How Gout Is Treated

Gout is a form of arthritis caused by the buildup and crystallization of uric acid in a joint. Depending on the severity of an attack, treatment may involve over-the-counter (OTC) anti-inflammatory drugs to alleviate pain, as well as behavioral modifications (such as dietary and alcohol restrictions) to reduce the frequency of attacks. Chronic attacks may require prescription medications to help reduce uric acid levels in the blood.

Gout symptoms are caused by the excessive accumulation of uric acid, a condition known as hyperuricemia. Over time, the build-up can lead to the formation of uric acid crystals in and around a joint, triggering severe and protracted bouts of pain and inflammation.

As such, gout treatment would be focused on two things: the reduction of uric acid and the alleviation of gout pain.

Pain Management

There are a number of home treatments and lifestyle adjustments that can help.

Among the home treatment options:

• An ice pack or cold compress may provide ample relief of a mild attack. Be sure to wrap the ice pack in a thin towel and apply to the joint for only 15 to 20 minutes to prevent frostbite. You can do this several times a day.
• Rest the joint. Since the big toe is most often affected, elevate the foot to alleviate the swelling. Keep off your feet as much as possible, and, if you do need to move about, use a cane or crutches.

Dietary Interventions

An important cause of hyperuricemia is the foods we eat. Some contain high levels of an organic compound known as purine which, when broken down, is converted into uric acid. Others contain substances which impair the excretion of uric acid from the kidneys.

To this end, you would need to:

• 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.

Tylenol (acetaminophen) can be used in milder cases. While it doesn't have the anti-inflammatory properties of NSAIDs, it can help relieve pain.

Prescription drugs are often used if dietary and lifestyle interventions fail to provide relief and/or there is evidence of increasing joint damage. The prescription medications used to treat gout can be broadly broken down into two types: anti-inflammatory and uric acid-reducing.

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 alleviate acute symptoms. Among the options:

• Colchicine is an oral anti-inflammatory drug used to prevent and treat acute gout attacks. Colchicine can be used on its own but is more commonly prescribed alongside a uric acid-reducing drug like allopurinol. Side effects of colchicine include diarrhea, nausea, and abdominal cramps.
• Corticosteroids, taken either orally or by injection into a joint, offer short-term relief of acute symptoms. The drugs work by suppressing inflammation and tempering the immune system as a whole and 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 joint is involved or there is a need to reduce systemic (body-wide) effects of oral corticosteroids.

Uric Acid-Reducing Drugs

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

• Probenecid is an oral medication taken daily to help your kidneys eliminate uric acid. While effective in reducing uric acid levels and symptoms, it can often take time before the drug actually works. In some cases, gout attacks may increase during the first six to 12 months until the body adjusts to the treatment (an important reason why colchicene is often given at the same time). Side effects include kidney stones, nausea, rash, stomach upset, and headache. 
• Uloric (febuxostat) is an oral xanthine oxidase inhibitor (XOI) which reduces the body’s production of uric acid. Taken daily, Uloric can reduce the severity and frequency of attacks. Flare-ups are common when first starting treatment (see use of colchicene above). Even if they occur, you should continue to take the medication as prescribed.
  • Common side effects include nausea, joint pain, and muscle ache. 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).
• Zyloprim (allopurinol) is another oral XOI drug. As with Uloric, symptom flares can occur during early treatment. To prevent this, the drug is often prescribed at lower doses and then gradually increased. In addition, allopurinol is typically given with colchicene to reduce the short-term risk of 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.
• Zurampic (lesinurad) is an oral drug that boosts the effects of XOIs when an XOI alone is enough. It can be taken alongside Uloric or Zyloprim but must be used with caution as it can increase your cardiovascular risk. You would also need to stay well hydrated to prevent kidney stones.
  • Side effects may include a headache, mild fever, muscle aches, joint pain, and acid reflux. Lesinurad is also available with allopurinol in a co-formulated tablet called Duzallo.
• Krystexxa (pegloticase) is a newer biologic drug delivered by intravenous infusion into a vein and is only used when other treatments have failed. Krystexxa works by converting uric acid into a substance called allantoin, which is easily expelled from the body. 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.

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