Gout Treatment

The immediate goals for treating a gout flare-up are to reduce intense pain, swelling, warmth, and redness. With proper treatment, gout pain and other symptoms can be under control within 24 hours and completely gone within a matter of days.

Avoid Pressure

During the peak of gout pain, contact with any surface—even a bedsheet, may cause a sharp increase in pain. It is advisable to avoid putting even minor pressure on the joint until this phase has passed.

Rest

It is usually painful to use the affected joint, and resting it will help alleviate pain, swelling, and other symptoms.

Ice

If some pressure can be tolerated, a soft, cool compress applied to the affected joint may help relieve discomfort caused by inflammation.

See 3 Types of Cold Packs for Arthritis

Elevation

Elevate the affected limb to help reduce swelling. If the foot is affected, sit down with the foot resting on a footstool or lie down with the foot propped up on a pillow.

Over-the-counter Anti-inflammatory Medications

Ibuprofen, naproxen, and other nonsteroidal anti-inflammatory medications (NSAIDs) can relieve pain from a gout attack. These medications may be particularly effective if they are taken as soon as the person feels the gout attack coming on. ¹ Schlesinger N. Dietary factors and hyperuricemia. Curr Pharm Des. 2005;11(32):4133-8. Review. PubMed PMID: 16375734.

While NSAIDs are an effective and recommended treatment for many people, they can have a negative effect on the kidneys, reducing their ability to filter out uric acid and increasing the risk of future gout attacks. NSAIDs can also cause gastrointestinal side effects. A doctor can advise whether or not to take NSAIDs and at what dosage.

See Pain Medications for Arthritis Pain Relief

Colchicine

A prescription drug called colchicine was developed to treat gout. Evidence shows that colchicine reduces gout pain, swelling, and inflammation decrease when it is taken within the first 36 hours of an attack. ² Khanna D, Khanna PP, Fitzgerald JD, et al. 2012 American College of Rheuma- tology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken) 2012;64(10): 1447–61. As cited in Sidari A, Hill E. Diagnosis and Treatment of Gout and Pseudogout for Everyday Practice. Prim Care. 2018;45(2):213-236. doi:10.1016/j.pop.2018.02.004 A second, smaller dose should be taken an hour or two later. ³ Terkeltaub RA, Furst DE, Bennett K, et al. High versus low dosing of oral colchicine for early acute gout flare: twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum 2010;62(4):1060–8. As cited in Sidari A, Hill E. Diagnosis and Treatment of Gout and Pseudogout for Everyday Practice. Prim Care. 2018;45(2):213-236. doi:10.1016/j.pop.2018.02.004 ^{, 4} Slobodonick A, Toprover M, Pillinger M. Crystal Arthritis. In: Efthimiou P, ed. Absolute Rheumatology Review. Springer Nature Switzerland AG; 2020; chap 15. Accessed September 15, 2020. https://doi.org/10.1007/978-3-030-23022-7_15

Colchicine should be taken only as directed. Many people taking colchicine experience gastrointestinal side effects, such as vomiting or diarrhea.

Corticosteroids

A doctor may recommend corticosteroid treatment to alleviate inflammation. Corticosteroids may be taken orally or delivered by injection.

Steroid treatment is particularly useful for people with sensitivities to NSAIDs and colchicine.4 Repeated corticosteroid injections and/or long-term oral cortisone treatment can have side effects. Oral steroids should not be taken with NSAIDs. ⁴ Slobodonick A, Toprover M, Pillinger M. Crystal Arthritis. In: Efthimiou P, ed. Absolute Rheumatology Review. Springer Nature Switzerland AG; 2020; chap 15. Accessed September 15, 2020. https://doi.org/10.1007/978-3-030-23022-7_15

See Cortisone Injections (Steroid Injections)

Biologics

While the FDA has not approved biologics drugs to treat gout, ⁴ Slobodonick A, Toprover M, Pillinger M. Crystal Arthritis. In: Efthimiou P, ed. Absolute Rheumatology Review. Springer Nature Switzerland AG; 2020; chap 15. Accessed September 15, 2020. https://doi.org/10.1007/978-3-030-23022-7_15 they may be recommended. They may be particularly appropriate for people who have other medical conditions, such as kidney disease, heart failure, diabetes, and high blood pressure, that prevent them from taking traditional gout medications. ⁵ Liew JW and Gardner GC. Use of anakinra in hospitalized patients with crystal-associated arthritis. J Rheumatol 2019 Oct; 46:1345. (https://doi.org/10.3899/jrheum.181018)

Biologics can target and prevent inflammation from occurring, thereby reducing and possibly eliminating joint pain, swelling, redness. Examples of biologic drugs prescribed for gout include anakinra and canakinumab. ⁴ Slobodonick A, Toprover M, Pillinger M. Crystal Arthritis. In: Efthimiou P, ed. Absolute Rheumatology Review. Springer Nature Switzerland AG; 2020; chap 15. Accessed September 15, 2020. https://doi.org/10.1007/978-3-030-23022-7_15 ^{, 6} Sidari A, Hill E. Diagnosis and Treatment of Gout and Pseudogout for Everyday Practice. Prim Care. 2018;45(2):213-236. doi:10.1016/j.pop.2018.02.004 ^{, 7} Dinarello CA. An expanding role for interleukin-1 blockade from gout to cancer. Mol Med. 2014;20 Suppl 1(Suppl 1):S43-S58. Published 2014 Dec 16. doi: 10.2119/molmed.2014.00232 ^{, 8} Janssen CA, Oude Voshaar MAH, Vonkeman HE, et al. Anakinra for the treatment of acute gout flares: a randomized, double-blind, placebo-controlled, active-comparator, non-inferiority trial, Rheumatology, Volume 58, Issue 8, August 2019, Pages 1344–1352, https://doi.org/10.1093/rheumatology/key402 Biologics tend to cost more than traditional medications.

See Biologics for RA and Other Autoimmune Conditions

Surgery

Gout cannot be cured with surgery. However, if untreated gout leads to the development and buildup of tophi, surgery to remove the tophi may be recommended.

Gout is usually so painful that a person cannot ignore it and will take steps to treat it. Once the symptoms of a gout attack are under control, a person can take steps to lower the uric acid levels in the blood and prevent another attack.