Arthritis Health Center

Medicine treatment for gout may be done in two separate stages.

• First, the pain, swelling, redness, and warmth (inflammation) during an attack of gout is treated until the symptoms have gone away.
• Second, after the inflammation has subsided, other medicines may be used to reduce the uric acid level in the blood and reduce the frequency of future attacks. Most doctors do not start these medicines until several days to weeks after a gout attack is over.

Medicines to lower uric acid levels are not given until a gout attack is over. Starting these medicines during a gout attack can cause movement of uric acid stored elsewhere in the body, which can make the gout attack worse.

Long-term medicine treatment depends on how high your uric acid levels are and how likely other gout attacks are. In general, the higher the uric acid levels and the more frequent the attacks, the more likely it is that long-term medicine treatment will help.

During a gout attack

You may already be taking a medicine to lower uric acid levels in the blood at the time of an attack. If so, you should continue taking your medicine, even during an attack.

If you have been prescribed a medicine to lower uric acid levels (probenecid or allopurinol) and have not been taking the medicine, it is more likely that another gout attack will occur. Do not start taking the medicine during an attack. Medicines that control the uric acid levels in your blood can also make the uric acids stored elsewhere in the body move into your bloodstream. Starting these medicines while you are having a gout attack can make your attack much worse.

Medication Choices

Medicine treatment for gout usually involves some combination of:

• Short-term treatment, using medicines that relieve pain and reduce inflammation during an acute attack or prevent a recurrence of an acute attack. These medicines may include:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), except for aspirin, which should never be used to relieve pain during a gout attack. Aspirin may change uric acid levels in the blood and may make the attack worse.
  • Colchicine, which may also be used for long-term treatment.
  • Corticosteroids, which may be given in pills or by a shot for cases of gout that do not respond to NSAIDs or colchicines. They may also be given to people who cannot take NSAIDs for other reasons, such as those with chronic kidney failure, heart failure, gastrointestinal bleeding or those using a blood-thinner, such as warfarin.
• Long-term treatment, using medicines to lower uric acid levels in the blood, which can reduce the frequency and severity of gout attacks in the future. This may include:
  • Uricosuric agents, to increase elimination of uric acid by the kidneys.
  • Xanthine oxidase inhibitors, to decrease production of uric acid by the body.
  • Colchicine, to prevent flare-ups during the first months that you are taking medicines that lower uric acid.

What to think about

• Relief from symptoms in a gout attack often occurs within 24 hours if treatment is started immediately.
• During a gout attack, your doctor will prescribe a maximum daily dose of one or more medicines used for short-term treatment to stop the attack. Doses are then reduced as the symptoms go away.
• NSAIDs other than aspirin are used most often to treat a gout attack.
• Because all medicines that lower uric acid levels in the blood have risks, an accurate diagnosis of gout is necessary before they are used.
• Aspirin should never be used to relieve pain during a gout attack.