Gout attacks, or flares, are caused by a buildup of uric acid in your blood. Uric acid is a substance your body makes when it breaks down other substances, called purines. Most of the uric acid in your body dissolves in your blood and leaves in your urine. But for some people, the body makes too much uric acid or doesn’t remove it quickly enough. This leads to high levels of uric acid in your body, which can lead to gout.
The buildup causes needle-like crystals to form in your joint and the surrounding tissue, causing pain, swelling, and redness. Although flares can be quite painful, medication can help you control gout and limit flares.
While we don’t yet have a cure for gout, short- and long-term medications are available to help keep your symptoms under control.
Before long-term treatments, your doctor will likely prescribe a high dose of anti-inflammatory drugs or steroids. These first-line treatments reduce pain and inflammation. They’re used until your doctor confirms that your body has reduced the levels of uric acid in your blood on its own.
These medications can be used in combination with each other or with long-term drugs. They include:
Nonsteroidal anti-inflammatory drugs (NSAIDs): These drugs are available over the counter as the medications ibuprofen (Motrin, Advil) and naproxen (Aleve). They’re also available by prescription as the medications celecoxib (Celebrex) and indomethacin (Indocin).
Colchicine (Colcrys, Mitigare): This prescription pain reliever can stop a gout flare at the first sign of an attack. Low doses of the drug are well-tolerated, but higher doses may cause side effects such as nausea, vomiting, and diarrhea.
Corticosteroids: Prednisone is the most commonly prescribed corticosteroid. It can be taken by mouth or injected into the affected joint to relieve pain and inflammation. It can also be injected into the muscle when several joints are affected. Corticosteroids are usually given to people who can’t tolerate NSAIDs or colchicine.
While short-term treatments work to stop a gout attack, long-term treatments are used to reduce uric acid levels in the blood. This can help reduce the number of future flares and make them less severe. These medications are only prescribed after blood tests have confirmed that you have hyperuricemia, or a high uric acid level.
Long-term medication options include:
Allopurinol (Lopurin and Zyloprim): This is the most commonly prescribed medication for lowering uric acid levels. It may take several weeks to take full effect, so you may experience a flare during that time. If you do have a flare, it can be treated with one of the first-line treatments to help relieve symptoms.
Febuxostat (Uloric): This oral medication blocks an enzyme that breaks purine into uric acid. This prevents your body from making uric acid. Febuxostat is processed mainly by the liver, so it’s safe for people with kidney disease.
Probenecid (Benemid and Probalan): This medication is mostly prescribed for people whose kidneys don’t excrete uric acid properly. It helps the kidneys increase excretion so that your uric acid level becomes stable. It’s not recommended for people with kidney disease.
Lesinurad (Zurampic): This oral medication was approved by the Food and Drug Administration in 2015. It’s used in people for whom allopurinol or febuxostat didn’t reduce uric levels enough. Lesinurad is also always used with one of those two drugs. It’s a promising new treatment for people having trouble controlling their gout symptoms. However, it comes with a risk of kidney failure.
Pegloticase (Krystexxa): This drug is an enzyme that converts uric acid into another, safer compound, called allantoin. It’s given as an intravenous (IV) infusion every two weeks. Pegloticase is only used in people for whom other long-term medications haven’t worked.
Many medications are available today to help relieve gout symptoms. Research is ongoing to find more treatments, as well as a possible cure. To learn more about treating your gout, talk to your doctor. Questions you might ask include:
- Are there other medications I should be taking to treat my gout?
- What can I do to help avoid gout flares?
- Is there a diet you can recommend that would help keep my symptoms under control?