Gout - Treatment Overview

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

Specific treatment depends on whether you are having an acute attack or are trying to manage long-term gout and prevent future attacks.

To treat an acute attack

• Rest the affected joint(s).
• Use ice to reduce swelling.
• Take short-term medicines at the first sign of a gout attack, as prescribed by your doctor.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Colchicine
  • Oral corticosteroids

To manage long-term gout and prevent future attacks

If gout symptoms have occurred off and on without treatment for several years, they may become ongoing (chronic) and may affect more than one joint.

• Take medicines as your doctor prescribes for pain.
• Take steps to reduce the risk of future attacks.
  • Talk to your doctor about all the medicines you take. Some medicines may raise the uric acid level.
  • Manage your weight; get exercise; and limit alcohol, meat, and seafood.
• Take a long-term medicine that reduces uric acid levels in the blood.
  • Uricosuric agents
  • Drugs called xanthine oxidase inhibitors
  • Colchicine
  • Pegloticase (Krystexxa). This medicine is for gout that has lasted a long time and has not responded to other treatment.
• Treat tophi. These are chalky nodules that form from uric acid crystals. Treatment includes:
  • Drugs called xanthine oxidase inhibitors, which may shrink the tophi until they disappear.
  • In rare cases, surgery to remove large tophi that are causing deformity.

What to think about

If the blood uric acid is high but a person has never had an attack of gout, treatment is rarely needed. But 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 watched by your doctor until it is lowered to normal levels.

Long-term medicine 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.

After an acute attack of gout, talk with your doctor about the causes of the elevated uric acid levels in your blood. A review of your overall health may reveal diseases, medicines, and habits that could be raising your uric acid levels.

Most doctors will wait several days to weeks after a gout attack is over to begin medicine to lower the high uric acid levels. These medicines 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 doctor may relieve the pain and pressure by aspiration. A needle is inserted into the joint and fluid is drawn out (aspirated) with a syringe connected to the needle.

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