The good news is that although the underlying causes of gout cannot be completely cured, it is a relatively simple condition to treat. With proper care, attacks can be minimised, and the chronic stage delayed or avoided altogether. 

Treatment falls into two categories: 

  • relief treatments are used during an attack and may be taken for a period of time afterwards
  • prevention treatments are long term medications used to prevent further attacks and are taken every day

There are a number of medications for both, some of which have been in use for a long time. 

Relief treatments for gout

An attack of gout is an inflammation in the area around your joint. Your doctor will prescribe a medication aimed to reduce discomfort and pain during the flare.  It is important to note that none of these medications affect your serum uric acid level. 

Colchicine is a treatment which has been in use for hundreds of years. It is actually an extract of a plant known as the autumn crocus. It works to help reduce inflammation at the site of your flare. At high doses, there may be side effects, such as nausea and diarrhoea, but doctors nowadays tend to use lower doses which work well and can be used for longer periods of time.

Non-steroidal anti-inflammatory drugs (nSAIDs) are designed to interrupt your body’s normal response which leads to inflammation. They limit or block the chemicals in your body that cause the inflammation, and therefore reduce pain and swelling. As suggested by their name, they do not contain steroids and are generally used for short to medium periods of time. 

NSAIDs work well if you take them early in a gout attack and can shorten the overall length of your flare. They may also help reduce pain later in an attack. Your doctor may prescribe lower doses for a period of time after your flare.  This can reduce the possibility of future flares. 

These products work well to reduce pain; however they do have some side effects. Common complaints include headaches, dizziness and upset stomach, but more serious problems such as stomach ulcers, bleeding and rashes may occur. 

Steroids are a very effective treatment for acute attacks of gout and can offer a faster reduction of pain and swelling than colchicine or NSAIDs. They can be administered by means of a needle, directly into the site of your flare, or as a short course of tablets. Steroids are generally well tolerated; however some people are unable to take them due to side effects, other treatments or medical conditions where they are not recommended. 

Prevention treatments for gout

Urate lowering treatments (ULTs) work to lower the level of uric acid in your blood. This reduces the likelihood of crystals forming, which in turn prevents further gout attacks and long-term effects such as tophi and joint destruction. 

ULTs generally reduce your serum uric acid levels quite quickly, however if you have had untreated gout for a while it may take a little longer. Unlike treatments for many other arthritic diseases, ULTs offer the possibility of reversing damage and can prevent further development of your gout altogether. 

If you have been prescribed ULTs, you will need to take them every day for the rest of your life. This may seem a daunting prospect at first, however, these medications when taken correctly can greatly help to improve your condition. 

If you stop taking your medication, symptoms are likely to return. 

IMPORTANT

A short-term side effect of ULT treatment may be a gout attack shortly after you start taking it, especially if you have been untreated for some time. The treatment is dissolving urate crystals already present in your joints into uric acid.  This in turn goes back into your blood stream, which can dislodge other crystals causing a new attack. However, if taken every day, the ULT treatment will quickly reduce your uric acid to a level where this will stop happening. To ease any discomfort in the meantime, your doctor may prescribe a ULT plus a relief treatment, such as colchicine, until your uric acid levels are stable. 

Keep Your Uric Acid Down

Like many other chronic conditions, such as diabetes, blood pressure and cholesterol, gout has a target. If you have been diagnosed with gout, the aim of long-term gout treatment is to reduce your serum (blood) uric acid to a concentration of 360μmol/L. Once your doctor gets your uric acid to 360μmol/L they will try to keep it as close to that number as possible. In order to keep it at this number, you will most likely need to take ULT tablets each day for the rest of your life. 

The reason why 360μmol/L is such an important number is that at that blood concentration the following is likely to happen; 

  • dissolving of uric acid crystals in the joint
  • prevention of future crystal formation
  • reduced joint damage
  • prevention of future gout attacks

It is important that you and your doctor know what your blood uric acid concentration is. This is done by carrying out a simple blood test. You will find a helpful gout diary at the back of this booklet that will allow you to monitor your level. 

With the help of your doctor you can... 

…Keep your URIC ACID down!



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