Gout is caused by the overabundance of uric acid in your body. This excess may result from the body either producing too much or excreting too little. The term “gout” is used generically to describe the spectrum of this illness from acute to chronic.
People who have gout typically suffer from symptoms affecting the feet, like swelling, pain, and redness, particularly in the joint behind the big toe. Acute gout causes sporadic attacks and can affect most any major extremity joint, with the small joints of the hands and feet affected most often.
With chronic gout, hard swellings known as tophi can form on the joints. These tophi are made of uric acid and can grow very large, even to the point of breaking through the skin.
People who suffer from gout usually undergo one or more of the following treatments to help them manage their condition.
Treatments for gout are designed to reduce either the pain and inflammation of individual attacks or the frequency of attacks. Traditional treatments include making dietary changes and taking certain medications.
Diet modification
Adjusting your diet is one of the most important ways to reduce the number of acute gout attacks you experience. The goal of these changes is to lower blood levels of uric acid.
The following dietary changes can reduce gout symptoms:
- Reduce or eliminate alcohol, especially beer.
- Drink lots of water or other nonalcoholic beverages.
- Eat more low-fat or nonfat dairy products.
- Avoid high-purine foods, including organ meats (kidneys, liver, and sweetbreads) and oily fish (sardines, anchovies, and herring).
- Limit meat in favor of plant-based proteins like beans and legumes.
- Eat complex carbohydrates, such as whole-grain breads, fruits, and vegetables, rather than sugary sweets and refined carbohydrates like white bread.
Medications
Here’s a brief rundown of several classes of drugs used to treat gout:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and colchicine all reduce the pain and inflammation associated with an acute gout attack.
- Xanthine oxidase inhibitors like allopurinol reduce the amount of uric acid produced by the body.
- Probenecid improves the kidneys' ability to remove uric acid from the blood.
During an acute gout attack, the main priority of drug treatment is to reduce pain and inflammation. There are three categories of drugs used for this: NSAIDs, colchicine, and corticosteroids. Two other types of medications are taken daily to help prevent future gout attacks: xanthine oxidase inhibitors and probenecid.
NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce both pain and inflammation. Many NSAIDs are available over the counter at low doses and at higher doses by prescription. They can cause gastrointestinal side effects, such as nausea, diarrhea, and stomach ulcers. In rare cases, they can cause kidney or liver damage.
NSAIDs commonly used for gout include:
- aspirin (Bufferin)
- celecoxib (Celebrex)
- ibuprofen (Advil)
- indomethacin (Indocin)
- ketoprofen
- naproxen (Aleve)
Colchicine
Colchicine (Colcrys) is a drug used mainly to treat gout. It prevents uric acid in the body from forming urate crystals. If taken very soon after the onset of acute gout symptoms, it can effectively prevent pain and swelling. It’s also sometimes prescribed for daily use to prevent future attacks.
However, colchicine also causes side effects including nausea, vomiting, and diarrhea. It’s usually prescribed to people who can’t take NSAIDs.
Corticosteroids
Corticosteroids are very effective at reducing inflammation. They can be taken orally or injected directly into the affected joint on intravenously. They have serious side effects when used for long periods, including:
- diabetes
- osteoporosis
- high blood pressure
- cataracts
- increased risk of infection
- death of bone tissue (avascular necrosis) especially in the hip and shoulder joints
For this reason, they’re generally used only by people who can’t take NSAIDs or colchicine. Corticosteroids used for gout include:
- dexamethasone (DexPak)
- methylprednisolone (Medrol)
- prednisolone (Omnipred)
- prednisone (Rayos)
- triamcinolone (Aristospan)
Xanthine oxidase inhibitors
Xanthine oxidase inhibitors reduce the amount of uric acid produced by the body.
However, these drugs can trigger an acute gout attack when you start taking them. They can also make an acute attack worse if they’re taken during the attack. For this reason, people with gout are commonly prescribed a short course of colchicine when starting a xanthine oxidase inhibitor.
Side effects of these drugs include rash and nausea.
There are two main xanthine oxidase inhibitors used for gout:
- allopurinol (Lopurin, Zyloprim)
- febuxostat (Uloric)
Probenecid
Probenecid (Probalan) is a drug that helps the kidneys remove uric acid from the blood more effectively. Side effects include rash, upset stomach, and kidney stones.
Alternative treatments for gout aim either to reduce pain during attacks or to lower uric acid levels and potentially prevent attacks. As with many alternative treatments for any disease or condition, opinions are often mixed as to how well such treatment methods work. Research is often minimal in comparison to traditional medical treatments for gout.
However, many people have had success in using alternative treatments in the management of many diseases and conditions, including gout. Before trying any gout alternative treatments, you should always check with your doctor to be sure that the methods are safe and right for you.
Foods, herbs, and supplements
The following have shown at least some promise for gout.
Coffee. According to the Mayo Clinic, there’s evidence that drinking a moderate amount of coffee a day can lower gout risk.
Antioxidant-rich fruits. Dark-colored fruits like blackberries, blueberries, grapes, raspberries, and especially cherries can help keep uric acid under control.
Vitamin C. Consuming moderate amounts of vitamin C is also connected to lower uric acid levels. However, very large doses of the vitamin can actually raise uric acid levels.
Other supplements. There are also herbal supplements that have been found to effectively reduce inflammation including devil’s claw, bromelain, and turmeric. These haven’t been specifically studied for gout, but they may help with the swelling and pain associated with an attack.
Acupuncture
This technique, which is a form of traditional Chinese medicine, involves placing very thin needles in points on the body. It has been found effective in treating different types of chronic pain. There haven’t yet been any studies done on acupuncture and gout, but its pain-relieving properties are promising.
Hot and cold compresses
Switching between a hot compress for three minutes and a cold compress for 30 seconds on the affected area can help reduce pain and swelling that occurs during a gout attack.
In most people, a first acute gout attack comes without warning, and there aren’t any other symptoms of high uric acid. Prevention efforts for gout are focused on preventing future attacks or lessening their severity.
Medication
Xanthine oxidase inhibitors and probenecid both prevent gout attacks by reducing the amount of uric acid in the blood. A doctor may also prescribe an NSAID or colchicine to be taken every day to help make future attacks less painful.
Dietary changes
Careful dietary monitoring can also help to reduce uric acid levels. Your doctor and dietitian can help you create a specific plan, but here are some of the most common changes should make:
- Drink more water and other nonalcoholic fluids.
- Drink less alcohol, especially beer.
- Eat less meat.
- Limit high-purine meats and seafood.
- Limit added sugars and sodas.
- Increase intake of fruits, vegetables, legumes and whole grains.
Some gout is described as gouty arthritis and therefore may benefit from dietary changes similar to those recommended for arthritis sufferers, like avoidance of gluten-containing foods and dairy.
Maintaining a healthy weight
In addition, dietary changes may also have the goal of reducing body weight. Obesity is a risk factor for gout. Maintaining a healthy weight through a balanced diet and regular exercise can help prevent attacks.
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