Gout: Treatment Overview
February 28, 2023Gout is a form of inflammatory arthritis that has no cure. There are, however, a number of gout treatment options available.
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Reviewed by the Office of Clinical Evaluation and Policy (OCEP), Evernorth
Gout is a common form of inflammatory arthritis that can cause severe pain and discomfort. While there is no cure for gout, it can be effectively managed with the right treatment plan. There are various treatment options available for gout, including medications and lifestyle changes.
It’s essential to work with a healthcare provider who can develop a personalized treatment plan that is tailored to your specific needs. The right treatment plan can help provide significant symptom relief and improved quality of life.
Continue reading to learn more about gout treatment options.
What is Gout?
Gout is a form of inflammatory arthritis that occurs when high levels of uric acid in the blood cause crystals to form and build up in the joints. This can lead to episodes of severe pain and inflammation, especially in the big toe. However, gout can also affect other joints such as the ankles, heels, knees, wrists, and fingers.
The signs and symptoms of gout can come and go. Some people will experience a gout attack only once, while others will have recurring symptoms. A gout attack can come on suddenly and may last up to 2 weeks, but peaks at 1-2 days after onset. It is often accompanied by symptoms such as swelling, redness, and warmth in the affected joint. A mild fever and limited range of motion of the affected joint can also occur.
Gout Treatment Options
Treatment options include medication, lifestyle changes, and potentially surgery. The goal of gout treatment is to:
- Reduce uric acid levels
- Reduce pain and inflammation
- Prevent gout attacks
- Prevent joint damage
- Improve or continue the ability to carry out daily activities
Medications
Medications may be prescribed to treat gout. Some medications are taken to reduce pain and inflammation, while others are used to help reduce uric acid levels.
Drugs For Relief of Acute Gout Attacks
- NSAIDs. Nonsteroidal anti-inflammatory medications (NSAIDs) can help reduce pain and inflammation caused by gout. NSAIDs include over-the-counter medications like ibuprofen and naproxen, as well as prescription drugs like sulindac and indomethacin. NSAIDs should only be taken short term for an acute gout attack.
- Corticosteroids. Corticosteroids can help reduce inflammation associated with gout. For a gout attack, a healthcare provider may recommend corticosteroids taken orally or directly injected into the affected joint. Corticosteroids include prednisone, methylprednisolone and triamcinolone.
- Analgesics. Acetaminophen is a common over-the-counter analgesic (pain reliever) that can help treat pain caused by gout. However, for severe pain, other analgesics may be considered. Ask your healthcare provider about other pain relievers if you are experiencing severe pain.
- Colchicine: Colchicine is an oral anti-inflammatory drug that can be used to prevent and treat gout attacks.
Drugs For Lowering Uric Acid
If you have several gout attacks per year, tophi (hard, uric acid lumps) or signs of joint damage, your healthcare provider may suggest taking medication to lower uric acid and prevent further complications. Some medications lower uric acid levels by reducing uric acid production. Others improve the removal of uric acid from the body through the kidneys.
- Allopurinol (Zyloprim®). Allopurinol is a xanthine oxidase inhibitor that lowers the body's production of uric acid when taken every day.
- Febuxostat (Uloric®). Febuxostat is a xanthine oxidase inhibitor that works similarly to allopurinol. A healthcare provider may recommend febuxostat in people who are unable to take allopurinol. Febuxostat lowers uric acid production when it is taken orally every day.
- Pegloticase (Krystexxa®). Pegloticase is a relatively newer gout medicine that is given intravenously (IV) every two weeks. It is a biologic drug that is prescribed for gout that hasn't improved with other medications. This drug converts uric acid into allantoin, a substance that the body can easily clear from the body.
- Probenecid. Probenecid is an uricoseric agent taken twice daily that helps the kidneys remove uric acid, but only patients with good kidney function who do not overproduce uric acid should take it.
Lifestyle changes
Lifestyle changes play a crucial role in managing gout and reducing the risk of flare-ups. Some important lifestyle changes include maintaining a healthy weight, limiting alcohol intake, limiting sugary drinks and foods, eating a healthy diet that avoids purine-rich foods (such as red meat, bacon, anchovies, mussels, scallops), managing stress, and staying active. It is also important to drink plenty of fluids, particularly water, which can help flush excess uric acid from the body.
Surgical Options
Surgical options for gout are generally only considered in cases where the condition has caused severe joint damage that cannot be managed with medications or other non-surgical treatments. One surgical procedure that is used as gout treatment is joint replacement surgery, which involves replacing the damaged joint with an artificial joint. This procedure can be effective in relieving pain and improving function in the affected joint.
Other surgical options for gout may include joint fusion, which involves joining two bones together to create a more stable joint, and tophi removal.
Bottom Line
The right gout treatment can reduce the symptoms of gout, such as pain and inflammation. Consult a healthcare provider for the best treatment, as options can vary. Medications and lifestyle changes are often recommended to help manage gout attacks and prevent future ones.
It is important to be proactive in managing gout to prevent future flare-ups and joint damage. By following a treatment plan and making necessary lifestyle changes, people with gout can live active, healthy lives.
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