Gout - Treatment Overview

Treatment Overview

The goals of treatment for gout are rapid pain relief and prevention of future gout attacks and long-term complications, such as joint destruction and kidney damage. Treatment includes medications and steps you can take at home to prevent future attacks.

Initial treatment

Gout is treated with medications to relieve symptoms and measures to eliminate causes. Specific treatment depends on whether you are having an acute attack or are trying to prevent future attacks.

To reduce the pain, swelling, redness, and warmth of the affected joint(s) in an acute gout attack:

• Rest the affected joint(s).
• Take one or more of the following medications at the first sign of a gout attack, as prescribed by your health professional.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or indomethacin. Avoid aspirin because it may abruptly change uric acid levels in the blood and may make symptoms worse.
  • Colchicine
  • Corticosteroids

To prevent recurrent attacks:

• Take a medication that reduces uric acid levels in the blood, which reduces the risk of future attacks.
  • Uricosuric agents increase elimination of uric acid by the kidneys.
  • Allopurinol decreases production of uric acid by the body.
• Take steps to reduce the risk of future attacks.
  • Being overweight is a risk factor for gout. If you are overweight, a diet that is low in fat may help you lose weight. However, very low-calorie diets increase the amount of uric acid produced by the body and may bring on a gout attack. For more information, see the topic Healthy Weight.
  • Alcohol can reduce the release of uric acid by the kidneys into your urine, causing an increase of uric acid in your body. Beer, which is rich in purines, appears to be worse than some other beverages that contain alcohol.⁴
  • Diets high in meat and seafood (high-purine foods) can raise uric acid levels.⁵
  • Certain medications that are given for other conditions reduce the amount of uric acid eliminated by the kidneys. These include pills that reduce the amount of salt and water in the body (diuretics, or "water pills") and niacin. Regular use of low-dose aspirin (81 mg to 650 mg) may raise the uric acid level. Since low-dose aspirin may be important for the prevention of stroke or heart attack, your doctor may want you to continue to take low-dose aspirin.
  • Follow a moderate exercise program.

Most people with gout will need to take medications that lower uric acid levels throughout their lives. However, in a few cases some people may be able to reduce their uric acid levels to normal by controlling their weight, not drinking alcohol, and avoiding certain medications for other conditions.⁸

If the blood uric acid is high but a person has never had an attack of gout, treatment is rarely needed. However, people with extremely elevated levels may need regular testing for signs of kidney damage, and they may need long-term treatment to lower their uric acid levels. Your blood uric acid level may be monitored by your health professional until it is lowered to normal levels.

Ongoing treatment

If you have previously had a gout attack, you are likely to have another, especially if you are not managing the disease with medications or other treatment. The goal of treatment is to prevent future attacks, to reduce high levels of uric acid (hyperuricemia), and to identify and treat the causes of your hyperuricemia. Your health professional will review your health history and current health status to identify other medical conditions and medications that could be causing the elevated uric acid levels. Factors such as alcohol consumption, diet, and body weight can be modified to lower your uric acid levels and reduce the risk of future gout attacks.

To reduce the pain, swelling, redness, and warmth of the affected joint(s) in an acute gout attack:

• Rest the affected joint(s).
• Take one or more of the following medications at the first sign of a gout attack, as prescribed by your health professional.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or indomethacin. Avoid aspirin because it may abruptly change uric acid levels in the blood.
  • Colchicine
  • Corticosteroids

To prevent recurrent attacks:

• Take a medication that reduces uric acid levels in the blood, which reduces the risk of future attacks.
  • Uricosuric agents increase elimination of uric acid by the kidneys.
  • Allopurinol decreases production of uric acid by the body.
  • Colchicine is often prescribed to prevent flare-ups during the first months that you are taking uric acid-lowering medications.
• Take steps to reduce the risk of future attacks.
  • Being overweight is a risk factor for gout. If you are overweight, a diet that is low in fat may help you lose weight. However, very low-calorie diets increase the amount of uric acid produced by the body and may bring on a gout attack. For more information, see the topic Healthy Weight.
  • Alcohol can reduce the release of uric acid by the kidneys into your urine, causing an increase of uric acid in your body. Beer, which is rich in purines, appears to be worse than some other beverages that contain alcohol.⁴
  • Diets high in meat and seafood (high-purine foods) can raise uric acid levels.⁵
  • Making changes in your diet may help with your gout. If you want to try an eating plan for gout, see:

    Eating plan for gout.

  • Certain medications that are given for other conditions reduce the amount of uric acid eliminated by the kidneys. These include pills that reduce the amount of salt and water in the body (diuretics, or "water pills") and niacin. Regular use of low-dose aspirin (81 mg to 650 mg) may raise the uric acid level. Since low-dose aspirin may be important for the prevention of stroke or heart attack, your doctor may want you to continue to take low-dose aspirin.
  • Follow a moderate exercise program.

Long-term medication treatment depends on how high your uric acid levels are and how likely it is that you will have other gout attacks in the future.

Treatment if the condition gets worse

Gout can usually be successfully treated by eliminating its causes and taking medications to relieve symptoms. However, if gout symptoms have occurred off and on without treatment for more than 10 years, they may become ongoing (chronic) and may affect more than one joint. Uric acid crystals may have accumulated in the joints to form gritty, chalklike nodules called tophi. Treatment of gout that has advanced to this stage includes medications.

• Take one or more of the following medications, as prescribed by your health professional.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or indomethacin. Avoid aspirin, which may abruptly change uric acid levels in the blood.
  • Colchicine
  • Corticosteroids
• If you are having pain in the joints from an attack, your health professional may prescribe:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or indomethacin. Avoid aspirin, which may abruptly change uric acid levels in the blood.
  • Colchicine
  • Oral corticosteroids, such as prednisone or medrol.
  • A shot of corticosteroids in a muscle.
  • A shot of corticosteroids directly into the painful joint.

• To prevent recurrent attacks, you may be prescribed:
  • Uricosuric agents to increase elimination of uric acid by the kidneys.
  • Allopurinol to decrease production of uric acid by the body.
  • Colchicine to prevent flare-ups during the first months that you are taking uric acid-lowering medications.

Treatment to eliminate tophi includes:³

• Allopurinol medication, which may shrink the tophi until they disappear.
• In rare cases, surgery to remove large tophi that are causing deformity.

What To Think About

After an acute attack of gout, talk with your health professional about the underlying causes for the elevated uric acid levels in your blood. A review of your overall health may reveal diseases, medications, and habits that could be contributing to your uric acid levels.²

Most health professionals will wait 2 to 4 weeks after a gout attack is over to begin medication to lower the high uric acid levels.⁶ These medications can cause uric acid stored elsewhere in the body to begin moving through the bloodstream and could make symptoms worse if treatment begins during a gout attack.

If there is swelling that causes pressure in a large joint such as a knee or ankle, your health professional may relieve the pain and pressure by aspiration, in which a needle is inserted into the joint and fluid is drawn out (aspirated) with a syringe connected to the needle.⁶