What is gout?
Gout is caused by the overabundance of uric acid in your body. This excess may result from either overproduction or underexcretion. The term “gout” is used generically to describes the spectrum of 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 joint 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 either to reduce the pain and inflammation of individual attacks or to reduce the frequency of attacks.
The following dietary changes can reduce gout symptoms:
- Reduce or eliminate alcohol.
- Drink lots of water or other non-alcoholic beverages.
- Eat more low- or non-fat dairy products.
- Avoid high-purine foods, including organ meats like kidneys, liver, and sweetbreads; oily fish like sardines, anchovies, and herring; certain vegetables including asparagus and cauliflower; beans; and mushrooms.
- 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.
There are many classes of drugs used to treat gout.
- Non-steroidal 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.
Non-steroidal anti-inflammatory drugs (NSAIDs) are a large class of drugs that reduce both pain and inflammation. Many NSAIDs are available over-the-counter at low doses and at higher doses by prescription. NSAIDs 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:
- celecoxib (Celebrex)
- ibuprofen (Advil, Motrin)
- indomethacin (Indocin)
- ketoprofen (Orudis, Oruvail)
- naproxen (Aleve)
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 patients who cannot take NSAIDs.
Corticosteroids are very effective at reducing inflammation. They can be taken orally or injected directly into the affected joint on intravenously. Unfortunately, they have serious side effects when used for long periods including:
- high blood pressure
- increased risk of infection
- avascular necrosis of bone especially the hip and shoulder joints
For this reason, they are generally used only chronically by people who can’t take NSAIDs or colchicine. Corticosteroids used for gout include:
- methylprednisolone (Medrol, Depo-Medrol)
- triamcinolone (aristospan)
The following two types of drugs are taken daily to help prevent future gout attacks.
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 are 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.
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.
Gout alternative treatments
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 the efficacy of some treatment methods. 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.
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.
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 hot compress to the affected area for three minutes and a cold compress for 30 seconds 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.
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.
Careful monitoring of diet can also help to reduce uric acid levels. Your doctor can help you create a specific plan, but some of the most common changes are to:
- drink more water and other non-alcoholic fluids
- drink less alcohol
- eat less meat
- limit high-purine foods
- eat more low-fat dairy
Maintain 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.