How Is Gout Treated?
With proper treatment, most people who have gout are able to control their symptoms and live productive lives. Gout can be treated with one or a combination of therapies. The goals of treatment are to ease the pain associated with acute attacks, to prevent future attacks, and to avoid the formation of tophi and kidney stones. Successful treatment can reduce discomfort caused by the symptoms of gout, as well as long-term damage to the affected joints. Treatment will help to prevent disability due to gout.
The most common treatments for an acute attack of gout are nonsteroidal anti-inflammatory drugs (NSAIDs) taken orally (by mouth), or corticosteroids, which are taken orally or injected into the affected joint. NSAIDs reduce the inflammation caused by deposits of uric acid crystals, but have no effect on the amount of uric acid in the body.
Corticosteroids are strong anti-inflammatory hormones. The most commonly prescribed corticosteroids is prednisone. Patients often begin to improve within a few hours of treatment with a corticosteroids, and the attack usually goes away completely within a week or so.
When NSAIDs or corticosteroids do not control symptoms, the doctor may consider using colchicine. This drug is most effective when taken within the first 12-hours of an acute attack.
For some patients, the doctor may prescribe either NSAIDs or oral colchicine in small daily doses to prevent future attacks. The doctor also may consider prescribing medicine such as allopurinol, probenecid, or febuxostat to treat hyperuricemia and reduce the frequency of sudden attacks and the development of tophi.
People who have other medical problems, such as high blood pressure or high blood triglycerides (fats), may find that the drugs they take for those conditions can also be useful for gout. Both losartan, a blood pressure medication, and fenofibrate, a triglyceride-lowering drug, also help reduce blood levels of uric acid.
The doctor may also recommend losing weight, for those who are overweight; limiting alcohol consumption; and avoiding or limiting high-purine foods, which can increase uric acid levels.
What Can People With Gout Do to Stay Healthy?
Fortunately, gout can be controlled. People with gout can decrease the severity of attacks and reduce their risk of future attacks by taking their medications as prescribed. Acute gout is best controlled if medications are taken at the first sign of pain or inflammation. Other steps you can take to stay healthy and minimize gout’s effect on your life include the following:
- Tell your doctor about all the medicines and vitamins you take. He or she can tell you if any of them increase your risk of hyperuricemia.
- Plan follow up visits with your doctor to evaluate your progress.
- Drink plenty of nonalcoholic fluids, especially water. Nonalcoholic fluids help remove uric acid from the body. Alcohol, on the other hand, can raise the levels of uric acid in your blood.
- Exercise regularly and maintain a healthy body weight. Lose weight if you are overweight, but avoid low-carbohydrate diets that are designed for quick weight loss. When carbohydrate intake is insufficient, your body can’t completely burn its own fat. As a consequence, substances called ketones form and are released into the bloodstream, resulting in a condition called ketosis. After a short time, ketosis can increase the level of uric acid in your blood.
- Avoid foods that are high in purines.
High-Purine Foods
- anchovies
- asparagus
- beef kidneys
- brains
- dried beans and peas
- game meats
- gravy
- herring
- liver
- mackerel
- mushrooms
- sardines
- scallops
- sweetbreads
Research Highlights
Because uric acid’s role in gout is well understood and medications to ease attacks and reduce the risk or severity of future attacks are widely available, gout is one of the most—if not the most—controllable forms of arthritis. But researchers continue to make advances that help people live with gout. Perhaps someday these advances will prevent this extremely painful disease.
Some areas of gout research include the following:
- Refining current treatments. Although many medications are available to treat gout, doctors are trying to determine which of the treatments are most effective and at which dosages. Recent studies have compared the effectiveness of different NSAIDs in treating the pain and inflammation of gout and have looked at the optimal dosages of colchicine and allopurinol (a uric acid-lowering drug) to control and/or prevent painful attacks.
- Evaluating new therapies. A number of new therapies have shown promise in recent studies. They include infliximab and other biologic agents that block a chemical called tumor necrosis factor. This chemical is believed to play a role in the inflammation of gout.
- Discovering the role of foods. Gout is the one form of arthritis for which there is proof that specific foods worsen the symptoms. Now, research is suggesting that certain foods may also prevent gout. In a study published in the New England Journal of Medicine, scientists found that a high intake of low-fat dairy products reduces the risk of gout in men by half. The reason for this protective effect is not yet known. Another study examining the effects of vitamin C on uric acid suggests that it may be beneficial in the prevention and management of gout and other diseases that are associated with uric acid production.
- Searching for new treatment approaches. Scientists are also studying the contributions of different types of cells that participate in both the acute and chronic joint manifestations of gout. The specific goals of this research are to better understand how urate crystals activate white blood cells called neutrophils, leading to acute gout attacks; how urate crystals affect the immune system, leading to chronic gout; and how urate crystals interact with bone cells in a way that causes debilitating bone lesions among people with chronic gout. The hope is that a better understanding of the various inflammatory reactions that occur in gout will provide clues for treatment.
- Examining how genetics and environmental factors can affect hyperuricemia. Researchers are studying different populations in which gout is prevalent to determine how certain genes and environmental factors may affect blood levels of uric acid, which can leak out and crystallize in the joint, leading to gout.
More information on research is available from following resources:
- ClinicalTrials.gov offers up-to-date information for locating federally and privately supported clinical trials for a wide range of diseases and conditions.
- NIH RePORTER is an electronic tool that allows users to search a repository of both intramural and extramural NIH-funded research projects from the past 25 years and access publications (since 1985) and patents resulting from NIH funding.
- PubMed is a free service of the U.S. National Library of Medicine that lets you search millions of journal citations and abstracts in the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and pre clinical sciences.