Gout Remedies That Work

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By
Dorothy Foltz-Gray and Quinn Phillips
Updated on July 9, 2024
Medically Reviewed
by
Samir Dalvi, MD

Experiencing a gout attack, characterized by intense pain, swelling, and redness in the big toe or other joints, underscores the immediate need for effective relief. Gout, a form of arthritis, results from the accumulation of uric acid crystals within specific joints. This occurs when the body maintains high levels of uric acid, a natural byproduct of purine breakdown—chemicals found both within the body's cells and in various foods [1]. The sudden onset of a gout attack can be disorienting, often leaving individuals unaware of its nature or proper response.

Prompt medical attention is crucial for a gout attack, ideally within 24 hours of its onset, to allow for the effective administration of medications. In the interim, immediate home measures such as applying an ice pack to the affected area can provide some respite. As Kristaq Koci, DO, a rheumatologist at Mount Sinai in New York City, notes, "Flares can be quite painful, so it’s always best for the patient to have a plan." The approach to managing gout can vary, depending on whether it is an individual's first experience or if they have a history of recurrent flares. Understanding both medical treatments and complementary home remedies is vital for effective management and prevention.

Medications to Stop Gout Attacks

The selection of medication for an acute gout attack is highly individualized, contingent upon a patient's medical history, including any coexisting health conditions that might contraindicate certain drugs. Generally, three primary classes of medications are employed to halt an active gout attack: colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids. Dr. Koci emphasizes that for patients presenting with typical gout symptoms, one of these medications is usually prescribed as the initial course of action to alleviate acute symptoms and inflammation.

Colchicine (Colcrys, Mitigare) stands out as an anti-inflammatory medication frequently chosen for its efficacy in reducing gout pain. While highly effective, it may induce gastrointestinal side effects such as nausea and diarrhea, making it unsuitable for all patients [3]. For individuals with chronic gout, a daily regimen of colchicine can also serve as a preventive measure, offering a generally safe option with minimal long-term side effects, according to Dr. Koci. Its effectiveness is maximized when taken within 24 hours of symptom onset [4]. However, as it is a prescription drug, having it on hand ahead of time is beneficial, otherwise readily available over-the-counter NSAIDs might serve as a more immediate alternative.

NSAIDs represent a widely accessible class of medications, encompassing both prescription and nonprescription options, known for their ability to alleviate pain even at lower doses. At higher concentrations, these drugs effectively reduce the pronounced inflammation characteristic of a gout attack [5]. Common nonprescription NSAIDs for gout include ibuprofen (Advil) and naproxen (Aleve). While dosages can vary, Johns Hopkins Medicine suggests 800 milligrams (mg) of ibuprofen three to four times daily until symptoms resolve [6]. Dr. Koci often advises 500 mg of naproxen twice daily throughout a flare-up, stressing adherence to a doctor's specific recommendations based on individual health profiles. Prescription NSAIDs like indomethacin (Indocin) offer potent anti-inflammatory effects, potentially surpassing over-the-counter alternatives. However, indomethacin can exacerbate stomach discomfort and should always be taken with food, making it less ideal for individuals with a history of stomach ulcers.

Corticosteroids, commonly referred to as steroids, are potent anti-inflammatory agents that can rapidly mitigate inflammation and relieve gout symptoms. They are frequently prescribed when underlying health conditions preclude the use of NSAIDs, as noted by Johns Hopkins Medicine [6]. Steroids for gout can be administered orally or via direct injection into the affected joint. Intra-articular injections are typically performed by rheumatologists or other specialists skilled in arthritis treatment, reserved for cases involving one or two affected joints. For more widespread involvement or when injections are not feasible, oral steroids such as prednisone (Deltasone) or methylprednisolone (Medrol) are commonly prescribed [6]. Given their low doses and limited treatment duration—typically 5 to 10 days—oral steroids for gout generally avoid the adverse effects associated with long-term steroid use, such as significant weight gain or mood fluctuations. However, patients with diabetes should be aware that these medications can temporarily elevate blood sugar levels.

Medications to Prevent Gout Attacks

For individuals experiencing recurrent gout flares, a condition referred to as chronic gout, healthcare providers typically prescribe medications aimed at preventing future attacks. These preventive strategies primarily involve drugs that reduce uric acid levels in the body, either by inhibiting its production or by enhancing its elimination through the kidneys [3]. This proactive approach is crucial in managing long-term gout and improving overall patient quality of life, moving beyond merely addressing acute symptoms to preventing their recurrence and minimizing joint damage.

Allopurinol (Zyloprim) and febuxostat (Uloric) are key medications that work by limiting the body's production of uric acid. Allopurinol is the preferred first-line treatment, with febuxostat serving as a valuable alternative for patients who cannot tolerate allopurinol due to side effects or hypersensitivity [5]. Dr. Koci explains that proper use involves an initial low dose, which is then gradually increased based on blood uric acid levels until the target of below 6 mg/dL is achieved, a recommendation from the American College of Rheumatology [2]. He highlights a common issue where doses are not adequately increased, leading to persistent flares. For instance, some patients experience ongoing attacks at 300 mg of allopurinol daily, but achieve complete flare remission once the dose is carefully increased to 600 mg.

Probenecid (Benemid) offers an alternative mechanism of action by facilitating the kidneys' removal of uric acid from the blood and its excretion in urine. This medication is typically considered when allopurinol or febuxostat alone are insufficient to achieve optimal uric acid levels, and it can be effectively used in conjunction with either of these drugs. However, probenecid's efficacy is limited in individuals with kidney disease, and it is generally not recommended for patients with a history of kidney stones, as advised by Harvard Health Publishing [2].

In cases where conventional treatments fail to adequately prevent gout flares, biologic drugs may be considered. Pegloticase (Krystexxa) is one such biologic, a monoclonal antibody that transforms uric acid into allantoin, a compound more readily eliminated from the body. It is typically administered as an intravenous (IV) infusion every two weeks [5]. Dr. Koci notes that pegloticase is reserved for "patients that have tried everything," describing it as an option for those with multiple persistent flares unresponsive to other therapies. Additionally, two other biologic drugs, anakinra (Kineret) and canakinumab (Ilaris), may be used if pegloticase is ineffective or poorly tolerated. These medications are interleukin-1 (IL-1) inhibitors, working to suppress the body's inflammatory response, and are administered via injection [5].

Complementary Therapies for Gout

While medical consultation and prescribed treatments are paramount for managing gout, especially in chronic cases where medications are often needed to regulate uric acid levels and avert future attacks, complementary therapies offer valuable support. These approaches can significantly contribute to easing pain and inflammation during an acute gout episode and, importantly, help reduce the overall likelihood of future flares. Integrating these self-care strategies with conventional medical care provides a comprehensive approach to gout management, empowering individuals to take an active role in their well-being.

During a gout attack, minimizing movement and weight-bearing on the affected joint is instinctively appealing and highly recommended for comfort and recovery. Alongside rest, several additional measures can help alleviate pain and reduce inflammation. Applying an ice pack to the joint is a simple yet effective immediate step, as suggested by Dr. Koci. Consistent, intermittent application of ice can be maintained until the attack subsides. Conversely, warm compresses can also be beneficial, assisting in the dissolution of gout crystals. A warm pad can be created by soaking a dishcloth in water, placing it in a microwave-safe plastic bag with a small opening, heating for two minutes on high, then wrapping it in a towel before applying it to the joint for about 15 minutes. Elevating the affected foot, particularly if the big toe is involved, can further aid in reducing swelling [7].

Maintaining adequate hydration is crucial for general health and particularly beneficial for individuals with gout, as sufficient fluid intake helps the body flush out uric acid. Water and unsweetened tea are excellent choices for consistent daily consumption, as recommended by the University of Maryland Medical System [8]. Beyond basic hydration, certain beverages may offer additional gout-related benefits. Coffee, for instance, has been linked to a reduced likelihood of developing gout in regular drinkers, irrespective of their uric acid levels. One study found that habitual coffee consumption decreased the risk of a gout attack by 71 percent compared to non-drinkers [9]. Though scientific evidence for tart cherry juice in gout treatment is limited, many patients report its effectiveness, and research indicates that its beneficial compounds, known as anthocyanins, possess anti-inflammatory properties that could be particularly helpful in gout management [10].

The Takeaway

Effectively managing a gout attack involves a multi-pronged approach, encompassing both prescribed medications and diligent self-care strategies. During an acute flare, prompt medical consultation for appropriate medication is crucial, often supplemented by applying ice to the affected joint for immediate relief. For individuals experiencing their first attack or recurrent episodes, establishing a comprehensive management plan with their physician is essential to minimize the likelihood of future flares. This often includes long-term medication to regulate uric acid levels. Complementary lifestyle adjustments, such as maintaining optimal hydration and incorporating beverages like coffee or tart cherry juice, can further contribute to reducing gout risk and enhancing overall well-being.

Editorial Sources

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Sources

1. Gout. Arthritis Foundation.
2. Restivo J. Treatments for Gout. Harvard Health Publishing. May 31, 2023.
3. Gout. Mayo Clinic. November 16, 2022.
4. Gout. Cleveland Clinic. February 19, 2023.
5. Dunkin MA. Treatments for Gout. Arthritis Foundation. June 10, 2022.
6. Treatment of Gout. Johns Hopkins Medicine.
7. Gout: Diagnosis, Treatment, and Steps to Take. National Institute of Arthritis and Musculoskeletal and Skin Diseases. December 2023.
8. 7 Foods That Trigger Gout. University of Maryland Medical System.
9. Shirai Y et al. Coffee Consumption Reduces Gout Risk Independently of Serum Uric Acid Levels: Mendelian Randomization Analyses Across Ancestry Populations. ACR Open Rheumatology. June 2022.
10. Schlesinger N et al. Components of Tart Cherry Juice Inhibit NFκB Activation and Inflammation in Acute Gout. Clinical and Experimental Rheumatology. April 7, 2022.

Original article: https://www.everydayhealth.com/arthritis/gout/gout-remedies-work/