They are usually continued until the gout attack completely resolves. If side effects from the therapy occur, treatment may be changed to a different medication. Your healthcare provider will discuss the potential side effects with you. If you have kidney disease, heart failure, diabetes, ulcer disease, stomach or intestinal bleeding history, or other chronic conditions, the choice of therapy to treat the gout is affected.
Colchicine is usually the medication of choice for gout attacks, if patient does not have renal failure. Colchicine is sometimes used in low doses for a long period of time to reduce the risk of recurrent attacks of gout.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed to treat sudden gout attacks, if colchicine is not possible. NSAIDs usually reduce inflammation and pain within hours. However, these are contraindicated in certain patients who have impaired kidney function and the above mentioned health conditions.
Corticosteroids (also called steroids) may be prescribed for people who cannot take NSAIDs. Steroids also work by decreasing inflammation. Steroids can be injected into the affected joint or given as pills. Steroids have been used in certain severe gout attacks. These may also be contraindicated in certain cases.
Drugs that lower the uric acid levels
Some patients may need to take medicines that lower the level of uric acid in the blood. (Examples are allopurinol; febuxostat; rarely, probenecid; and, in severe cases, pegloticase). The most commonly used are allopurinol or febuxostat. These drugs are recommended for patients who have elevated uric acid and multiple attacks of gout or kidney stones due to uric acid. The goal of treatment is to reduce the uric acid level to less than 6 mg/dL.
The goal of lowering the blood uric acid is to slowly dissolve joint deposits of monosodium urate. Lowering the uric acid will not treat an acute attack but will, over time, prevent additional attacks from occurring. Sudden lowering of the uric acid level may cause an acute attack of gout. To prevent acute attacks in people who are taking uric acid-lowering drugs, colchicine, or an NSAID is temporarily prescribed. If an attack occurs while taking a medication to lower the uric acid, this medicine should NOT be stopped; stopping and starting the uric acid lowering medication may cause additional attacks.
Side effects of medicine
Not all patients will develop side effects from gout medications. How often any side effect occurs varies from patient to patient. The occurrence of side effects depends on the dose, type of medication, concurrent illnesses, or other medicines the patient may be taking. Before starting these medications, discuss with your doctor side effects and risks of these medications.
Some side effects are more serious than others. If any rash or itching develops while taking allopurinol, the medicine should be stopped immediately and your physician notified.
Can gout be treated through diet?
Dietary changes may play a significant role in controlling the uric acid levels. Limiting certain foods, such as fructose containing corn syrup, that cause an increased production of uric acid and reducing alcohol intake and decreasing the amount of meats/shellfish consumed and insuring adequate hydration have been shown to be helpful.