Gout - Treatment

Highlights	Complications	Medications
Introduction	Risk Factors	Lifestyle Changes
Causes	Diagnosis	Resources
Symptoms	Treatment	References

Treatment

Acute attacks of gout and long-term treatment of gout and its associated hyperuricemia require different approaches. All phases are treated mainly with drugs. There are also specific treatment regimes for conditions associated with gout, including uric acid nephropathy and uric acid nephrolithiasis.

Lifestyle Measures

Many patients do not require medications. During the period between gout attacks, patients are advised to avoid foods high in purines and to maintain a healthy weight. Patients should also avoid alcohol and reduce any stress.

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Treatments for Asymptomatic Hyperuricemia

Experts do not recommend treatment for hyperuricemia that causes no symptoms. For one, asymptomatic hyperuricemia usually does not lead to gout or other health problems. In addition, the drugs used to treat it are expensive and carry certain risks. In unusual circumstances treatment may be justified, for example in patients with very high uric acid levels that threaten the kidney or those with a personal or strong family history of gout, kidney stones, or kidney damage.

Treatment of an Acute Attack of Gout

Drug treatments for acute attacks of gout are aimed at relieving pain and reducing inflammation. They should be started as early as possible.

NSAIDs. Powerful forms of nonsteroidal anti-inflammatory drugs (NSAIDs) are the drugs of choice for an acute attack in younger, healthy patients with no serious health problems, particularly problems that affect the kidneys, liver, or heart. Usually indomethacin is prescribed for 2 to7 days.
Colchicine. Colchicine may be given within 48 hours of an attack to healthy adults. It is typically administered hourly to a maximum of six doses. It should not be used in patients with kidney or liver problems or in pregnant women.
Corticosteroids. Corticosteroids may be used in patients who cannot tolerate NSAIDs and they may be particularly beneficial for elderly patients. Injections into an affected joint provide effective relief for many patients, but this is not useful for patients who have multiple joints that are effected. Oral steroids may be used for patients who cannot take NSAIDs or colchicine and who have gout in more than one joint.

Rest and protecting the affected joint with a splint can also promote recovery. A 2002 study reported that applying ice packs for 30 minutes four times daily significantly reduced pain. Interestingly, one 2001 study recommended applying warm water continuously and moving the joint. The theory behind this advice was that the pain in a gout attack is due to grinding from the crystals and that warmth would help dissolve the crystals and relieve pain.