Gout medications & treatments

Gout is a common form of inflammatory arthritis that is due to a build-up of uric acid crystals in and around your joints. Fifty percent of first episodes occur in the big toe, but any joint can be involved. It is a common condition that affects 4% (over 8 million) Americans. Gout is more common in men than and more prevalent in African-American men than white men. It typically occurs after menopause in women.

It can be a very painful condition, but with medication and some self-care, symptoms, and flare-ups can be successfully managed.

What is gout?

Gout occurs when high levels of serum urate (uric acid) built up in your body form needle-shaped crystals in and around the joint. Not everyone with high levels of uric acid (hyperuricemia) will develop gout. Some people can develop kidney stones. Others can experience sudden, severe attacks of pain, swelling, redness, and tenderness in one or more joints, most often in the big toe. These attacks typically occur at night and can last for as little as hours or as long as a few weeks. It is usually followed by long periods without symptoms.

Some risk factors for developing gout include:

• Obesity
• Family history of gout
• Being a male
• High blood pressure
• Diabetes
• Drink alcohol
• Take certain medications such as diuretics
• Have a diet high in purines, which are found in red meats, anchovies, and some other kinds of seafood.
• Consume food and surgery drinks high in fructose.

How is gout diagnosed?

Some other kinds of arthritis can mimic gout so it can be hard to diagnose at times. Your doctor will usually an examination of your affected joints and several tests to confirm a diagnosis of gout.

Tests the doctor may use include:

• Blood tests to measure your uric acid level.
• Ultrasound to look for urate crystals in your joint or under your skin (called tophi)
• X-ray to rule out other forms of arthritis.
• Joint aspiration, uses a needle to take fluid from your joint and look for crystals under a microscope. This is the most reliable test to confirm your diagnosis.

What are some gout treatment options?

After being diagnosed with gout, your doctor will usually prescribe medications to help reduce inflammation and pain from the gout attack, prevent flare-ups, and lower the amount of uric acid in your blood.

Some of these medications include:

• Non-steroidal anti-inflammatory drugs (NSAIDs). These are used to reduce pain and inflammation in the affected joints in the management of acute gout. They include over-the-counter (OTC) meds like Advil/Motrin (ibuprofen) and Aleve (naproxen sodium) as well prescription drugs Indocin (indomethacin) and Celebrex (celecoxib). Some common side effects include stomach pain, headaches, bleeding, and ulcers.
• Corticosteroids. Meds such as Deltasone (prednisone) are also used to help relieve symptoms of gout such as inflammation and pain. It can cause increased appetite, weight gain, mood changes, increased blood sugar and increased blood pressure.
• Colcrys/Mitigare (colchicine). This is effective to reduce the inflammation caused by urate crystals. It works best if started at the first sign of an attack. Your doctor might also prescribe a low dose to help prevent attacks. It can cause nausea, vomiting, and diarrhea.
• Xanthine Oxidase Inhibitors. These are used to reduce the high uric acid levels in your blood. They include Zyloprim/Aloprim (allopurinol) and Uloric (febuxostat). They can cause some side effects including rash, nausea, and fever. Febuxostat can also increase your risk of heart-related death.
• Probalan/Benemid (probenecid). This uricosuric medication helps your body‘s ability to remove uric acid. It can cause nausea, an upset stomach, and increases your risk of kidney stones.
• Krystexxa (pegloticase). Used to treat severe or chronic gout that doesn‘t respond to other treatments, it is given by your doctor via IV every 2 weeks. It can cause gout flares, nausea, and changes in your mood.

What is the best medication for gout?

The best medication for the treatment of gout will depend on the individual’s specific medical condition, medical history, medications that the individual is already taking that may potentially interact with gout medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter gout medications approved by the Food and Drug Administration (FDA).

Best medications for gout

Your healthcare provider will determine the right dosage for you based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist; this is not a complete list.

What are the most common side effects of gout medications?

As with all medicines, those used for gout will have some side effects, depending on the class you are taking. The most common side effects of gout medications include headache, nausea, vomiting, upset stomach, and diarrhea.

NSAIDs can also cause stomach pain, bleeding, and ulcers. XOIs may also cause rash, fever, and joint pain. Corticosteroids can cause weight gain, mood changes, increased blood sugars, and hypertension. Probenecid can increase your risk of kidney stones.

What are some home remedies for gout?

While medications are the first-line treatment for gout, some lifestyle changes can help manage your condition and help prevent flare-ups.

These changes include:

• Drink plenty of water to stay hydrated.
• Exercise regularly for weight loss or to maintain a healthy weight.
• Avoid purine-rich foods. This includes red meat, organ meat (liver), anchovies, sardines, and tuna.
• Limit alcoholic drinks as well as those high in fructose (soda).

Frequently asked questions about gout

What’s the best way to manage an acute gout attack?

If you have medications prescribed by your doctor, take them at the first sign of an attack. You should also:

• Apply an ice pack to the affected joint(s) to help reduce swelling and inflammation.
• Elevate the joint(s) if possible to reduce swelling.
• Rest the affected joint.
• Avoid alcohol and soda.
• Drink plenty of water.

Why do gout attacks happen more often at night?

Experts are unsure as to the exact reason why attacks happen more often at night but some of the leading ideas are dehydration, lower body temperature, and changes in hormone levels during sleep.

What are the complications of gout?

Gout is a chronic disorder that can cause some serious complications, especially if left uncontrolled. These include joint damage, stiffness, and deformity, as well as an increased risk of kidney stones and kidney disease. It can also cause emotional distress from living with chronic and sometimes constant pain.

What increases your risk of developing gout?

Gout has a genetic link. From 20% to 80% of those with this condition have a family history of the disease. Diets high in purines, male gender, being overweight, lead exposure, and alcohol consumption are other risk factors.

Are there medications that increase the risk of gout?

Certain medications can trigger gout symptoms. Some of these include:

• Diuretics
• Aspirin
• Cyclosporine
• Vitamin B3 (niacin)
• Beta-blockers
• ACE inhibitors
• Levodopa

Related resources for gout

• Gout Symptoms and Causes. MayoClinic
• Gout overview. Cleveland Clinic
• What is gout? Centers for Disease Control and Prevention
• Overview of gout. National Institute of Arthritis and Musculoskeletal and Skin Diseases
• Gout Pictures Slideshow: Causes, Symptoms, and Treatments of gout. WebMD
• Gout fact page. Rheumatology.org