Treatment Overview

The goals of treatment for gout are rapid pain relief and prevention of future gout attacks and long-term complications, such as joint destruction and kidney damage. Treatment includes medicines and steps you can take at home to prevent future attacks.

Initial treatment

Gout is treated with medicines to relieve symptoms and measures to eliminate causes. Specific treatment depends on whether you are having an acute attack or are trying to prevent future attacks.

To reduce the pain, swelling, redness, and warmth of the affected joint(s) in an acute gout attack:

• Rest the affected joint(s).
• Take one or more of the following medicines at the first sign of a gout attack, as prescribed by your doctor.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or indomethacin. Avoid aspirin because it may abruptly change uric acid levels in the blood and may make symptoms worse.
  • Colchicine
  • Corticosteroids

To prevent recurrent attacks:

• Take a medicine that reduces uric acid levels in the blood, which reduces the risk of future attacks.
  • Uricosuric agents increase elimination of uric acid by the kidneys.
  • Allopurinol decreases production of uric acid by the body.
• Take steps to reduce the risk of future attacks.
  • Control your weight. Being overweight is a risk factor for gout. If you are overweight, a diet that is low in fat may help you lose weight. But very low-calorie diets increase the amount of uric acid produced by the body and may bring on a gout attack. For more information, see the topic Weight Management.
  • Limit alcohol, especially beer. Alcohol can reduce the release of uric acid by the kidneys into your urine, causing an increase of uric acid in your body. Beer, which is rich in purines, appears to be worse than some other beverages that contain alcohol.¹
  • Limit meat and seafood. Diets high in meat and seafood (high-purine foods) can raise uric acid levels.
  • Talk to your doctor about the medicines you take. Certain medicines that are given for other conditions reduce the amount of uric acid eliminated by the kidneys. These include pills that reduce the amount of salt and water in the body (diuretics, or "water pills") and niacin. Regular use of low-dose aspirin may raise the uric acid level. Since low-dose aspirin may be important for the prevention of stroke or heart attack, your doctor may want you to continue to take low-dose aspirin.
  • Follow a moderate exercise program.

If your doctor prescribes medicine to lower your uric acid levels, be sure to take it as directed. Most people continue to take this medicine for the rest of their lives.

If the blood uric acid is high but a person has never had an attack of gout, treatment is rarely needed. But people with extremely elevated levels may need regular testing for signs of kidney damage, and they may need long-term treatment to lower their uric acid levels. Your blood uric acid level may be watched by your doctor until it is lowered to normal levels.

Ongoing treatment

If you have previously had a gout attack, you are likely to have another, especially if you are not managing the disease with medicines or other treatment. The goal of treatment is to prevent future attacks, to reduce high levels of uric acid (hyperuricemia), and to identify and treat the causes of your hyperuricemia. Your doctor will review your health history and current health status to identify other medical conditions and medicines that could be causing the elevated uric acid levels. Factors such as alcohol consumption, diet, and body weight can be modified to lower your uric acid levels and reduce the risk of future gout attacks.

To reduce the pain, swelling, redness, and warmth of the affected joint(s) in an acute gout attack:

• Rest the affected joint(s).
• Take one or more of the following medicines at the first sign of a gout attack, as prescribed by your doctor.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or indomethacin. Avoid aspirin because it may abruptly change uric acid levels in the blood.
  • Colchicine
  • Corticosteroids

To prevent recurrent attacks:

• Take a medicine that reduces uric acid levels in the blood, which reduces the risk of future attacks.
  • Uricosuric agents increase elimination of uric acid by the kidneys.
  • Allopurinol decreases production of uric acid by the body.
  • Colchicine is often prescribed to prevent flare-ups during the first months that you are taking uric acid-lowering medicines.
• Take steps to reduce the risk of future attacks.
  • Control your weight. Being overweight is a risk factor for gout. If you are overweight, a diet that is low in fat may help you lose weight. But very low-calorie diets increase the amount of uric acid produced by the body and may bring on a gout attack. For more information, see the topic Weight Management.
  • Limit alcohol, especially beer. Alcohol can reduce the release of uric acid by the kidneys into your urine, causing an increase of uric acid in your body. Beer, which is rich in purines, appears to be worse than some other beverages that contain alcohol.¹
  • Limit meat and seafood. Diets high in meat and seafood (high-purine foods) can raise uric acid levels.
  • Making changes in your diet may help with your gout. If you want to try an eating plan for gout, see:

    Gout: Changing your diet.

  • Talk to your doctor about the medicines you take. Certain medicines that are given for other conditions reduce the amount of uric acid eliminated by the kidneys. These include pills that reduce the amount of salt and water in the body (diuretics, or "water pills") and niacin. Regular use of low-dose aspirin may raise the uric acid level. Since low-dose aspirin may be important for the prevention of stroke or heart attack, your doctor may want you to continue to take low-dose aspirin.
  • Follow a moderate exercise program.

Long-term medication treatment depends on how high your uric acid levels are and how likely it is that you will have other gout attacks in the future. If your doctor prescribes medicine to lower your uric acid levels, be sure to take it as directed. Most people continue to take this medicine for the rest of their lives.

Treatment if the condition gets worse

Gout can usually be successfully treated by eliminating its causes and taking medicines to relieve symptoms. But if gout symptoms have occurred off and on without treatment for several years, they may become ongoing (chronic) and may affect more than one joint. Uric acid crystals may have built up in the joints to form gritty, chalklike nodules called tophi. Treatment of gout that has advanced to this stage includes medicines.

• Take one or more of the following medicines, as prescribed by your doctor:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or indomethacin. Avoid aspirin, which may abruptly raise uric acid levels in the blood.
  • Colchicine
  • Corticosteroids
• If you are having pain in the joints from an attack, your doctor may prescribe:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or indomethacin. Avoid aspirin, which may abruptly raise uric acid levels in the blood.
  • Colchicine.
  • Oral corticosteroids, such as prednisone or medrol.
  • A shot of corticosteroids in a muscle.
  • A shot of corticosteroids directly into the painful joint.

• To prevent recurrent attacks, you may be prescribed:
  • Uricosuric agents to increase elimination of uric acid by the kidneys.
  • Allopurinol to decrease production of uric acid by the body.
  • Colchicine to prevent flare-ups during the first months that you are taking uric acid-lowering medicines.

Treatment to eliminate tophi includes:³

• Allopurinol medication, which may shrink the tophi until they disappear.
• In rare cases, surgery to remove large tophi that are causing deformity.

What To Think About

After an acute attack of gout, talk with your doctor about the causes of the elevated uric acid levels in your blood. A review of your overall health may reveal diseases, medicines, and habits that could be contributing to your uric acid levels.

Most doctors will wait several days to weeks after a gout attack is over to begin medicine to lower the high uric acid levels. These medicines can cause uric acid stored elsewhere in the body to begin moving through the bloodstream and could make symptoms worse if treatment begins during a gout attack.

If there is swelling that causes pressure in a large joint such as a knee or ankle, your doctor may relieve the pain and pressure by aspiration, in which a needle is inserted into the joint and fluid is drawn out (aspirated) with a syringe connected to the needle.⁴