How Gout Is Treated

Gout is a form of arthritis caused by the buildup and crystallization of uric acid in a joint. Depending on how severe a gout flare is, treatment may involve over-the-counter (OTC) anti-inflammatory drugs to relieve pain.

Lifestyle changes, such as dietary and alcohol restrictions, may reduce the frequency of attacks. Chronic flares may require prescription medications to help reduce uric acid levels in the blood.

This article covers the various home remedies, lifestyle changes, prescription drugs, and other therapies that are available to treat gout symptoms.

Home Remedies and Lifestyle

Gout symptoms are caused by the excessive buildup of uric acid, a condition known as hyperuricemia. Over time, the buildup can cause uric acid crystals to form in and around a joint, triggering severe flares of pain and inflammation.

A single flare can last anywhere from two to four weeks. Treatment is focused on two things: reducing uric acid levels to avoid gout flares, and relieving gout pain when flares happen.

Pain Management

For many people, pain in the beginning of a gout attack (typically the first 24 hours) tends to be the worst. There are a number of home treatments and lifestyle adjustments that can help with mild pain.

Tactics you can try to relieve gout pain include:

Apply a cold compress: Place a cold compress or ice pack on your affected joint(s) to help relieve pain during a mild gout flare. Wrap the ice pack in a thin towel, taking care to never apply ice directly to your skin. Use the cold pack for 15 to 20 minutes at a time, several times per day.

Rest the joint: The big toe joint is most often affected by gout. When that is the case, you can elevate your foot to help reduce swelling. Keep off your feet as much as possible, and, if you need to move about, consider using a cane or crutches.

OTC pain relievers: For milder gout pain, an OTC pain reliever, such as Tylenol (acetaminophen) can ease some pain. Keep in mind that people with kidney disease should avoid taking NSAIDS, including Advil (ibuprofen) and Bayer (aspirin). Kidney disease and gout commonly occur together. That said, if you do not have kidney disease, it is okay to take an NSAID for your pain.

Weight loss: Being obese increases your risk of developing gout. The extra weight also places more stress on affected joints and increases pain. If you are overweight or obese, losing weight will help reduce uric acid levels to prevent flares. A lower weight will also take pressure off your joints, reducing pain and inflammation.

Dietary Interventions

Hyperuricemia can be linked to the foods we eat. Some foods contain high levels of an organic compound known as purine which, when broken down, is converted into uric acid. Other foods contain substances that make it harder for your kidneys to eliminate uric acid efficiently.

Other changes you can make to help avoid hyperuricemia include:

• Avoid or limit drinking alcohol of any sort, especially beer.
• Avoid or limit high-purine foods.
• Avoid or limit fructose-sweetened drinks, which impair uric acid excretion.

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Prescriptions

For some people, dietary and lifestyle changes may provide adequate relief from gout pain. If making these changes doesn't help or if there is evidence that joint damage is getting worse, prescription drugs may be needed.

The prescription medications used to treat gout can be broadly broken down into two types: anti-inflammatory drugs and drugs that reduce uric acid.

Anti-Inflammatory Drugs

The prescription anti-inflammatory drugs commonly used to treat gout are either prescribed on an ongoing basis or used when needed to ease acute symptoms.

Among the options:

Colchicine: This oral anti-inflammatory drug is used to prevent and treat acute gout attacks. Colchicine can be used on its own, but it is more commonly prescribed alongside a uric acid-reducing drug like allopurinol. Side effects of colchicine include diarrhea, nausea, and abdominal cramps.

Corticosteroids: When taken orally or by injection into a joint, corticosteroids offer short-term relief from acute symptoms. The drugs work by suppressing inflammation and tempering the immune system as a whole. They are generally not used as a form of ongoing therapy.

Oral treatment (usually with the drug prednisone) may be prescribed over several days to weeks. Corticosteroid injections are most commonly used when only one or two joints are involved, or there is a need to avoid the systemic (body-wide) effects that oral corticosteroids cause.

Uric Acid-Reducing Drugs

If other interventions fail to reduce uric acid levels, healthcare providers will often turn to medications that can either decrease uric acid production, or increase uric acid excretion from the body.

The 2020 gout treatment guidance from the American College of Rheumatology recommends urate-lowering therapies as the first-line option in most patients who have gout.

Commonly prescribed urate-lowering therapies include:

Zyloprim (allopurinol): This drug is a xanthine oxidase inhibitor (XOI), so it reduces the body’s uric acid production. The medication is taken once daily. It is typically recommended as a first-line treatment for most patients with gout.

Symptom flares can occur during early treatment, so the drug is often prescribed at lower doses and then gradually increased. In addition, allopurinol is typically given with colchicine to reduce the short-term risk of a gout attack.

Allopurinol side effects include stomach upset and rare, but often serious, skin reactions. Ask your prescribing provider if you are at risk for severe allopurinol reactions. Side effects are far less extensive than other uric acid-reducing drugs and may include rash and stomach upset. Stomach problems usually go away as your body adjusts to the medication.

Uloric (febuxostat): This is another XOI treatment option that reduces the body’s uric acid production. It is primarily prescribed to people who cannot tolerate allopurinol.

Taken daily, Uloric can reduce the severity and frequency of attacks. Flare-ups are common when first starting treatment. Even if they occur, you should continue to take the medication as prescribed.

Common side effects include nausea, joint pain, and muscle aches. Do not take Uloric if you are using azathioprine (used to treat rheumatoid arthritis), or mercaptopurine (used to treat lymphoma, Crohn's disease, or ulcerative colitis).

Krystexxa (pegloticase): This is a newer biologic drug delivered by intravenous (IV) infusion into a vein. It is only used when other treatments have failed.

Krystexxa works by converting uric acid into a substance called allantoin, which your body can easily eliminate. It is administered every two weeks at a clinic and is therefore reserved for only the most severe cases.

Common side effects include short-term flare-ups, nausea, bruising, sore throat, constipation, chest pain, and vomiting. After repeated doses, serious allergic reactions may occur.

IL-1 inhibitors: This class of drugs is recommended for people in whom anti-inflammatory drugs are ineffective, poorly tolerated, or contraindicated. IL-1 inhibitors include the medications anakinra and canakinumab.

Other complementary drugs may be used in gout treatment, including Cozaar (losartan), an antihypertensive (blood pressure-lowering) drug, and Tricor (fenofibrate), a lipid-lowering drug. Both can aid in reducing uric acid levels in the blood.

Summary

Treatment for gout involves managing pain and reducing uric acid levels in the blood to prevent flares. During a flare, OTC medications like Tylenol can reduce pain. NSAID pain relievers like Advil can be used if you don't have chronic kidney disease.

In people who are obese or overweight, losing weight can reduce uric acid levels and ease pain by taking pressure off joints. Prescription drugs, such as corticosteroids, may be indicated when lifestyle changes and OTC medications fail to achieve positive results.

A Word From Verywell

Gout is not directly fatal, but it can lead to dangerous complications if left untreated, including severe joint damage and deformity and kidney disease. Given how painful gout flares can be, it makes sense to focus on pain relief as the flare occurs. That said, when you are in remission, your treatment shouldn't stop. Remission is an important time for you to switch your focus onto making healthy lifestyle changes that reduce the frequency of flares and prevent complications down the line.