Once a diagnosis of gout has been confirmed, treatment is aimed at achieving the following:
- Alleviation of symptoms such as pain, swelling, inflammation and tenderness in the affected joint.
- Prevention of recurring gout attacks, which can cause progressive and permanent joint damage. This is achieved by reducing the blood levels of uric acid.
Alleviation of symptoms
- Pain relief can be achieved using self care, home remedies and medication. The joint should be completely rested and the relevant limb raised and kept cool by placing an ice pack over it. The ice pack should be applied for around 20 minutes, although not directly to the skin as this can cause ice burns.
- Medications include anti-inflammatories and pain relievers. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used, which reduce both pain and inflammation. Examples of drugs in this class include diclofenac and naproxen.
For people who cannot take NSAIDs due to side effects or because the drugs are ineffective, colchicine can be used instead. This agent is not a pain reliever but acts by reducing the ability of the urate crystals to cause inflammation of the joint lining, therefore indirectly relieving the pain associated with a gout attack. However, colchicine can cause side effects such as diarrhea, vomiting and abdominal pain.
- Corticosteroids are used to reduce joint inflammation in severe cases of gout. Corticosteroids can be injected directly into the affected joint to provide relief from pain and inflammation.
Preventing recurrent attacks
Patients with gout are advised to decrease their intake of foods rich in purines, which increase the uric acid level. Examples of purine rich foods include red meats such as beef, pork, lamb; offal including liver, kidneys and heart; game meats such as rabbit, and venison; seafoods such as shellfish, mussels, crab, shrimp; oily fish such as herring, mackerel, sprats, whitebait, anchovies, sardines and trout and pulses and legumes such as dried beans and peas. Foods or supplements containing yeast should also be avoided, as should alcohol. A healthy body weight should be maintained and regular exercise should be preformed. Patients should also ensure they are well hydrated by consuming adequate amounts of water.
Sometimes, crystals in the joints clump together to form lumps called tophi. These tophi can eventually cause irreversible damage to the joint cartilage and adjacent bone, causing pain and stiffness whenever the joint is used. For those experiencing frequent gout attacks or where there is X-ray evidence of tophi, medications may be used to reduce the blood uric acid level. This is called urate-lowering therapy and the aim is to lower uric acid levels enough to prevent crystals forming and also dissolve any existing crystals.
Drugs used for this purpose include:
- Allopurinol, which inhibits the enzyme xanthine oxidase to prevent conversion of purines into uric acid. Allopurinol can be taken as a pill once daily.
- Febuxostat, which also acts by inhibiting the enzyme xanthine oxidase. However, this drug is a safer option than allopurinol for patients with kidney damage.
- Other agents that help the kidneys to excrete excess uric acid from the body include probenecid, sulphinpyrazone and benzbromarone.
Reviewed by Sally Robertson, BSc