Arthritis Health Center

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Long-term medicine treatment depends on how high your uric acid levels are and how likely it is that you will have other gout attacks in the future. If your doctor prescribes medicine to lower your uric acid levels, be sure to take it as directed. Most people continue to take this medicine for the rest of their lives.

Treatment if the condition gets worse

Gout can usually be successfully treated by eliminating its causes and taking medicines to relieve symptoms. But if gout symptoms have occurred off and on without treatment for several years, they may become ongoing (chronic) and may affect more than one joint. Uric acid crystals may have built up in the joints to form gritty, chalky nodules called tophi. Treatment of gout that has advanced to this stage includes medicines.

• Take one or more of the following medicines, as prescribed by your doctor:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or indomethacin. Avoid aspirin, which may abruptly raise uric acid levels in the blood.
  • Colchicine
  • Corticosteroids
• If you are having pain in the joints from an attack, your doctor may prescribe:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or indomethacin. Avoid aspirin, which may abruptly raise uric acid levels in the blood.
  • Colchicine.
  • Oral corticosteroids, such as prednisone or medrol.
  • A shot of corticosteroids in a muscle.
  • A shot of corticosteroids directly into the painful joint.
  • Pegloticase (Krystexxa). This medicine is for gout that has lasted a long time and has not responded to other treatment.

• To prevent recurrent attacks, you may be prescribed:
  • Uricosuric agents to increase elimination of uric acid by the kidneys.
  • Drugs called 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.

Treatment to eliminate tophi may include:²

• Drugs called xanthine oxidase inhibitors, which may shrink the tophi until they disappear.
• In rare cases, surgery to remove large tophi that are causing deformity.

What to think about

After an acute attack of gout, talk with your doctor about the causes of the elevated uric acid levels in your blood. A review of your overall health may reveal diseases, medicines, and habits that could be contributing to your uric acid levels.

Most doctors will wait several days to weeks after a gout attack is over to begin medicine to lower the high uric acid levels. These medicines can cause uric acid stored elsewhere in the body to begin moving through the bloodstream and could make symptoms worse if treatment begins during a gout attack.

If there is swelling that causes pressure in a large joint such as a knee or ankle, your doctor may relieve the pain and pressure by aspiration, in which a needle is inserted into the joint and fluid is drawn out (aspirated) with a syringe connected to the needle.