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Treatment

To treat an attack of gouty arthritis, your doctor usually will begin by prescribing a nonsteroidal anti-inflammatory drug (NSAID), such as indomethacin (Indocin), ibuprofen (Advil, Motrin and others) or naproxen (Aleve, Anaprox, Naprosyn and others). Aspirin should be avoided because it can raise the level of uric acid in your blood (although low dose aspirin for prevention of heart disease or stroke has little effect on gout).

If you cannot tolerate an NSAID, or if these drugs don't work for you, your doctor may suggest a corticosteroid. Corticosteroids can be given orally or injected directly into the affected joint. Another option is an injection of a compound called adrenocorticotrophic hormone, which directs your adrenal gland to make more cortisone.

A drug called colchicine sometimes is used, but it often causes unpleasant side effects (such as nausea, vomiting, cramps, diarrhea) before it helps the arthritis.

To prevent attacks of gout, your doctor may prescribe allopurinol (Aloprim, Zyloprim) or febuxostat (Uloric) to make your body produce less uric acid. If attacks are rare and respond well to treatment, this may not be necessary. It is usually recommended when:

  • Gout attacks are frequent.

  • Gout attacks do not respond promptly to treatment.

  • Gout attacks affect more than one joint at a time.

  • There is a history of kidney stones and previous gout.

  • A tophus has developed.

The level of uric acid in your blood usually begins to drop within days of the first dose of allopurinol or febuxostat. It may take weeks of daily treatment for the full effect to occur. Another treatment approach is to take a medication (such as Probenecid) that makes your kidneys excrete more uric than usual. These drugs work well in 70% to 80% of people with gout. But they should not be taken by people who have significant kidney disease or who have had a kidney stone.

A more recently approved medication to lower uric acid is pegloticase (Krystexxa). Because of its expense and side effects (especially allergic reactions) and because it can only be taken intravenously, this medication will likely be recommended only when other treatments don't work.

Medications to lower uric acid levels (such as allopurinol, febuxostat, or probenecid) are usually taken indefinitely. If discontinued, the uric acid level will usually rise again and attacks of gout are likely to resume.

When your doctor prescribes a medication to reduce uric acid in your blood, he or she also should prescribe a second medication to prevent a gout attack. That's because any change in uric acid levels, up or down, can trigger an attack. These preventive medications include a low dose of colchicine or a low dose of an NSAID. Once the uric acid is lowered enough for a prolonged period (about 6 months), the preventive medication can be stopped.

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From Health A-Z, Harvard Health Publications. Copyright 2007 by the President and Fellows of Harvard College. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications. Used with permission of StayWell.

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