Treatment

While some medications are used to treat the hot, swollen joint, other medications are used to prevent further attacks of gout. With any of these medications, call your doctor if you think you are having problems from them or if they are not working.

Medicines used to treat acute gout and/or prevent further attacks are as follows:

(1) Nonsteroidal anti-inflammatory drugs (NSAIDs)

o Examples include indomethacin (Indocin), ibuprofen (Advil), and naproxen (Aleve). Newer drugs such as celecoxib (Celebrex) can also be used. Aspirin should not be used for this condition.


o High doses of anti-inflammatory medications are needed to control the inflammation and can be tapered off within a couple of weeks.


o Tell your doctor about your other health problems, particularly if you have a history of peptic ulcer disease or intestinal bleeding, if you are taking warfarin (Coumadin), or if you have problems with your kidney function.


o The primary complications of these medications include upset stomach, bleeding ulcers, and decreased kidney function.

(2) Colchicine


o This medication is given in two different ways, either to treat the acute attack of arthritis or to prevent recurring attacks.


o To treat the hot, swollen joint, colchicine is given rapidly (up to once an hour until symptoms improve, side effects develop, or a maximum of 10 doses is reached). While this approach is often effective, most people develop nausea, vomiting, or diarrhea and so it is currently seldom used for this purpose.


o To help prevent an attack from coming back, colchicine can be given once or twice a day. At this frequency, diarrhea is much less likely to occur. While the chronic use of colchicine can reduce the attacks of gout, it does not prevent the accumulation of uric acid that can lead to joint damage even without attacks of hot, swollen joints.


o Tell your doctor if you have any problems with your kidney or liver function.

(3) Corticosteroids


o Corticosteroids such as prednisone are generally given when your doctor feels this is a safer approach than using NSAIDs.


o When given by mouth, a high dose is used initially and is tapered off within a couple of weeks. It is important to take these medications as prescribed to avoid problems.


o Some complications with the short-term use of corticosteroids include altered mood, elevated blood pressure, and problems with control of glucose in patients with diabetes.


o Corticosteroids can also be injected into the swollen joint. Resting the joint temporarily, after it is injected with steroids, can be helpful.


o Occasionally, corticosteroids or a related compound, corticotropin (ACTH), can also be injected into the muscle or given intravenously.

Medicines in addition to low-dose colchicine used to prevent further attacks of gout and lower the level of uric acid in the blood include the following.

(4) Probenecid


o This medication helps the body eliminate excess uric acid through the kidneys and into the urine.


o You should drink at least 2 liters of fluid a day while taking this medication (to help prevent uric acid kidney stones from forming).


o Advise your doctor if you have kidney problems or a history of kidney stones or if you are taking aspirin. You may need to take allopurinol instead.


o There are a number of drug interactions with probenecid, so you should advise your doctor of your other medications. If you are prescribed a new medication, let your doctor know that you are taking probenecid.

(5) Allopurinol


o This medication decreases the formation of uric acid by the body and is a very reliable way to lower the blood uric acid level. Allopurinol is currently the gold standard of maintenance therapy.


o Advise your doctor if you have kidney problems. Allopurinol can be still used, but the dose may need to be adjusted.


o Common side effects include stomach pain, headache, diarrhea, and rash.


o Discontinue allopurinol if you develop a rash or a fever, and call your doctor.


o A very rare risk of allopurinol hypersensitivity exists. This problem can cause a severe skin rash, fever, kidney failure, liver failure, bone marrow failure, and can be fatal.


o Advise your doctor if you are taking azathioprine, 6-mercaptopurine, or cyclophosphamide; dose adjustments of allopurinol may be needed.


o Ampicillin is more likely to cause a rash if you are taking allopurinol.


(6) Febuxostat (Uloric)


o Febuxostat is first new medication developed specifically for the control of gout in over 40 years.


o Febuxostat decreases the formation of uric acid by the body and is a very reliable way to lower the blood uric acid level.


o Febuxostat can be used in patients with mild to moderate kidney impairment.


o Febuxostat should not be taken with theophylline, 6-mercaptopurine (6-MP), or azathioprine.

It is important to understand that these maintenance medications are used to lower the uric acid well below normal to prevent recurrent gouty arthritis attacks. Generally, doctors want the blood uric acid level to be below 6.0 mg/dL.