Gout - Treatment

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What is the treatment for gout?

When gout is mild, infrequent, and uncomplicated, it can be treated with diet and lifestyle changes. When attacks are frequent, uric acid kidney stones are present, the uric acid level is very high, tophi are present, or there is evidence of joint damage from gout, medications are necessary to treat gout. Studies have shown that even the most rigorous diet does not lower the serum uric acid enough to control gout, and therefore medications are generally necessary for gout treatment in these instances.

Medications for the treatment of gout generally fall into one of three categories: uric-acid-lowering medications, prophylactic medications (medications used in conjunction with uric-acid-lowering medications to decrease the risk for a gout flare during the first six months of treatment), and rescue medications to provide immediate relief from gout pain.

Uric-acid-lowering medications are the cornerstone of treatment for gout. These medications decrease the total amount of uric acid in the body and subsequently lower the serum uric acid level. For most patients, the goal of uric-acid-lowering medication is to achieve a serum uric acid level of less than 6. For some patients, the goal may be even lower. These medications also are effective treatments to decrease the size of tophi, with the ultimate goal of eradicating them. Uric-acid-lowering medications include allopurinol (Zyloprim, Aloprim), febuxostat (Uloric), probenecid, and pegloticase (Krystexxa).

Prophylactic medications are used during approximately the first 6 months of therapy with a uric acid lowering medication to either prevent gout flares, or decrease the number and severity of flares. This is because any medication or intervention that either increases or decreases the uric acid level in the bloodstream can trigger a gout attack. The uric acid lowering medications described above therefore can trigger an attack of gout because they lower the uric acid level. Colcrys (colchicine) and any of the NSAIDs (non-steroidal anti-inflammatory drugs) such as indomethacin (Indocin, Indocin-SR), diclofenac (Voltaren, Cataflam, Voltaren-XR, Cambia), ibuprofen (Advil), or naproxen sodium are frequently used as prophylactic medications. By taking one of these prophylactic or preventative medications during the first 6 months of treatment with allopurinol, febuxostat or probenecid, the risk of having a gout attack during this time is decreased. Prophylactic medications are not used in combination with Krystexxa.

The third category of medications are those used during an acute gout attack to decrease pain and inflammation. Both colchicine (Colcrys) and NSAIDs can be used during an acute gout attack to decrease inflammation and pain. Steroid medications, such as prednisone and methylprednisolone (Medrol), also can be used during an acute gouty flare. However, the total dose of steroids is generally limited due to potential side effects such as cataract formation and bone loss. Steroid medications are extremely helpful in treating gout flares in patients who are unable to take colchicine or NSAIDs.

Return to Gout (Gouty Arthritis)

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Comment from: Allan, 65-74 Male (Patient) Published: December 06

I suffered with gout from around 35 to 65 years old. I took many courses of action, including almost all of the drugs mentioned here. The pain was so bad one day I tried something I had read about but didn't quite believe: a teaspoon of baking soda in a glass of water gradually reducing over a one-week period. From the first day, the pain went and after five years has not returned.

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Comment from: Steve, 55-64 Male (Patient) Published: February 06

I have had two bouts with the gout and now know the pain associated. I had blood work done with a 9 reading for uric acid. My doctor said that wasn't real high but I still got a second bout. I found that on the first case that cherries and the juice helped with treating it. Also I went on a diet not excluding the alcohol and a second bout accrued. I am now going to try the B -12s with extra B-6 and PABA. Hope this keeps me from starting medication. I am cutting the alcohol too!

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