Treatment of Gout

Managing Symptoms and the Underlying Triggers

doctor checking woman's weight
Science Photo Library - IAN HOOTON./Getty Images

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.

Home Remedies and Lifestyle

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

Pain Management

A gout attack will usually last from three to 10 days. The pain during the early part of the attack (typically the first 36 hours) will typically be the worst.

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 time a day.

     

    • Rest the joint. Since the big toe is most often affected, elevate the foot to alleviate the direct pressure. Keep off your feet for as much as possible, and, if you do need to move about, use a cane.

    Dietary Interventions

    One of the primary causes 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.

    While there is no evidence that dietary interventions can reduce either the severity or duration of an attack, you should make an effort to avoid exacerbating your condition.

    To this end, you would need to:

    • Stop drinking alcohol of any sort, especially beer.
    • Avoid high-purine foods.
    • Avoid fructose-sweetened drinks which impair uric acid excretion.
    • Drink plenty of water to dilute the uric acid concentration in your blood.

    Over-the-Counter (OTC) Medications

    OTC medications are commonly used during a mild to moderate attack to alleviate joint pain and inflammation. Among the options:

      Prescriptions

      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 treat chronic gout. The drug works by blocking the inflammatory enzymes triggered by the formation of uric acid crystals. Colchicine can be used on its own but is more commonly prescribed alongside a uric acid-reducing drug like probenecid. Side effects include diarrhea, nausea, and abdominal cramps.
      • Corticosteroids, taken either orally or by injection into a joint, offer short-term relief of acute symptoms. The drug works by tempering the immune system as a whole and, as such, cannot be used as a form of ongoing therapy. Oral treatment (usually with the drug prednisone) may be prescribed over five days. Corticosteroid injections are most commonly use when there is evidence of arthritis and joint erosion. Overuse can lead to weight gain, easy bruising, osteoporosis, eye problems, high blood pressure, and an increased risk of infection.
      • Qutenza (capsaicin) 8.0 percent patch may provide moderate pain relief during an acute attack. Side effects include application site reactions, including burning, itchiness, redness, swelling, and mild rash.

      Uric Acid-Reducing Drugs

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

      There are currently five drugs approved by the U.S. Food and Drug Administration for these purposes:

      • Probenecid is an oral medication taken daily to help your kidneys eliminate uric acid. While effective in reducing symptoms, it can often take time before the drug actually works. In some cases, bout attacks may increase during the first six to 12 months until the body adjusts to the treatment.

        Side effects include kidney stones, nausea, rash, stomach upset, and headache. A co-formulated tablet called ColBenemid is also available which combines probenecid with colchicine.

       

      • 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. Even if they occur, you must 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 dosages and then gradually increased.

        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 (lesinuradis 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. In rare cases, a serious allergic reaction 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.

      Sources:

      Anaud, P. and Bley, K. "Topical capsaicin for pain management: therapeutic potential and mechanisms of action of the new high-concentration capsaicin 8% patch." Br J Anaesth. 2011; 107(4):490-502. DOI: 10.1093/bja/aer260.

      Hanier, B; Matheson, E. and Wilke, T. "Diagnosis, Treatment, and Prevention of Gout."  Am Fam Physician. 2014; 90(12):831-836.

      Richette, P. and Barden, T. "Gout." Lancet. 2010; 375(9711):318-28. DOI: 10.1016/S0140-6736(09)60883-7.