How Gout Is Treated

Managing Symptoms and the Underlying Triggers

Gout, a common and often debilitating form of arthritis, is characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in the joints. Effective treatment for gout involves a two-pronged approach: swiftly alleviating the acute pain and inflammation experienced during a flare-up, and, more importantly, reducing the chronic buildup and crystallization of uric acid within affected joints. This dual focus is crucial for long-term management, aiming to prevent future attacks and preserve joint health.

Beyond immediate symptom relief, managing gout often necessitates significant lifestyle adjustments, particularly concerning diet and alcohol consumption. These changes can play a pivotal role in decreasing the frequency and intensity of flares. For individuals experiencing persistent or severe gout attacks, prescription medications become a vital component of treatment, working to lower uric acid levels in the blood and prevent further crystal formation. This comprehensive guide explores the various home remedies, lifestyle interventions, over-the-counter options, and prescription therapies available for treating gout symptoms effectively.

Verywell

Home Remedies and Lifestyle

Initial management of mild gout symptoms often begins with practical lifestyle modifications. The primary objective of these changes is to mitigate the severity of current symptoms and proactively prevent future episodes. Gout symptoms are fundamentally triggered by an excessive accumulation of uric acid in the body, a condition medically known as hyperuricemia. Over time, this heightened concentration of uric acid can lead to the formation of sharp, needle-like crystals in and around the joints, culminating in intense pain and significant inflammation characteristic of gout flares. Therefore, treatment strategies are precisely aimed at two core goals: lowering uric acid levels to avert future gout flares and effectively alleviating existing gout pain when attacks occur.

Pain Management

The pain associated with a gout attack is typically at its most severe during the initial 24 hours, often described as excruciating. Fortunately, several home treatments and lifestyle adjustments can provide meaningful relief for milder pain. Applying a cold compress or an ice pack to the affected joint(s) is an effective method to help reduce pain and swelling during a mild gout flare. It is essential to always wrap the ice pack in a thin towel, ensuring ice is never applied directly to the skin, and to use the cold pack for 15 to 20 minutes at a time, several times per day, for optimal benefit.

Resting the affected joint is another crucial step in managing acute gout pain. The big toe joint is the most commonly impacted area, and when this occurs, elevating the foot can significantly help in reducing swelling and discomfort. Minimizing weight-bearing activities and staying off your feet as much as possible is highly recommended. For necessary movement, consider utilizing supportive aids such as a cane or crutches to protect the joint and facilitate mobility without exacerbating pain. These simple yet effective strategies can offer substantial comfort during a flare-up.

Addressing weight can also be a profound intervention for gout management. Individuals living with obesity face an increased risk of developing gout, and excess body weight places additional stress on already inflamed joints, intensifying pain. If you are living with obesity or are overweight, losing weight can contribute significantly to reducing uric acid levels, thereby preventing future flares. Furthermore, achieving a healthier weight alleviates pressure on your joints, which in turn reduces pain and inflammation during active gout attacks. This holistic approach not only manages symptoms but also addresses an underlying risk factor for the condition.

Dietary Interventions

The levels of uric acid in the blood, and thus the risk of hyperuricemia, are closely linked to dietary choices. Certain foods contain elevated concentrations of purines, organic compounds that, upon breakdown in the body, are converted into uric acid. Conversely, other foods may contain substances that impede the kidneys' efficiency in eliminating uric acid from the system, further contributing to its buildup. Understanding these dietary influences is fundamental to managing gout effectively through nutrition.

Evidence suggests that adopting a Mediterranean diet can be particularly beneficial for individuals with gout. This dietary pattern is characterized by being high in fiber, low in purines, and rich in antioxidants, all of which support overall health and specific gout management goals. Adhering to the Mediterranean diet can not only assist with weight loss, which, as previously discussed, is crucial for gout, but also lead to a measurable reduction in circulating uric acid levels, thereby lessening the likelihood of future attacks.

Several other targeted dietary adjustments can significantly help in avoiding hyperuricemia and managing gout. It is strongly advised to avoid or severely limit the consumption of all types of alcohol, with particular emphasis on beer, which is known to be high in purines. Additionally, minimizing or eliminating high-purine foods such as anchovies, sardines, haddock, bacon, and turkey from your diet is essential. Moreover, avoiding or limiting fructose-sweetened beverages is critical, as these drinks can specifically impair the body's ability to excrete uric acid efficiently, contributing to its accumulation.

Gout Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.
Download PDF
Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life.
Email Address
Sign Up
You're in!
Thank you, , for signing up.
There was an error. Please try again.

Over-the-Counter Medication

For individuals experiencing milder gout pain, over-the-counter (OTC) pain relievers can offer a viable initial approach to symptom management. Medications like Tylenol (acetaminophen) are often recommended for their ability to ease discomfort without significantly impacting uric acid levels. However, it is crucial to avoid aspirin in the context of gout, as it can paradoxically increase uric acid levels, potentially worsening a flare-up rather than providing relief. This highlights the importance of selecting appropriate pain relievers carefully.

A significant consideration when choosing OTC medications is the presence of co-existing medical conditions. Notably, kidney disease and gout frequently occur together, which complicates medication selection. Individuals diagnosed with kidney disease should generally avoid nonsteroidal anti-inflammatory drugs (NSAIDs), including common options like Advil (ibuprofen) and Bayer (aspirin), as these can adversely affect kidney function. Conversely, for those without kidney disease, NSAIDs can be a safe and effective option for pain relief. Always consult with your healthcare provider to determine the most suitable OTC pain reliever for your specific health profile and gout condition, ensuring safety and efficacy.

Prescriptions

While lifestyle modifications and OTC medications can offer substantial relief for some individuals, they may not be sufficient for everyone. If these interventions fail to adequately control uric acid levels, or if there is evidence of progressive joint damage, prescription drugs become a necessary component of the treatment plan. Prescription medications for gout are broadly categorized into two primary types: those designed to reduce inflammation during acute attacks and those aimed at lowering chronic uric acid levels to prevent future flares. A comprehensive approach often involves using both types of medications to manage the disease effectively.

Anti-Inflammatory Drugs

Prescription anti-inflammatory drugs serve a critical role in managing the acute symptoms of gout. These medications are either prescribed for ongoing use to prevent flares or are taken as needed to quickly alleviate symptoms during an attack. Colchicine is a prominent oral anti-inflammatory drug widely used to prevent and treat acute gout attacks. While it can be prescribed alone, it is more commonly administered in conjunction with a uric acid-reducing drug, such as allopurinol, to provide comprehensive control. Patients should be aware of potential side effects, including diarrhea, nausea, and abdominal cramps, which are relatively common with colchicine.

Corticosteroids represent another powerful class of anti-inflammatory drugs effective for gout. When taken orally, typically as prednisone, or administered by injection directly into an affected joint, corticosteroids provide rapid, short-term relief from acute symptoms by powerfully suppressing inflammation and modulating immune system activity. They are generally not recommended for long-term, ongoing therapy due to their systemic side effects. Overuse of corticosteroids can lead to a range of adverse effects, including weight gain, easy bruising, osteoporosis, elevated blood pressure, eye problems such, and an increased susceptibility to infections, underscoring the importance of careful dosing and monitoring.

Oral corticosteroid treatment, often with prednisone, is typically prescribed for several days to weeks, depending on the severity of the flare. Corticosteroid injections are particularly useful when only one or two joints are involved, or when there is a desire to avoid the systemic effects that oral corticosteroids can produce throughout the body. These targeted injections deliver potent anti-inflammatory action directly to the site of inflammation, providing localized relief with fewer systemic consequences. The choice between oral and injectable corticosteroids depends on the extent of joint involvement and individual patient considerations.

Uric Acid-Reducing Drugs

When non-pharmacological interventions prove insufficient in reducing elevated uric acid levels, healthcare providers typically turn to specific medications designed to either decrease uric acid production or enhance its elimination from the body. The 2020 gout treatment guidelines from the American College of Rheumatology strongly advocate for urate-lowering therapies (ULTs) as the primary treatment option for most patients diagnosed with gout. This emphasizes a proactive approach to prevent chronic complications rather than merely reacting to acute flares.

Currently, the U.S. Food and Drug Administration (FDA) has approved five distinct drugs specifically aimed at reducing uric acid levels in the body. Zyloprim (allopurinol) is a widely prescribed urate-lowering therapy that acts as a xanthine oxidase inhibitor (XOI), effectively reducing the body's overall uric acid production. It is typically administered once daily and is generally recommended as a first-line treatment for the majority of gout patients. It is important to note that symptom flares can occasionally occur during the initial stages of treatment, so the drug is often started at lower doses and gradually increased. Furthermore, allopurinol is frequently co-prescribed with colchicine to mitigate the short-term risk of a gout attack as uric acid levels stabilize. Allopurinol's side effects are generally less extensive than other uric acid-reducing drugs, primarily including stomach upset and, rarely, serious skin reactions. Patients should consult their prescribing provider regarding any personal risk for severe allopurinol reactions. Stomach problems typically resolve as the body adapts to the medication.

Uloric (febuxostat) represents another vital XOI treatment option that also functions by reducing the body’s uric acid production. This medication is typically reserved for individuals who may not tolerate allopurinol or for whom allopurinol is not sufficiently effective. Taken daily, Uloric has demonstrated its ability to decrease both the severity and frequency of gout attacks over time. Similar to allopurinol, flare-ups can be common when initially starting treatment with Uloric, but it is crucial for patients to continue taking the medication as prescribed even if a flare occurs. Common side effects associated with Uloric include nausea, joint pain, and muscle aches. It is contraindicated for use with azathioprine, a drug used to treat rheumatoid arthritis, or mercaptopurine, used in the treatment of lymphoma, Crohn's disease, or ulcerative colitis, due to potential drug interactions.

Krystexxa (pegloticase) is a newer biologic drug administered via intravenous (IV) infusion directly into a vein. Its use is typically reserved for severe cases of gout where other treatments have proven ineffective or poorly tolerated. Krystexxa operates by converting uric acid into a more soluble substance called allantoin, which the body can then easily eliminate. This therapy is administered every two weeks at a clinic, reflecting its targeted use for the most challenging cases. While highly effective, common side effects can include short-term flare-ups, nausea, bruising, sore throat, constipation, chest pain, and vomiting. A critical consideration with Krystexxa is the potential for serious allergic reactions, which may occur after repeated doses, necessitating careful monitoring during infusions.

IL-1 inhibitors constitute a class of drugs recommended for individuals in whom conventional anti-inflammatory medications are ineffective, poorly tolerated, or medically contraindicated. This category includes medications such as anakinra and canakinumab, which target specific inflammatory pathways. Beyond these primary gout medications, other complementary drugs may be incorporated into a patient's treatment regimen. For instance, Cozaar (losartan), an antihypertensive drug used to manage high blood pressure, and Tricor (fenofibrate), a lipid-lowering medication, have both been shown to aid in reducing uric acid levels in the blood, offering additional therapeutic benefits for certain patients.

Summary

Effectively treating gout involves a dual focus: managing acute pain and inflammation during a flare-up and consistently reducing uric acid levels in the blood to prevent future attacks. During an acute gout flare, over-the-counter medications like Tylenol (acetaminophen) can help alleviate pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) can also be used, provided the individual does not have chronic kidney disease, a common comorbidity that necessitates caution with NSAID use.

Beyond immediate pain relief, lifestyle interventions play a crucial role in long-term gout management. For individuals who are overweight or living with obesity, achieving weight loss is particularly beneficial, as it can directly reduce uric acid levels and ease joint pain by lessening mechanical stress. When lifestyle changes and OTC medications are insufficient to control symptoms or prevent recurrent flares, prescription drugs become essential. These include anti-inflammatory medications, such as colchicine and corticosteroids, which provide immediate relief during attacks, and uric acid-reducing drugs, which target the root cause of gout by lowering uric acid levels to prevent crystal formation and subsequent flares.

A Word From Verywell

Given the intense pain associated with gout flares, it is entirely understandable that the primary focus during an attack is on immediate pain relief. However, effective gout management extends far beyond simply treating acute symptoms. When you are in remission, a period free from active flares, your treatment should not cease. This remission phase is a critical window of opportunity to implement healthy lifestyle changes consistently. By focusing on these preventative measures, you can significantly reduce the frequency of future flares, minimize the risk of joint damage, and ultimately improve your long-term quality of life. Proactive management during remission is key to maintaining control over gout and preventing its debilitating complications.

Frequently Asked Questions

• What medications treat gout pain?
  Over-the-counter pain medications like Tylenol (acetaminophen), Advil (ibuprofen), or Aleve (naproxen) may help relieve pain from a mild case of gout. However, prescription anti-inflammatories or corticosteroids are typically used to treat a gout attack.
  Your healthcare provider will also likely prescribe medication to lower uric acid levels.

• How do you stop gout pain at home?
  To treat an acute gout attack at home, try ice and elevation to relieve the pain. Apply an icepack or cold compress to the affected joint for 15 to 20 minutes several times a day. Just be sure to keep a towel between your skin and the ice.
  Staying off your feet can also help to relieve the pain.

• How do you flush uric acid out of your body?
  Drinking lots of water is the best way to flush uric acid out of your system. During a gout attack, drinking 16 8-ounce glasses of water daily is recommended. To keep uric acid levels low to prevent attacks, stay hydrated with at least eight glasses of water a day.16

Read more:

• Health A-Z
• Arthritis
• Gout

16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Johns Hopkins Arthritis Center. Symptoms and diagnosis of gout.
2. Arthritis Foundation. Managing a gout flare.
3. Centers for Disease Control and Prevention. Gout.
4. Nielsen S, Bartels E, Henriksen M, et al. Weight loss for overweight and obese individuals with gout: A systematic review of longitudinal studies. Ann Rheum Dis. 2017 Sep;76(1):1870-1882.
5. Hong F, Zheng A, Xu P, et al. High-protein diet induces hyperuricemia in a new animal model for studying human gout. Int J Mol Sci. 2020 Mar;21(6):2147. doi:10.3390/ijms21062147
6. Kakutani-Hatayama M, Kadoya M, Okazaki H, et al. Nonpharmacological management of gout and hyperuricemia: Hints for better lifestyle. Am J Lifestyle Med. 2017 Aug;11(4):321-329. doi:10.1177/1559827615601973
7. Arthritis Foundation. Which foods are safe for gout?
8. Stamp L, Farquhar H, Pisaniello HL, et al. Management of gout in chronic kidney disease: A G-CAN consensus statement on the research priorities. Nature Rev Rheumatol. 2021 Jul;17(1):633-641. doi:10.1038/s41584-021-00657-4
9. Harvard Health Medical School. All about gout.
10. American College of Rheumatology. Gout.
11. Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. All Asth Clin Immun. 2013 Aug;9(1):30. doi:10.1186/1710-1492-9-30
12. Johns Hopkins Arthritis Center. Treatment of gout.
13. FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology guideline for the management of gout. Arthritis Care Res (Hoboken). 2020 Jun;72(6):744-760.
14. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Gout: Diagnosis, treatment, and steps to take.
15. Krystexxa. Safety guidelines.
16. Arthritis Foundation. Gout diet: Dos and don’ts.

By Carol Eustice Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis.
See Our Editorial Process
Meet Our Medical Expert Board