How is gout treated?

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Gout is a form of arthritis caused by the accumulation and crystallization of uric acid in the joint. Depending on the severity of the attack, treatment may include over-the-counter anti-inflammatory medications to relieve pain and behavior changes (such as diet and alcohol restriction) to reduce the frequency of attacks. Chronic attacks may require prescription medications to help lower the uric acid level in the blood.

Home remedies and lifestyle

Gout symptoms are caused by an excessive buildup of uric acid , a condition known as hyperuricemia . Over time, this build-up can lead to the formation of uric acid crystals in and around the joint, causing prolonged and severe episodes of pain and inflammation.

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Therefore, gout treatment aims at two things: reducing uric acid levels and relieving gout pain.

Pain management

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

A gout attack usually lasts three to 10 days. Pain at the beginning of an attack (usually the first 36 hours) is usually more severe.

Home treatment options include:

  • An ice pack or cold pack can make a mild attack much easier. Make sure to wrap the ice pack in a thin towel and apply it to the joint for only 15 to 20 minutes to prevent frostbite. You can do this several times a day.
  • Put down the joint. Since the big toe is the most affected, raise the foot to reduce swelling. Stay off your feet if possible, and consider using a cane or crutches if you need to walk.
  • Tylenol (acetaminophen) or another over-the-counter pain reliever can be used for milder cases. Although it does not have the anti-inflammatory properties of NSAIDs, it can help relieve pain.
  • Weight loss in overweight or obese patients with gout can help relieve pressure on affected joints.

Dietary interventions

Hyperuricemia can be related to the food we eat. Some contain large amounts of an organic compound known as purine that, when broken down, turns into uric acid. Others contain substances that make it difficult for the kidneys to excrete uric acid.

While there is little evidence that dietary interventions can reduce the severity or duration of a gout attack, changes can help reduce the risk of future attacks.

To do this, you need to make the following changes to avoid hyperuricemia :

  • Avoid or limit any type of alcohol, especially beer.
  • Avoid or limit your intake of foods that are high in purines .
  • Avoid or limit consumption of fructose-sweetened beverages that impair uric acid excretion.

A guide to talking about gout with a doctor

Get our printable guide to your next doctor's appointment to help you ask the right questions.

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Prescription medications are often used when diet and lifestyle changes do not provide adequate relief and / or there is evidence of increased joint damage. Prescription medications used to treat gout can be classified into two types: anti-inflammatory and uric acid lowering.

Anti-inflammatory drugs

Prescription anti-inflammatory medications commonly used to treat gout are either prescribed on an ongoing basis or used as needed to relieve acute symptoms.

Among the options:

  • Colchicine is an oral anti-inflammatory drug used to prevent and treat acute attacks of gout. Colchicine can be used alone, but is most commonly prescribed with a uric acid-lowering drug such as allopurinol. Side effects of colchicine include diarrhea, nausea, and abdominal cramps.
  • Corticosteroids , taken by mouth or injected into the joint, offer short-term relief from acute symptoms. Medications work by suppressing inflammation and calming the immune system in general and are generally not used as a form of ongoing therapy.

Overuse of any form of corticosteroid can lead to weight gain, bruising, osteoporosis, eye problems, high blood pressure, and an increased risk of infection.

Oral treatment (usually with prednisone ) can be given over days or weeks. Corticosteroid injections are most often used when only one joint is affected or when the systemic (whole-body) effects of oral corticosteroids must be avoided.

Medicines that lower uric acid levels.

If other measures fail to lower uric acid levels, healthcare providers often turn to medications that can decrease uric acid production or increase uric acid excretion from the body. The 2020 Gout Treatment Guidelines from the American College of Rheumatology recommends these urate-reducing therapies as a first-line option for most patients with this condition.

Currently, the US Food and Drug Administration (FDA) has approved five drugs to lower uric acid levels.

Commonly prescribed urate reducing medications include:

  • Cyloprim (allopurinol) is an oral xanthine oxidase (XOI) inhibitor that reduces uric acid production in the body. This medication is taken once a day and is generally recommended as a first-line treatment for most gout patients. An exacerbation of symptoms may occur at the beginning of treatment, so the drug is often prescribed in lower doses, then gradually increased. Additionally, allopurinol is generally prescribed with colchicine to reduce the short-term risk of a gout attack. Side effects of allopurinol include an upset stomach and rare but often serious skin reactions. Ask your doctor if you are at risk for serious reactions to allopurinol. Side effects are much less serious than other medications that lower uric acid levels and can include rashes and an upset stomach. Stomach problems usually go away when your body adjusts to the medicine.
  • Uloric (febuxostat) is another XOI treatment option that reduces uric acid production in the body. This drug is mainly prescribed for people who cannot tolerate allopurinol. Taking Uloric daily can reduce the severity and frequency of seizures. When treatment is first started, exacerbations often occur. Even if they do occur, you should continue taking your medication as directed.
    Common side effects include nausea, joint and muscle pain. 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) is a new biological drug that is injected into a vein by intravenous infusion and is used only when other treatments have failed. Krystexxa works by converting uric acid into a substance called allantoin, which is easily eliminated from the body. It is administered in the clinic every two weeks, so it is used only in the most severe cases.
    Common side effects include short-term flare-ups, nausea, bruising, sore throat, constipation, chest pain, and vomiting. Serious allergic reactions can occur after repeated doses.
  • IL-1 inhibitors, including anakinra and canakinumab, are a class of recommended treatment options for patients in whom anti-inflammatory drugs are ineffective, poorly tolerated, or contraindicated.

Other complementary medications can be used to treat gout, including Cozaar (losartan), an antihypertensive medication, and Tricor (fenofibrate), a lipid-lowering medication. Both can help reduce serum uric acid levels.

Frequently asked questions

  • Over-the-counter pain relievers like Tylenol (acetaminophen), Advil (ibuprofen), or Alev (naproxen) can help relieve pain in mild gout, but prescription anti-inflammatories or corticosteroids are most often used to treat gout. attack. Your healthcare provider will likely also prescribe medications to lower uric acid levels.

  • To treat an acute gout attack at home, try ice and elevation for pain relief. Apply an ice pack or cold pack to the affected joint for 15 to 20 minutes several times a day, but be sure to keep a towel between your skin and the ice. Avoid standing up to relieve pain.

  • Drinking lots of water is the best way to flush uric acid from your body. During a gout attack, it is recommended that you drink 16 8-ounce glasses of water a day. To keep uric acid levels low and prevent seizures, stay hydrated by drinking at least eight glasses of water a day.

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