Gout Treatment & Prevention

Gout Treatments and drugs By Mayo Clinic
Treatment for gout usually involves medications. What medications you and your doctor choose will be based on your current health and your own preferences.
Different medications are prescribed to:
 Treat acute gout attacks and prevent future attacks
 Reduce the risk of gout complications, such as the deposits of urate crystals that cause nodules to form under the skin (tophi)
Drugs used to treat acute attacks and prevent future attacks include:
 Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may control inflammation and pain in people with gout. Your doctor may prescribe a higher dose to stop an acute attack, followed by a lower daily dose to prevent future attacks.
NSAIDs include over-the-counter options such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others), as well as more powerful prescription NSAIDs such as indomethacin (Indocin). NSAIDs carry risks of stomach pain, bleeding and ulcers.
 Colchicine. If you're unable to take NSAIDs, your doctor may recommend colchicine, a type of pain reliever that effectively reduces gout pain — especially when started soon after symptoms appear. The drug's effectiveness is offset in most cases, however, by intolerable side effects, such as nausea, vomiting and diarrhea.
After an acute gout attack resolves, your doctor may prescribe a low daily dose of colchicine to prevent future attacks.
 Corticosteroids. Corticosteroid medications, such as the drug prednisone, may control gout inflammation and pain. Corticosteroids may be administered in pill form, or they can be injected into your joint. Corticosteroids are generally reserved for people who can't take either NSAIDs or colchicine.
Side effects of corticosteroids may include thinning bones, poor wound healing and a decreased ability to fight infection. To reduce the risk of these serious side effects, your doctor will try to find the lowest dose that controls your symptoms and prescribe steroids for the shortest possible time.
Drugs used to prevent the complications associated with frequent gout attacks include:
 Medication that blocks uric acid production. Drugs called xanthine oxidase inhibitors, including allopurinol (Zyloprim, Aloprim) and febuxostat (Uloric), limit the amount of uric acid your body makes. This may lower your blood's uric acid level and reduce your risk of gout. Side effects of allopurinol include a rash and low blood counts. Febuxostat side effects include rash, nausea and reduced liver function.
Xanthine oxidase inhibitors may trigger a new, acute attack if taken before a recent attack has totally resolved. Taking a short course of low-dose colchicine before starting a xanthine oxidase inhibitor has been found to significantly reduce this risk.
 Medication that improves uric acid removal. Probenecid (Probalan) improves your kidneys' ability to remove uric acid from your body. This may lower your uric acid levels and reduce your risk of gout, but the level of uric acid in your urine is increased. Side effects include a rash, stomach pain and kidney stones.
Lifestyle and home remedies
Medications are the most proven, effective way to treat gout symptoms. However, making certain changes to your diet also may help.
The American Dietetic Association recommends following these guidelines during a gout attack:
 Drink 8 to 16 cups (about 2 to 4 liters) of fluid each day, including at least half water.
 Avoid alcohol.
 Eat a moderate amount of protein, preferably from healthy sources, such as low-fat or fat-free dairy, tofu, eggs, and nut butters.
 Limit your daily intake of meat, fish and poultry to 4 to 6 ounces (114 to 170 grams).
Alternative medicine
If gout treatments aren't working as well as you'd hoped, you may be interested in trying complementary and alternative treatments for your gout. Discuss these treatments with your doctor first. Your doctor can help you weigh the benefits and risks and tell you if the treatments will interfere with your gout medications.
Though you may be reluctant to discuss complementary and alternative medicine with your doctor, many mainstream doctors are becoming more open to discussing these options. But, since few of these treatments have been extensively studied in clinical trials, it's difficult to assess whether these treatments are helpful for gout pain. In some cases, the risks of these treatments aren't known.
Some complementary and alternative treatments that have been studied include:
 Coffee. Studies have found an association between coffee drinking — both regular and decaffeinated coffee — and lower uric acid levels, though no study has demonstrated how or why coffee may have an influence on uric acid in your body. The available evidence isn't enough to encourage noncoffee drinkers to start, but it may give researchers clues to new ways of treating gout in the future.
 Vitamin C. Supplements containing vitamin C may reduce the levels of uric acid in your blood. However, vitamin C hasn't been studied as a treatment for gout. Don't assume that if a little vitamin C is good for you, then lots is better. Megadoses of vitamin C may increase your body's uric acid levels. Talk to your doctor about what a reasonable dose of vitamin C may be. And don't forget that you can increase your vitamin C intake by eating more fruits and vegetables, especially oranges.
 Cherries. Cherries have been associated with lower levels of uric acid in studies, but it isn't clear if they have any effect on gout signs and symptoms. Adding cherries and other dark-colored fruits, such as blackberries, blueberries, purple grapes and raspberries, to your diet may be a safe way to supplement your gout treatment, but discuss it with your doctor first.
Other complementary and alternative medicine treatments may help you cope until your gout pain subsides or your medications take effect. For instance, relaxation techniques, such as deep-breathing exercises and meditation, may help take your mind off your pain.
Prevention
Medications
If you experience several gout attacks each year or if your gout attacks are less frequent but particularly painful, your doctor may recommend medication to reduce your risk of future gout attacks and of gout-related complications.
You usually begin taking preventive medications once your acute gout attack has subsided. Options include:
 Low-dose NSAIDs
 Low-dose colchicine
 Allopurinol or febuxostat
 Probenecid
Dietary changes
During symptom-free periods, these dietary guidelines may help protect against future gout attacks:
 Keep your fluid intake high. Aim for 8 to 16 cups (about 2 to 4 liters) of fluid each day, including at least half water.
 Limit or avoid alcohol. Talk with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence suggests that beer may be particularly likely to increase the risk of gout symptoms, especially in men.
 Eat a balanced diet following the Dietary Guidelines for Americans. Your daily diet should emphasize fruits, vegetables, whole grains, and fat-free or low-fat milk products.
 Get your protein from low-fat dairy products. Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein sources.
 Limit your intake of meat, fish and poultry. A small amount may be tolerable, but pay close attention to what types — and how much — seem to cause problems for you.
 Maintain a desirable body weight. Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body. But avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid levels