Gout

Prevention

To help prevent gout:

• Follow a healthy diet.

• Avoid alcohol use, especially binge drinking.

• Avoid dehydration.

• Lose weight if you are obese.

• Avoid diuretics (water pills) if possible.

For most people with gout, dietary restrictions do not seem to help much, but you should avoid any foods that seem to trigger gout attacks.

Treatment

To treat an attack of gouty arthritis, your doctor usually will begin by prescribing a nonsteroidal anti-inflammatory drug (NSAID), such as indomethacin (Indocin), ibuprofen (Advil, Motrin and others) or naproxen (Aleve, Anaprox, Naprosyn and others). Aspirin should be avoided because it can raise the level of uric acid in your blood. If you cannot tolerate an NSAID, or if these drugs don't work for you, your doctor may suggest a corticosteroid. Corticosteroids can be given orally or injected directly into the affected joint. Another option is an injection of a compound called adrenocorticotrophic hormone, which directs your adrenal gland to make more cortisone. A drug called colchicine sometimes is used, but it tends to cause unpleasant side effects (nausea, vomiting, cramps, diarrhea) and causes side effects in about 80% of people.

To prevent attacks of gout, your doctor may prescribe allopurinol (Aloprim, Zyloprim) to make your body produce less uric acid. If attacks are rare and respond well to treatment, this is not necessary. It usually is recommended when:

• Gout attacks are frequent.

• Gout attacks do not respond promptly to treatment.

• Gout attacks affect more than one joint at a time.

• There is a history of kidney stones and previous gout.

• A tophus has developed.

The level of uric acid in your blood usually begins to drop within 24 hours after the first dose of allopurinol. The full effect occurs after two weeks of daily treatment.

Another treatment approach is to make your kidneys release more uric acid by taking probenecid (Benemid, Probalan) or sulfinpyrazone (Anturane). These drugs work well in 70% to 80% of people with gout. But they should not be taken by people who have significant kidney disease or who have had a kidney stone.