How is gout treated?

How is gout treated?

Once a diagnosis is made, a doctor is likely to prescribe medications which treat the painful symptoms of the condition. Medications can target the acute effects of an attack and help to reduce risk of tissue and joint damage in the process.

Medication use for gout is generally broken down into the following categories:

  • Uric (urate) acid lowering medication treatment (targeting the amount of uric acid in the body, lowering serum uric acid and preventing tophi formations)
  • Prophylactic medication treatment (used in conjunction with uric acid lowering medications and helps to decrease flare frequency – medications may be prescribed for use over a 6-month period)
  • Rescue medication treatment (provides immediate symptom relief during the worst of a gout attack)

Before medications are recommended a doctor will take into consideration any co-existing health conditions which may result in worsening symptoms and complications, such as hypertension (high blood pressure), high cholesterol, diabetes, and kidney or liver disease.

Other medications which may be recommended include:

  • NSAIDs (non-steroidal anti-inflammatories): A variety of over-the-counter medications, such as ibuprofen or naproxen sodium, as well as stronger prescription drugs may be recommended to alleviate the pain and inflammation caused by acute gout attacks. Higher doses may be recommended to stop an acute attack, after which doses may be lowered so as to reduce the risk of a future flare down the line. It is advisable to only use the recommended doses so as to avoid unwanted side-effects such as abdominal (stomach) pain, the development of ulcers, kidney function problems and internal bleeding. It is not advisable to use aspirin for the treatment of gout.
  • Colchicine (Colcrys / Mitigare): This type of pain-reliever has proven effective for treating the effects of gout. Low daily doses may be prescribed once the sufferer is over the worst of an acute gout attack. This is to lower the risk of future attacks and better manage the condition. This medication aids in the management of the symptoms of gout, but does not target levels of uric acid in the system. Side-effects can include nausea, vomiting and diarrhoea.
  • Corticosteroids: These medications, which include drugs such as Prednisone and may be administered in pill form or as an injectable, can help to keep inflammation and pain under better control. They may be prescribed as an alternative to NSAIDs or colchicine. High doses may be prescribed initially and then tapered off. Side-effects of these medications include elevated blood sugar and blood pressure levels as well as mood changes.
  • Probenecid (Benemid): This medication can assist in expelling excess uric acid from the body. A doctor will likely advise drinking plenty of water when taking this medication in order to help flush out the system and prevent uric acid kidney stone formations.
  • Allopurinol: This medication targets uric acid in the body and can help to lower levels in the system. The medication may cause side-effects of abdominal pain, diarrhoea, rash and headache. If fever and a rash develop, a doctor will advise that use of the medication be discontinued. Some have experienced hypersensitivity which can cause serious complications, such as liver, kidney or bone marrow failure (all of which can be life-threatening).
  • Febuxostat (Uloric): This medication also targets the formation of uric acid in the system, lowering levels considerably.
  • Pegloticase (Krystexxa): This medication is administered intravenously and is normally prescribed for chronic gout (in adults). It helps to break down uric acid in the body, making it easier for the substance to be eliminated through the urinary system. A doctor will monitor the effects of use as some can experience serious allergic reactions (anaphylaxis).

Surgical treatment for gout

Extensive damage to affected joints can sometimes be treated surgically, although this is rarely needed. Tophi (deposits of uric acid crystals causing deformity and joint damage) can be surgically removed.

Are follow-up consultations necessary?

Yes, a doctor is likely to recommend periodic follow-ups for gout (gouty arthritis). Once a diagnosis is made, treatment effectively covers two stages – first to manage symptoms of acute gout attacks (flares) and secondly to prevent or reduce risk for future painful episodes. From there an evaluation may be requested to assess the use of medications to potentially help manage levels of uric acid in the body (on a chronic basis).

Gout complications - What can go wrong?

Potential problems or complications can be better managed if a person is under treatment. Even so, some may experience more severe ailments or side-effects.

Some health problems to be mindful of include:

  • Recurrent gout: One attack can lead to another, sometimes several times in an annual period. If evaluated and diagnosed by a medical doctor, attack frequency can be better managed and potentially avoided altogether with the use of medication. Managing gout effectively can help to avoid complications of joint and tissue damage and erosion (which can be permanent).
  • Advanced gout: Untreated, advanced symptoms of gout can result in the development of tophi, which can occur in more than one joint in the body. Tophi nodules can develop in the hands, fingers, elbows, feet and Achilles tendons (at the back of the ankles). Nodules are not normally painful, but they are unsightly and can become swollen and a little tender to the touch, especially during a gout attack.
  • Kidney stones: Uric acid in the system can form crystals which may accumulate in a person’s urinary system. This can result in of the formation of kidney stones. Any sign of kidney stones should be evaluated and diagnosed by a medical doctor so that effective medical treatment can resolve the complication safely.
  • Medication side-effects: Some may experience adverse reactions to medications taken for the treatment of gout, including a severe allergic rash (Allopurinol), severe nausea, diarrhoea, muscle weakness, an abnormal blood count, kidney function impairments, liver function problems, and ulcers.

Close-up of advanced gout (formation of tophi).

Signs that gout is becoming worse

If left untreated or treatment measures aren’t effective, the following signs and symptoms may indicate that a person’s condition is worsening and they should seek medical intervention as soon as possible:

  • Frequent and longer lasting or intense gout attacks (flare-ups).
  • Gout attacks which occur in other parts of the body, such as the ankles or knees, and not just limited to the joint at the base of the big toe.
  • The development of tophi (deposits of crystallised uric acid and substances at the surface of a joint or in skin or cartilage).
  • Signs of kidney damage (kidney stones, gouty kidney and kidney failure).

Close-up of female feet, pain-free.

Outlook for gout

Considered a chronic condition, if treatment is implemented, gout can be very well managed. Treatment is critical if intense and often disabling attacks as well as irreversible damage to the joints and tissues affected by the symptoms of gout are to be avoided. Once diagnosed and under treatment, most respond well and experience very few associated health problems and complications.

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