Gout treatments usually involve medications for both short-term and long-term management. A patient who is suffering from an acute gout attack should get an immediate treatment. In this case, medications can be used to relieve the pain and stop the acute joint inflammation caused by gouty arthritis. For the long-term management, medications are usually aimed to prevent the severity of gouty arthritis attacks in the future as well as to avoid the complications that may appear such as the development of tophi from urate crystal deposits, kidney stones, and joint destruction.
Gout medications to treat acute attacks may include:
- Pain relievers. Acetaminophen (Tylenol) or other more potent analgesics can be used to relieve the intense pain of gout.
- Anti-inflammatory agents. Nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids are used to reduce joint inflammation.
1) Nonsteroidal anti-inflammatory drugs (NSAIDs).
NSAIDs are commonly prescribed to treat acute gout attacks, since they can reduce the joint inflammation effectively. NSAIDS may be prescribed at maximum dosage in the beginning to stop an acute attack, and then reduced as symptoms subside. NSAIDs include over-the-counter options such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others), and more-powerful prescription NSAIDs such as indomethacin (Indocin). Side effects of NSAIDS include irritation of the gastrointestinal system, ulceration of the stomach and intestines, and even intestinal bleeding.
2) Colchicine. Colchicine is used to control acute attacks of gout and to prevent recurrent acute attacks. It can effectively relieve gout pain by reducing inflammation. Your doctor may prescribe colchicines, if you’re unable to take NSAIDs. Some patients taking colchicine may develop diarrhea or have a greatly reduced number of white blood cells.
3) Corticosteroids. Corticosteroids, like prednisone, are powerful anti-inflammatory agents to treat acute gout, and can be used for patients who cannot take NSAIDs or colchicine. They can be administered orally (in pill form) or injected directly into the inflamed joint. Long-term use of corticosteroids is not suggested due to its serious long-term side effects. The side effects of corticosteroids may include thinning bones, poor wound healing and a decreased ability to fight infection. Your doctor will help you reduce the risk of these side effects by trying to find the lowest dose that controls your symptoms and prescribe steroids for the shortest possible time.
Aspirin should be avoided since it can abruptly change uric acid levels and may make symptoms worse.
Medications that manage the underlying causes of hyperuricemia and gout (such as the elevated levels of uric acid), and reduce the risk of gout-related complications (such as the formation of tophi from urate crystal deposits) include:
1) Uric acid-lowering medications.
Xanthine oxidase inhibitors, including allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric), control the levels of uric acid in your body. Allopurinol lowers the blood uric acid level by inhibiting uric acid production. It blocks the metabolic conversion from purines into uric acid. This medication should be used with caution in patients with poor kidney function, as it may also develop side effects, including rash and liver damage.
Febuxostat was approved by the U.S. Food and Drug Administration (FDA) for the chronic management of hyperuricemia from gout in 2009. Febuxostat is considered effective in preventing acute gout attacks and in shrinking tophi deposits of uric acid in the tissues such as the fingers, elbows, and ears. The side effects of febuxostat include rash, nausea and reduced liver function. While taking febuxostat, the patient’s uric acid levels and liver function are monitored regularly.
These medications are used to prevent gout attacks, not to treat them once they occur. Even xanthine oxidase inhibitors may trigger a new, acute attack if taken before a recent attack has totally resolved. But if patients are already taking these medications, they are maintained at the same doses during the acute attacks. In some patients, increasing the dose of uric-acid-lowering medications can precipitate gout attacks..
2) Uricosuric agents.
These drugs (including probenecid, and sulfinpyrazone) are prescribed for chronic gout and gouty arthritis. They lower uric acid levels in the blood by improving uric acid excretion in the urine. Uricosuric agents are never started during a gout attack. They can be used to prevent gout attacks, but not to treat them once they occur. The side effects of probenecid may include a rash, stomach pain and kidney stones. Patients with a history of kidney stones might consider to avoid these drugs. Taking these medications with plenty of fluid can promote the rapid passage of uric acid out of the urinary system in order to prevent kidney stone formation.
All of the aforementioned medications may be used in combination, to control symptoms, prevent future attacks, and maintain healthy uric acid levels. But here is a thing you must always keep in mind: consult a doctor before taking any of those medications. Seek medical care immediately if you have a fever and a joint is hot and inflamed, which can be a sign of infection.
Other gout treatments that can be applied involve lifestyle changes, like limiting or avoiding the consumption of high-purine foods/ beverages, moderate exercises, losing weight, and avoiding medications that contribute to hyperuricemia, including diuretics.
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