Medicines To Prevent Recurrent Gout Attacks
If you have repeated attacks of gout, your doctor may recommend preventive medication. This helps to prevent further attacks of gout and damage to your joints and organs such as your kidneys.
Because gout is caused by raised uric acid levels in the blood, preventive medications work by reducing uric acid levels. This is also called urate lowering therapy.
The goal of these medicines is to reduce the uric acid levels below 0.36mmol/L. If the uric acid level is kept at this level long-term, the gout crystals will dissolve, and the risk of gout attacks and joint damage from gout will gradually reduce. The options include:
Can Diet Make A Difference
Your doctor may recommend that you limit foods that may hike uric acid levels. That includes organ and red meats, shellfish , alcohol , and sugar and high-fructose corn syrup.
According to the ACR, purine-rich vegetables like mushrooms and spinach should be fine, and low-fat dairy foods may help lower uric acid levels. But even with a gout-preventing diet, most people see, at best, a modest decline in uric acid levels, Shoor says. So if youre on ULT, sticking to your regimen is key.
Editors Note: A version of this article also appeared in the January 2021 issue of Consumer Reports On Health.
Sally Wadyka
Sally Wadyka is a freelance writer who contributes to Consumer Reports, Real Simple, Martha Stewart Living, Yoga Journal, and the Food Network on topics such as health, nutrition, and wellness.
Risk Factors For Gout
Gout is more likely to occur in:
- Men. Men have a seven to nine times higher risk of gout than women, although the risk increases for women after menopause
- People with a diet high in purine-rich foods such as red meat, organ meats , seafood . Processed foods , refined carbohydrates and beverages high in fructose or sucrose also contribute to gout
- Certain ethnicities
- People who overindulge in alcohol, particularly beer and spirits
- People with certain medical conditions , and with some medications or treatments .
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How Should I Use Allopurinol
Take allopurinol exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.
Take allopurinol oral with a full glass of water. To reduce your risk of kidney stones forming, drink 8 to 10 full glasses of fluid every day, unless your doctor tells you otherwise.
If this medicine upsets your stomach, take allopurinol oral after a meal.
Allopurinol injection is given as an infusion into a vein if you are unable to take the medicine by mouth. A healthcare provider will give your first dose and may teach you how to properly use the medication by yourself.
You may need to mix the injection with a liquid in an IV bag. When using injections by yourself, be sure you understand how to properly mix and store the medicine. Ask your doctor or pharmacist if you don’t understand all instructions.
Prepare an injection only when you are ready to give it. Do not use if the medicine has changed colors or has particles in it. Call your pharmacist for new medicine.
You may need frequent medical tests. Even if you have no symptoms, tests can help your doctor determine if allopurinol is effective.
You may have gout attacks more often when you first start taking this medicine oral. Your doctor may recommend other gout medication to take with allopurinol. Keep taking the medicine as directed.
Store at room temperature away from moisture and heat.
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Vitamins And Minerals For Gout
Vitamins and minerals for gout will not only help alleviate the symptoms of gout, they will also help to improve the disbursement of uric acid from the body.
Vitamin C helps to reduce uric acid levels.
Vitamin E has anti-inflammatory properties.
Potassium, B-complex and calcium help to excrete uric acid from the body.
Before Taking This Medicine
You should not use febuxostat if you are allergic to it, or if you also use:
-
azathioprine or
-
mercaptopurine.
Taking febuxostat may increase your risk of serious or fatal heart problems. Talk with your doctor about the risks and benefits of febuxostat.
Tell your doctor if you have ever had:
-
heart problems
-
an organ transplant .
Tell your doctor if you are pregnant or breastfeeding.
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How To Treat Gout
It can be excruciating, and many sufferers go undertreated. But you can prevent the pain.
The word gout may make you think of overweight Victorian-era royalty with overly rich diets. But this common form of inflammatory arthritis, which leads to pain and swelling in one or more jointsespecially in the lower bodyaffects people even in the modern era. In fact, more than 9 million adults in the U.S. have been diagnosed with the disease, which occurs when the body produces too much uric acid or the kidneys dont excrete enough.
That surplus forms crystals in and around joints, eventually causing flares or attacks. People with high levels of uric acid can be accumulating crystals and damage to the joints for years before they have their first gout attack, says Larry Edwards, MD, a professor of medicine at the University of Florida.
Gout is on the rise, says John FitzGerald, MD, a professor of medicine at the David Geffen School of Medicine at UCLA and an author of guidelines from the American College of Rheumatology about gout management.
A genetic predisposition, diabetes, kidney disease, and other health problems may increase the chance of developing it. The growing number of people with metabolic syndrome and obesity is increasing the risk of gout, says FitzGerald, adding that some of the treatments for the conditions mentioned above may also raise the risk.
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The Right Treatment Plan
Over-the-counter medications such as ibuprofen , prescription anti-inflammatory drugs like colchicine , and prescription steroids like prednisone can help reduce joint pain and swelling during an acute attack or flare.
Long-term, your doctor may recommend urate-lowering therapy , which means taking medications such as allopurinol and febuxostat daily. There is the possibility of future damage to your joints if you dont control it, says Stanford Shoor, MD, a clinical professor of medicine and rheumatology at Stanford University.
ACR recommends ULT if you have tophi or evidence of joint damage, or if youve had two or more attacks in a year. But whether or not you start ULT after one attack depends a bit on how much we think youre going to have future attacks, FitzGerald says. If you dont have kidney disease or very high uric acid levels, it may be years before you have another attack, and you might not want to go on daily therapy.
The standard of care generally calls for whats called treat to target, starting with a low dose of ULT and adjusting it until your uric acid levels drop to a specific level. Newer ACR guidelines strongly recommend treatment that keeps uric acid concentrations below 6 mg/dL, which is low enough to keep the acid from crystallizing.
What Happens At Your Appointment
The GP may ask about your diet and if you drink alcohol.
They may refer you to see a specialist and arrange a blood test and scan. Sometimes a thin needle is used to take a sample of fluid from inside the affected joint, to test it.
The blood test will find out how much of a chemical called uric acid there is in your blood.
Having too much uric acid in your blood can lead to crystals forming around your joints, which causes pain.
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Medication Options For Uric Acid Lowering
It is important to note that whenever starting a uric acid lowering treatment, there is a risk of precipitating a gout flare. A plan should be in place for management if this occurs. This generally can be avoided with the co-administration of prophylactic medications along with the uric acid lowering therapy.
Probenecid
Probenecid may be given to patients with decreased clearance of uric acid by the kidney and normal renal function. In general its use should be limited to patients under the age of 60. Probenecid acts by inhibiting reabsorption of uric acid in the proximal tubules of the kidney. Starting dose is at 500 mg to 1000 mg daily and increased to 1500 mg to 2000 mg as needed. Occasionally higher doses are needed. Probenecid may precipitate renal stone formation and good oral hydration should be encouraged. Probenecid is contraindicated in patients with renal stones and in patients with urate nephropathy. Probenecid given inappropriately to patients with hyperuricemia due to overproduction of uric acid can cause renal stones and urate nephropathy.
- uricosuric
- useful in patients with decreased renal clearance of uric acid
- can only be used if creatinine clearance > 40 cc/min
- must have 24 hour urine for uric acid < 800 mg/dl
- can be used in renal failure
- increased risk of renal stones
Allopurinol
Pegloticase
- pegylated porcine uricase
Elevating The Affected Joints
Gout can cause pain and swelling, especially in the feet, hands, knees, and ankles.
One way to reduce swelling is by elevating the affected joints. This encourages blood and fluid to move away from the joint and back toward the heart.
A person can also use an ice-pack in combination with elevation to reduce their gout symptoms.
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Warm Water With Apple Cider Vinegar Lemon Juice And Turmeric
Apple cider vinegar, lemon juice, and turmeric are each frequently recommended anecdotally for gout. Together, they make a pleasant beverage and remedy.
No strong research supports apple cider vinegar for gout, though studies show it may support the kidneys. Otherwise, research is promising for lemon juice and turmeric for lowering uric acid.
Mix juice from one squeezed half lemon into warm water. Combine with 2 teaspoons turmeric and 1 teaspoon apple cider vinegar. Adjust to taste. Drink two to three times per day.
Managing A Gout Flare
Gout flares are unexpected and painful heres how to get a handle on them.
Few things in life are more painful than a gout flare, so if youre awakened in the wee hours by a joint that is tender, swollen, red and radiating heat, youll want to act fast. Heres what you can do when a gout flare starts to ease the pain of and reduce the risk of others.
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Fourth Stage Chronic Tophaceous Gout
Finally, chronic tophaceous gout, or fourth-stage gout, occurs when gout is left untreated for too long. Most people do not get this far with proper medication and treatment. Often taking several years or more than a decade to develop fully, chronic tophaceous gout entails hard nodules called tophi developing in the joints and tissues surrounding the joints.
Over time, tophi can do permanent damage to the joints and is the most debilitating, causing skin ulcers to appear. This is extremely rare and only if left untreated for decades. Tophi also often appear in other parts of the body, such as the fingers and ears. Permanent kidney damage at this point is also a possibility.
Treating Gout Pain With Compounded Pain Creams
Gout is a complicated medical condition that usually affects the feet. It begins with too little uric acid being eliminated out of the body. Excess uric acid in the body builds up and forms crystals in the joints, causing swelling and pain. The pain that typically accompanies sudden gout attacks is intense and can feel as though the foot or joint is on fire. The small joint at the base of the big toe is the most common site for a gout attack. Other joints that can be affected include the ankles, knees, wrists, fingers, and elbows.
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Research And Statistics: How Prevalent Is Gout In The United States
Research published in the journal Arthritis & Rheumatology found that gout rates in the United States have been climbing steadily over the past 50 years, likely because of increases in obesity and high blood pressure.
Gout is the most common type of inflammatory arthritis among men. Its more common in men than women. About 6 percent of men in the United States have gout, while only about 2 percent of women have it. Women rarely develop gout before reaching menopause.
Gout is rare in children and young adults.
What Triggers Gout
Something that causes a flare in one person might not do it in another. But common triggers include:
- Heavy alcohol use, especially drinking beer and hard liquor
- Foods high in purines, including red meat, organ meat , and some seafood, including shellfish
- Sugary sodas and foods with fructose, a type of sugar
- Some drugs used to treat high blood pressure, leg swelling, or heart failure
If you think something may trigger gout for you, talk to your doctor about ways to avoid it.
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What Causes Gout
Gout usually happens when uric acid builds up in the blood . This acid is a waste that your body makes when it breaks down purines, substances found in your body tissue and some foods. Normally, the acid dissolves in your blood, passes through your kidneys, and leaves when you pee.
If your body makes extra uric acid, or if the kidneys canât clear enough of it, the levels of the acid in your blood get too high. With time, the acid forms crystals that get stuck in your joints or soft tissue. Thatâs what causes the painful symptoms.
A first attack of gout may last a week to 10 days. Itâs estimated that almost 85% of people who have it once have another episode within 3 years. Gout often runs in families. So if a parent, brother, or sister has it, you might get it too.
How To Take It
Swallow the allopurinol tablets with water, ideally after food. You’ll usually take it once a day, but if you’re on a high dose, your doctor may advise you to split the dose and take it twice a day.
If your doctor has recommended you take allopurinol with lots of fluid, try to drink 2 to 3 litres of fluids every day.
You can take allopurinol at any time of the day, however, try to take your doses at the same time of day each day.
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Celery Or Celery Seeds
Celery is a food traditionally used to treat urinary issues. For gout, extract and seeds of the vegetable have become popular home remedies.
Experimental use is well-documented, though scientific research is scant. Its thought that celery may reduce inflammation.
Adequate celery amounts for treating gout arent documented. Try eating celery many times per day, especially raw celery sticks, juice, extract, or seeds.
If purchasing an extract or supplement, follow label directions closely.
Avoid Changing Hypouricaemic Therapy
During the treatment of acute gout any sudden change in the concentration of serum uric acid will exacerbate the attack. Patients taking regular hypouricaemic therapy should therefore not stop their treatment. Likewise, hypouricaemic therapy should not commence until after the attack has settled. The use of concurrent low-dose colchicine during the introductory phase of hypouricaemic therapy reduces the frequency of attacks during that relatively high-risk period.
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Take Your Prescription Drugs
If you’ve had a gout attack before, your physician may have prescribed drugs to treat attacks. This may be your first line of defense or you may decide to use them only when NSAIDs fail to relieve your pain.
Prescription medications to treat gout include:
- Prednisolone oral tablets, which has been shown to work as well as NSAIDs and often doesnt cause the same stomach upset. Prednisolone is a type of corticosteroid and does carry other potential side effects, particularly if it is taken for longer than the recommended 5 days.4
- Colchicine, which has been shown effective in reducing pain and inflammation if taken in the first 24 hours of an attack. Always follow your physicians instructions regarding dosing to decrease your risk for potential complications and side effects.
Opioid painkillers, such as codeine, hydrocodone, and oxycodone, are not recommended to treat the pain caused by gout.
See Pain Medications for Arthritis Pain Relief
Take Caution With Supplements For Gout
As for the many supplements and other purported home remedies available for gout, including turmeric and bromelain, there is no significant evidence backing them up as of now, and theres no adequate evidence showing that supplements have any effect even comparable to that of medicines.
From my point of view, says Dr. Fields, the home remedy concept to gout is often harmful because it keeps patients from taking medications that we know are effective.
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