Gout Treatments and Medications

What is gout?

Gout, also known as gouty arthritis, is a painful form of arthritis that can occur in people with high levels of uric acid in their blood. This acid, also known as sodium urate monohydrate, can crystallize and deposit in the joints, causing sudden pain and tenderness typically around the big toe and other joints. Gout is not to be confused with pseudogout, or calcium pyrophosphate deposition disease (CPDD), a condition where calcium crystals deposit in the joints.

How is gout diagnosed?

Gout is caused by hyperuricemia, a condition where there are elevated levels of uric acid in the body. Your risk of gout increases if you have a family history of gout, you’re overweight, you’re recovering from surgery, or you’re on medications used to treat hypertension.

If you think you might be at risk, schedule an appointment with your primary care doctor right away, as he or she can help diagnose the issue. Here’s what you can expect at your appointment:

• Your doctor will examine the affected joint and may recommend a blood test (also called a serum uric acid measurement) to measure the levels of uric acid in your blood.
• Your doctor will ask about your symptoms, current medications, diet, and severity of the attack to help rule out an injury or an underlying condition, such as arthritis.
• Your doctor may take an X-ray, ultrasound, dual energy CT scan, or MRI to detect urate crystals, or tophi, in the affected joint. Tophi often look like swollen growths just under the surface of the skin.
• Your doctor may perform a joint aspiration and remove some joint fluid and examine it for uric acid crystals—this is the surest way to diagnose your gout.

Questions your doctor may ask you

• Where is the pain? Are other joints involved?
• Have you noticed pain or swelling in your big toe?
• How long does the pain and swelling last?
• Have you taken any medications to relieve the pain? If so, which ones?
• Do you frequently take aspirin?
• Are you on high blood pressure medication?
• Does your diet consist of red meats, shellfish, alcohol, and sugary beverages?
• Have you tried losing weight recently?

Questions you should ask your doctor

If you do have gout, it’s important to understand its causes and course of action over the short- and long-term. Here are some of the more important questions to ask your doctor about the disease:

• What causes gout?
• What is a tophus?
• What’s the difference between rheumatoid arthritis and gout?
• What is uric acid?
• Is gout hereditary?
• How do I keep the issue under control?
• Is there a different plan of treatment for short-term gout vs. long-term gout?
• How should I change my diet?
• What types of medication will I have to take?
• Are there alternative treatments for gout?
• Is it likely gout will damage some of my joints?

Though primary care physicians can usually treat gout, they may refer you to a rheumatologist if your case is more severe or involves joint damage.

Gout treatment options

After you receive your diagnosis, your doctor should provide you with a variety of options to treat your gout. In most cases, treatment will consist of self-care, uric acid reducers, and NSAIDs to relieve pain and inflammation. Those with more severe bouts of gout may need to make behavioral changes and alter their diet, exercise levels, and alcohol intake. Their physician may prescribe stronger medications, such as colchicine, to relieve pain and swelling.

How to prevent gout flare-ups

In addition to taking specific medications, there are a few things you can do to prevent recurrent gout:

• Limit your intake of alcohol—Discuss with your doctor the appropriate amount of alcohol, if any, that is safe for you. Studies show that alcohol, especially beer, and sugary drinks link to an increase in gout symptoms, so try to limit consumption of these whenever possible.
• Maintain a healthy weight—Consume healthy meal portions, exercise regularly, and avoid fasting or crash diets.
• Drink plenty of water—The guideline is to drink at least eight glasses of water a day and limit your intake of beverages with high fructose levels.
• Limit your intake of meat—Eating high-purine foods, such as veal, venison, liver, fish, and scallops can increase your uric acid levels and lead to a gout attack.
• Eat more low-fat dairy foods—These can be alternatives to some of the protein you’re getting from meat.

Gout medications

Your doctor may prescribe one or more medications in the following drug classes to prevent your uric acid levels from rising and recurring attacks from happening. In general, NSAIDs are some of the first options your doctor will recommend, followed by xanthine oxidase inhibitors (XOIs). Talk to your doctor about which medications are safe for you.

Allopurinol

This is the most common medication for those with chronic gout. It’s an XOI that limits the amount of uric acid your body makes and reduces your chance of experiencing gout. Some popular brands are Aloprim, Lopurin, and Zyloprim. Side effects include a skin rash, upset stomach, and low blood counts. In rare cases, you might experience a severe allergic reaction.

Colchicine

This pain reliever, typically prescribed as Colcrys or Mitigare, is most effective at reducing gout pain at the first signs of a gout attack. However, it does have some side effects, such as nausea, vomiting, abdominal cramping, and diarrhea. Your doctor may prescribe you a low dosage to prevent future attacks.

Febuxostat

Also an XOI, this medication is prescribed to those who make too much uric acid in their body. A common brand name is Uloric. Febuxostat is a good alternative if you have a reaction to Allopurinol. This drug can cause liver damage, nausea, and joint pain and can also increase your risk of heart-related death, so talk with your doctor before use.

Lesinurad

This medicine (brand name Zurampic) can be taken only with an XOI. It treats high blood uric acid levels associated with gout. It may be difficult to get as the manufacturer stopped production of Lesinurad in 2018 due to financial reasons. Some side effects include gout flares and the risk of acute renal failure.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

These medications decrease pain, swelling, and discomfort. They are especially effective within the first 24 hours of your gout attack. Some NSAIDs, like ibuprofen (Advil and Motrin IB) and naproxen sodium (Aleve), are available over the counter, while others, like indomethacin (Indocin) and celecoxib (Celebrex), must be prescribed by a doctor. Common side effects include stomach pain, heartburn, headaches, dizziness, wheezing, rashes, and high blood pressure.

Probenecid

This medicine is a uricosuric, a medication that improves uric acid removal. Taken daily, Probenecid may be combined with antibiotics to boost effectiveness. A popular brand name within this drug class is Probalan or Benemid. Though this drug can effectively remove uric acid from your body, it can cause stomach pain, headaches, nausea, upset stomach, and increase your risk of kidney stones.

Pegloticase

If you have severe or recurrent gout or refractory chronic gout, and no other medications work, your doctor might recommend Pegloticase, a medication that converts uric acid to a less harmful compound called allantoin. Popular brand names are Krystexxa and Puricase. This medicine is given in an IV by your doctor every two weeks. Some side effects include mood changes, gout flares, nausea, bruising, sore throat, constipation, increased blood sugar levels, and elevated blood pressure.

Prednisone

This corticosteroid can be taken as a pill or injected into an inflamed joint to relieve pain and swelling caused by a gout attack. Popular brands include Deltasone, Rayos, and Prednisone Intensol. Some side effects include increased appetite and subsequent weight gain, headache, nausea, stomach pain, insomnia, or mood changes.

What is the best medication for gout?

The best medication for gout depends on patients’ medical conditions, medical history, and medications they may already be taking that could interact with gout medication as well as response to treatment.

What are common side effects of gout medication?

In general, common side effects of gout medication include nausea, vomiting, headache, dizziness, and drowsiness. For XOIs, the most common side effects are upset stomach, diarrhea, joint pain, and drowsiness. NSAIDs may cause an upset stomach and heartburn. For corticosteroids, loss of appetite, trouble sleeping, headaches, and dizziness may occur.

What is the best home remedy for gout?

Since there’s no cure for gout, you may need to make some lifestyle changes to help manage the disease. In particular, eating a healthy diet is one of the biggest changes you can make to prevent gout episodes. Avoid trigger foods that are high in purines, like a diet rich in red meat, organ meat, and seafood. You should also try avoiding alcohol and sugary drinks whenever possible and stay hydrated with water.

Here are some other natural remedies that may help during a gout attack. If you find that your pain worsens, seek medical advice before starting any natural treatment of gout.

• Cherries—Cherries and tart cherry juice are high in Vitamin C, which makes uric acid come out in the urine.
• Lemon water—Drinking lemon water helps neutralize uric acid, which can help reduce the body’s overall uric acid levels.
• Celery—Traditionally used to treat urinary issues, celery and celery seeds have become a popular home remedy for gout. Try incorporating celery sticks into your daily diet.
• Nettle tea—Stinging nettle may help with inflammation. Steep one to two teaspoons of dried nettle in a cup of boiling water. Drink this tea two to three times a day.
• Cold compress—Applying ice or a cold compress to the affected area may help reduce swelling and inflammation.
• Fruit—Apples contain malic acid, which lowers uric acid. Try eating at least one apple per day.

The CDC also recommends five alternative strategies for managing your gouty arthritis:

1. Learn self-management skills—Take a self-management education class, where you can learn to understand gout and how to manage your symptoms.
2. Get physically active—Regular physical activity (30 minutes, five days a week) can reduce the risk of developing heart disease, stroke, or diabetes. It can also help manage gout flare-ups.
3. Talk to your doctor—Be consistent with attending your regularly scheduled doctor’s appointments and following your course of treatment.
4. Lose weight—If you’re overweight or obese, losing weight eases the pressure on your joints and tends to lower inflammation levels, reducing your risk of gout.
5. Protect your joints—Choose low-impact activities, like walking or swimming, that are easy on the joints.

How to treat acute gout attacks

If your doctor prescribed medication to take during an acute attack, take it as soon as you notice signs of an attack coming on. If you don’t have any prescribed medications, consider taking an NSAID like Advil or Aleve to help reduce pain. Here are a few steps you can follow after you’ve taken your medicine:

1. Grab an ice pack and start putting cold compresses on the affected area. This can help reduce inflammation and swelling.
2. Rest the joint that’s hurting. If it’s your knee or toe, keep your legs elevated and try to limit movement as much as possible. Have friends or family help out with tasks around the house so you can rest as much as possible.
3. Drink plenty of water and limit your intake of alcohol and sugary drinks.

If your symptoms don’t get better after a few days and seem to worsen, call your doctor. Most gout attacks will go away by themselves after around 10 days.

Can gout be cured?

No, there is no cure for gouty arthritis; it’s a long-term disease. However, you can treat acute attacks and long-term gout with a combination of medication and lifestyle changes.

How long does it take for gout to go away?

On average, it can take one to two weeks for a gout flare-up to subside. Left untreated, you might experience new episodes which can lead to joint damage.

What can trigger an attack of gout?

Foods that are high in purines which the body converts to uric acid, alcohol (especially beer), high blood pressure medication, stress, dehydration, obesity, and fasting can all trigger a gout episode.

What foods cause gout?

Foods that are high in purine content make gout more likely. These include seafood, like scallops, sardines, mussels, trout, and codfish; meats like bacon, turkey, venison, and veal; and alcoholic beverages can cause gout.

Related resources for gout:

• What is gout?
• How to prevent gout attacks
• System for studying diseases finds new drug targets
• Treatment options for gout