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What Do You Do To Treat Gout

Medications For Acute Gout

How to Prevent & Treat Gout | Foot Care
  • Non-steroidal anti-inflammatory agents and COX-2 inhibitors are the mainstay of therapy of acute attacks of gout in patients who have no contra-indication to them. These medications include such agents as naproxen , ibuprofen , celecoxib , indomethacin and many others. These agents reliably decrease the inflammation and pain of gout. However, patients with ulcers, hypertension, coronary disease, and fluid retention must be careful with these agents, even for the short courses needed to resolve a gout attack. The doses of non-steroidal anti-inflammatory agents needed to resolve a gout attack are on the higher side, since full anti-inflammatory effect is needed. See examples of dosage in Table 2. Over-the-counter dosage levels, for example, ibuprofen at 200mg, two tabs three times a day, are often insufficient.
  • Corticosteroids, such as prednisone and methylprednisolone , are anti-inflammatory agents that are quite effective against gout attacks. Anti-inflammatory steroids are very different in action and side-effects as compared to male hormone steroids. Anti-inflammatory steroids have long-term risks, such as bone thinning and infection, but their risk for short-term therapy is relatively low. These agents can raise blood pressure and blood sugar, so can be a problem for those with uncontrolled hypertension or uncontrolled diabetes mellitus.
  • When To Get Help For A Gout Flare

    It’s always a good idea to let your doctor know that you are having a flare. Sometimes, you may need to follow up to make sure your treatment plan is working or if your symptoms don’t improve. Call your doctor if:

    This is your first flare-up. There are several other conditions, such as a joint infection, that have some of the same symptoms as gout attacks.

    You have a highfever and chills. Gout attack symptoms may include a mild fever, but a higher temperature may be a sign of an infection.

    Your symptoms don’t get any better after 48 hours or don’t end after about a week. If you don’t start to feel somewhat better after a few days, call your doctor. They may suggest a different treatment. Most gout attacks will go away by themselves in several weeks, even without treatment.

    Show Sources

    Rebecca Manno, MD, MHS, assistant professor of medicine, division of rheumatology, Johns Hopkins University School of Medicine.

    Robert T. Keenan, MD, MPH, assistant professor of medicine, division of rheumatology and immunology, Duke University School of Medicine.

    Scott Zashin, MD, clinical professor of medicine, University of Texas Southwestern Medical School attending physician, Presbyterian Hospital.

    Lan Chen, MD, PhD, attending rheumatologist, Penn Presbyterian Medical Center.

    Gout and Pseudogout Treatment & Management: “Treatment.”

    Johns Hopkins Arthritis Center: “Gout — Treatments for Gout.”

    Merck Manual: “Gout.”

    How To Take Colchicine

    • Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about colchicine and will provide you with a full list of the side-effects which you may experience from taking it.
    • You must take colchicine exactly as your doctor tells you to. Most doctors will recommend that when a gout attacks starts, you should take one tablet 2-4 times a day until the pain eases. It is important that you do not take more than 12 tablets of colchicine as a course of treatment during any one gout attack. It is also important that you leave at least three days between courses of colchicine. If you find you are having frequent attacks of gout, please let your doctor know about this.
    • If you have recently been prescribed a medicine to prevent gout attacks and you have been given colchicine to prevent a flare-up attack of gout, the usual dose for this is one tablet twice each day.
    • Take colchicine tablets with a drink of water.
    • If you forget to take a dose, take it as soon as you remember unless it is nearly time for your next dose, in which case leave out the missed dose. Do not take two doses together to make up for a forgotten dose.

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    Home Remedies For Gout

    Gout is a fairly common problem that affects people across the planet. It is caused by an excess of uric acid, which then transforms into tiny crystals in the joints. These tiny needle-like crystals dig into the soft tissues of the joints, causing inflammation and often considerable pain.

    The excess uric acid is often a result of eating a diet that contains a lot of seafood, red meats, and organs. As such, avoiding these foods in your diet can help to overcome gout.

    There are also various remedies that can help to at least reduce the severity of the symptoms. Hereâs a look at just a few remedies that can help to treat your gout.

    How To Get Rid Of Gout Fast

    How to Treat Gout Naturally and Prevent Gout Attacks

    Gout is a painful type of arthritis that feels similar to the pain experienced with rheumatoid arthritis, as both diseases cause inflammation in the joints.

    Gout is caused by a buildup of uric acid in the blood.

    When the body cannot get rid of the excess uric acid, that buildup ends up accumulating as crystals in a joint, such as the big toe.

    This creates swelling, redness, warmth, and severe joint pain in the affected area.

    This condition has historically been seen as a disease that only affects old, wealthy men.

    About 4% of Americansmore than 8 million peoplesuffer from gout.

    Since gout can be caused by genetic, environmental, and lifestyle factors, anyone can get gouteven if they eat what would typically be deemed a healthy diet.

    Attacks and flare-ups of the condition can be painful.

    While there is no cure for gout, there are things you can do to get relief from the pain and inflammation.

    In this article, Ill talk about ways to get fast relief from a gout attack, treatment options for these flare-ups, and warning signs that an attack may be coming.

    Ill also tell you when its best to talk to your doctor or another healthcare provider about gout symptoms.

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    How To Get Fast Relief From Gout Attacks

    Gout pain can be debilitating, and can prevent you from performing routine activitieseven walking or standing can hurt.

    Thats because many attacks start at the base of the big toe.

    Pain and inflammation in this region can make walking or standing for long periods of time excruciating.

    There are a few home remedies that may provide quick relief for a gout flare-up.

    But if your pain is severe, sudden, or worsening, contact a healthcare professional before attempting any remedies at home.

    How Gout Treatment Prevents Disease Progression

    Fortunately, in part because of its long history, gout is one of the most well-understood and most medically treatable forms of arthritis. The progression of gout is preventable by starting appropriate treatment as soon as possible, Dr. Meysami says. Uric acid-lowering agents, such as allopurinol , can decrease uric acid levels and prevent gout attacks.

    During flares, gout patients can take NSAIDs or corticosteroids to calm the attack. Local steroid injections may also be given. A medication called colchicine is also often used to stop acute attacks, but its given now at a much lower dose in order to avoid side effects, including stomach upset.

    After a flare ends, long-term treatment can begin. Almost all people with gout will need medication to control their urate, Dr. Fields says. To get a good outcome, people with gout need to get their blood urate level below 6.0 mg/dl and keep it there. By doing that, the body will gradually pull the urate crystals out of their joints, and the flares can stop. Tophi will also gradually disappear.

    Medications called xanthine oxidase inhibitors limit the amount of uric acid your body produces. These include allopurinol and febuxostat . Colchicine, which decreases the inflammatory response to gout, may also be given along with allopurinol at the start of long-term treatment after a flare subsides.

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    What Are Future Possible Treatments Of Gout

    Fortunately, present medications are successful in the vast majority of gout patients. But some patients cannot tolerate our present arsenal of gout medications. For others, these agents are not sufficiently effective. Therefore, new treatments are continually being sought. Some of the more promising include anakinra, rilonacept, canakinumab, BCX4208 and arhalofenate.

    What Else Should I Ask My Healthcare Provider About Gout

    What Is Gout and How Do You Treat It? [Dr. Claudia]

    Consider asking your healthcare provider:

    • What is causing the gout?
    • Do I have any joint damage?
    • What can I do to prevent future attacks?
    • Can any gout medications help me?
    • How long will I need to take gout medications?

    A note from Cleveland Clinic

    Gout is a painful form of arthritis. Extra uric acid in your body creates sharp crystals in the joints, leading to swelling and extreme tenderness. Gout usually starts in the big toe but can affect other joints. Gout is a treatable condition, and the uric acid level can be decreased by medication and lifestyle changes. Talk to your healthcare provider about medications that can reduce uric acid levels. They can also discuss changes you can make to your diet and lifestyle to prevent and reduce gout attacks.

    Last reviewed by a Cleveland Clinic medical professional on 11/15/2020.

    References

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    Symptoms And Signs Of Gout In Foot

    An attack of gout is often sudden. Symptoms:

    • It may present with excruciatingly painful swelling of joints in the big toe, it is known as Podagra. The joint may be stiff and appear red or purple, very swollen, and tender to even light touch. Other gout sites include the instep, wrist, ankle, fingers, and knee.
    • Skin may peel and itch as healing begins.
    • An attack often begins at night the acute phase lasts up to 12 hours. If untreated, the inflammation may last up to two weeks. In 10 percent of people, acute episodes present in more than one joint.
    • Kidney stones precede the onset of gout in 14 percent of patients.
    • Chronic gout may develop, and it may affect more than one joint, mimicking rheumatoid arthritis.
    • Tophi are soft tissue swellings caused by urate buildup in chronic gout. They may be found in the ear, fingers, toes, kneecap, and elbow.

    Some people have a single attack of gout, others are affected intermittently, often when they have overindulged or experienced dehydration.

    COMPLICATIONS OF GOUT IN FOOT

    Its rare for complications of gout to develop, but they do happen and can include severe degenerative arthritis, secondary infections, kidney stones and kidney damage, nerve or spinal cord impingement, and joint fractures.

    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

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    Ways To Deal With Painful Gout Attacks

    Its difficult to focus on work or other daily activities when youre experiencing gout inflammation and pain. Symptoms can last for a few days or even weeks, with the worst pain usually occurring in the first day or two.

    While the best thing to do is talk to your physician, there are several steps you can take right away ease your gout symptoms:

    Excess uric acid in the bloodstream can lead to the formation of uric acid crystals in one or more joints, resulting in gout.Read:All About Gout – Symptoms, Diagnosis, Treatment

    Using Tart Cherry Juice For Gout

    What Is Gout And How Does It Affect You

    Tart cherry juice may help decrease uric acid levels and inflammation in gout. Research is limited, with often small numbers of study participants and short-term follow-up.

    Nevertheless, a 2019 review of six studies that looked at the effect of cherry juice or cherry extract intake on gout concluded that cherry intake was associated with a reduced risk of gout attacks. Researchers did note that larger, more long-term studies are needed to clarify this association.

    When choosing tart cherry juice, be sure to look for unsweetened varieties to help reduce the amount of added sugar in your diet.

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    Who Should Diagnose And Treat Gout

    The disease should be diagnosed and treated by a doctor or a team of doctors who specialize in care of gout patients. This is important because the signs and symptoms of gout are not specific and can look like signs and symptoms of other inflammatory diseases. Doctors who specialize in gout and other forms of arthritis are called rheumatologists. To find a provider near you, visit the database of rheumatologistsexternal icon on the American College of Rheumatology website. Once a rheumatologist has diagnosed and effectively treated your gout, a primary care provider can usually track your condition and help you manage your gout.

    How Can An Attack Of Gout Be Treated

    The management of an acute attack of gout is very different from the prevention of subsequent attacks.

    Treatments used for prevention, such as allopurinol can actually make things worse if given during an attack, and so need to be held back until the attack has resolved for several weeks.

    There are a number of measures that can help resolve an attack of gout. See Table 2 for summary of treatment strategies for acute gout. One principle is that treatment for an attack of gout should be instituted quickly, since quick treatment can often be rewarded with a quick improvement.

    If an attack of gout is allowed to last more than a day or so before treatment is started, the response to treatment may be much slower.

    Table 2: Medications to treat acute attacks of gout

  • Nonsteroidal anti-inflammatory drugs or COX-2 inhibitorsExamples of : Naproxen 500mg twice daily, indomethacin 25mg three times daily. Example of COX-2 inhibitor: celecoxib 200mg twice a day. Possible side-effects: Elevation of blood pressure, ankle swelling, upset stomach, ulcer . Use with caution if kidney or liver problems.
  • Anti-Inflammatory corticosteroidsExamples of : Prednisone 40mg first day, 30mg 2nd day, 20mg third day, 10mg fourth day. Possible side-effects: Elevation of blood pressure, elevation of blood sugar, mood changes. Short-term use, as in gout, generally much better tolerated than long-term use. Use with caution if diabetic.
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    How To Handle Your First Gout Attack

    After a first attack of gout, its OK to try to stave off another one with dietary changes alone. But if you have another attack, its important to start taking preventive gout medications on a regular basis. Long-term medications for gout include allopurinol and febuxostat, both of which limit uric acid production.

    Some patients, says Dr. Fields, treat each attack as a separate event and dont talk to their doctors about doing a preventive approach. He uses the analogy of lighting a book of matches. If you have one match lit, its easy to put out, but if you have the whole book lit, its a lot harder.

    The Role Of Diet In Gout Prevention

    Got a flare of Gout How to treat it

    Dietary control may be sufficient in a patient with mildly elevated uric acid, for example, 7.0 mg/dL

    For those with a higher level, for example, 10.0 mg/dL, diet alone will not usually prevent gout. For the latter, even a very strict diet only reduces the blood uric acid by about 1 mg/dL- not enough, in general, to keep uric acid from precipitating in the joints. The cutoff where patients with gout seem to dramatically reduce their number of attacks is when their uric acid level is taken below 6.0 mg/dL.4

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    Important Information About All Medicines

    This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

    If you buy any medicines ‘over-the-counter’, always check with a pharmacist that they are suitable for you to take alongside your other medicines.

    If you are having an operation or any dental treatment, tell the person carrying out the treatment which medicines you are taking.

    Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

    If you have any questions about this medicine ask your pharmacist.

    The Role Of Physical Activity In Prevention Of Gout

    Along with diet, physical activity can help with weight loss, and gout has been associated with being overweight.7 in patients with well-established gout, especially if X-rays have demonstrated joint damage in the foot, a low-impact exercise program is reasonable. An exercise program combined with diet in gout can reduce risk for attacks.7 If an attack seems to be coming on in the lower extremity, patients are well-advised to try to get off their feet, since impact seems to worsen gout attacks. Clues to an attack of gout coming on include local swelling, heat, redness, and tenderness in a joint, especially in the foot, ankle, or knee. Some patients have fever and chills as the first warning that an attack of gout is coming on.

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    Some Side Effects Can Be Serious If You Experience Any Of The Following Symptoms Stop Taking Colchicine And Call Your Doctor Immediately:

    • muscle pain or weakness
    • numbness or tingling in the fingers or toes
    • unusual bruising or bleeding
    • sore throat, fever, chills, and other signs of infection
    • weakness or tiredness
    • paleness or grayness of the lips, tongue, or palms

    Colchicine may decrease fertility in men. Talk to your doctor about the risks of taking colchicine.

    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .

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