Gout is an acute disease, which usually attacks a single joint, the joint at the base of the big toe being most commonly affected. It can be a very painful condition and treatment of an acute gout attack primarily aims to relieve these symptoms of gout.
This is done with drugs, which include NSAIDs, colchicines, and corticosteroids.
The second aim of treating gout is to prevent further attacks and stopping this condition from going chronic. The reason for this is that ignoring gout can cause certain complications, which should be avoided.
To achieve this goal, you will be advised oral uricosuric agents like probenecid/sulfinpyrazone and Allopurinol for long-term to maintain uric acid levels and prevent gout.
Gout Do’s and Don’ts
Before starting on gout cures, it is necessary to know and pursue the following. They are discussed separately, but a short mention is required here.
- Follow healthy lifestyle habits: Drink plenty of water, avoid alcohol and avoid being overweight.
- Stick to a diet that is not rich in purines. It is the purine in our body cells that is converted into uric acid when it gets broken down.
- Know the causes and risk factors that can trigger an attack of gout and if any are applicable in your case, have them corrected.
- Give as much rest to the affected joint as possible.
- Keep the limb elevated above chest level when sleeping or sitting, to reduce swelling.
- Take care to avoid trauma to the joint.
- Keep ice packs on the affected joints for not more than 15 minutes at a time. The ice should be covered in an ice pack bag or a towel. Do not keep the ice directly on the joint. Do it 2 to 3 times a day. This will help to relieve symptoms.
- During the day, you could wrap a cotton bandage around the swollen limb.
- Drink plenty of fluids.
- Control your weight with diet and physical activity.
- Avoid alcohol, especially beer.
- Eat less of red meat, organ meat, and seafood.
Medications for an acute gout attack
It can be quite testing for your doctor to treat gout because medicines need to be changed and doses frequently adjusted from individual to individual. Choice of drugs and their dosages vary from person to person.
Gout cure, therefore, requires regular follow-ups to your physician until he is satisfied that the right gout medicine and dosage are established.
One aim of gout cure, as mentioned above involves the use of medicines that will give relief from symptoms, which are pain, swelling, and tenderness. Fever may also be present.
The joint pain from gout usually subsides anytime within three to ten days, but with medication, you will feel better more quickly.
Your doctor will prescribe anti-inflammatory drugs such as NSAIDs or colchicines in low doses to be taken regularly for six weeks or 12 months.
NSAIDs (nonsteroidal anti-inflammatory drugs ) are the first drugs of choice, which give relief from pain and swelling and shorten the duration of a gout attack.
These medicines should be taken as prescribed during the attack and are to be continued for 48 hours even after the attack has subsided. The list of these drugs is long, but to mention a few:
- Aspirin is avoided in gout because it causes abrupt changes in uric acid levels and can worsen the symptoms.
- Ibuprofen (Motrin)
- Diclofenac (Voltaren)
- Naproxen (Naprocen)
- Indomethacin (Indocin)
NSAIDs block the action of certain enzymes, which are responsible for the formation of certain chemicals in the body called prostaglandins. Prostaglandins promote pain, inflammation, and fever. Blocking the action of the enzymes prevent the formation of prostaglandins, thereby giving relief from inflammation, pain, and swelling.
These drugs are to be avoided in patients having kidney diseases, bleeding disorders, indigestion and stomach ulcers.
Colchicine is used when NSAIDs are contraindicated for some reason. It is very effective for relieving gout pain especially when taken immediately at the onset of gout pain. They give relief within 12 to 24 hours.
Colchicine also helps to prevent further attacks when continued in low doses. It is also used when necessary with other medicines for gout such as probenecid and allopurinol.
Colchicine does not lower the uric acid levels but interferes with the formation of uric acid crystals, thereby reducing inflammation.
A short course of corticosteroids such as dexamethasone or prednisolone (prednisone 30-40 mg/d for 5 days) or its derivatives is recommended when NSAIDs or colchicines fail to yield results or are contraindicated in patients who have kidneys diseases or peptic ulcer or bleeding disorders.
They may be given as oral pills or by injection, either intramuscular or intravenous depending on the severity of the gout attack.
Corticosteroids are also injected directly into the affected joint when the inflammation is very severe. This is done when only one joint is involved. Steroids are given over a short period of time of 5 days and then taken off in tapering doses.
Corticosteroids are useful in stubborn gout cases and give rapid relief by reducing the inflammation and thereby the pain.
Medicines to prevent further gout attacks
These long-term medications are advised:
- If you have had more than one gout attack in a year or
- If your affected joint is damaged by gout or
- You have tophi in your affected joint
Uricosuric agents: Probenecid and Sulfinpyrazone
Probenecid and Sulfinpyrazone are used in gout therapy to help prevent further attacks of gout.
These drugs are not given during an acute gout attack but are primarily used to prevent recurrence after the acute attack of gouty arthritis has subsided.
They are, however, continued even during an acute attack if the patient is already taking them. These drugs help to prevent gout attacks but do not cure the gout attack. Required results are obtained in only 75% of the cases.
These drugs lower serum uric acid levels by increasing the excretion of uric acid through the urine. They thus prevent the formation of uric acid crystals in the joints.
These gout medicines are contraindicated
- in patients having kidney disease or stones in the genitourinary tract,
- in cancer patients who are on radiotherapy and/or chemotherapy,
- those on maintenance doses of aspirin.
While uricosuric agents lower uric acid levels by increasing their excretion through the kidneys, Allopurinol lowers uric acid levels by blocking its formation.
It does this by blocking the release of xanthine oxidase, which is responsible for the formation of uric acid in the body. It also helps to lower tophi, which are uric acid nodules formed under the skin.
Allopurinol is indicated after an attack of acute gout has subsided. However, if acute gout develops when you are already on allopurinol, allopurinol therapy is continued.
Allopurinol is contraindicated in people who develop sensitivity to it and in people who have high levels of iron in the blood.