How Gout Is Treated: Managing Symptoms and the Underlying Triggers

Effectively treating gout involves a dual approach: alleviating the intense pain and inflammation during acute attacks, and systematically reducing the accumulation and crystallization of uric acid within affected joints. While lifestyle adjustments, including specific dietary choices and alcohol moderation, can significantly decrease the frequency of gout flares, chronic or recurrent attacks often necessitate prescription medications designed to lower systemic uric acid levels. This comprehensive guide explores the various home remedies, impactful lifestyle modifications, over-the-counter options, and advanced prescription therapies currently available for managing gout symptoms and preventing long-term complications.

Verywell

Home Remedies and Lifestyle

Managing gout symptoms often begins with incorporating targeted lifestyle modifications, especially for individuals experiencing milder flares. The primary objective of these interventions is twofold: to mitigate the immediate discomfort of a gout attack and to actively prevent future recurrences. Gout symptoms stem from an excessive buildup of uric acid in the body, a condition known as hyperuricemia. Over time, this surplus uric acid can precipitate and form needle-like crystals within and around joints, leading to the characteristic severe pain and debilitating inflammation of a gout flare. Effective treatment strategies are thus centered on both reducing uric acid levels to avert future episodes and providing prompt relief when flares inevitably occur [1].

Pain Management

For many individuals, the initial 24 hours of a gout attack are often the most excruciating. Fortunately, several home treatments and lifestyle adjustments can offer considerable relief from mild to moderate pain. Implementing these strategies promptly can significantly improve comfort during a flare. The key is to address both the pain and the inflammation effectively, allowing the body to begin its recovery process while supporting overall joint health. These self-care measures, when applied consistently, can be powerful tools in managing acute gout symptoms before or alongside medical intervention.

A straightforward and highly effective tactic for acute gout pain is applying a cold compress or ice pack directly to the affected joint(s) [2]. The cold helps to reduce swelling, numb the area, and constrict blood vessels, thereby lessening pain during a mild gout flare. Always wrap the ice pack in a thin towel, ensuring it is never applied directly to the skin, which can cause frostbite. Use the cold pack for 15 to 20 minutes at a time, allowing for a break before reapplication, and repeat this process several times throughout the day for continuous relief.

Resting the affected joint is another critical component of pain management during a gout attack. The big toe joint is frequently the primary site of gout flares [3], making elevation of the foot particularly beneficial for reducing swelling. It is advisable to minimize weight-bearing on the affected joint as much as possible. If movement is unavoidable, consider using assistive devices such as a cane or crutches to offload pressure from the painful joint, which can significantly reduce discomfort and prevent further irritation to the inflamed area.

Living with obesity is a significant risk factor for developing gout [3], and excess weight can also intensify pain by placing additional stress on already inflamed joints. Therefore, if you are overweight or obese, achieving and maintaining a healthier weight can be a transformative step in managing gout. Weight loss not only helps reduce uric acid levels, thereby preventing future flares, but it also alleviates the mechanical pressure on your joints, leading to a substantial reduction in pain and inflammation when flares do occur [4]. This makes weight management a cornerstone of long-term gout treatment.

Dietary Interventions

Hyperuricemia, the underlying cause of gout, is often intricately linked to dietary choices. Certain foods contain high levels of purines, organic compounds that, when metabolized by the body, are converted into uric acid. Furthermore, other dietary components can impede the kidneys' ability to efficiently excrete uric acid, leading to its accumulation in the bloodstream [5]. Understanding these connections is crucial for developing an effective dietary strategy to manage gout and prevent its painful flares.

Studies consistently demonstrate that adopting a Mediterranean diet can be particularly beneficial for individuals managing gout [6]. This dietary pattern emphasizes high fiber intake, features a low purine content, and is abundant in antioxidants, all of which contribute to better health outcomes for gout sufferers. Adhering to the Mediterranean diet not only supports weight loss but also significantly contributes to reduced uric acid levels, making it an excellent long-term strategy for preventing gout flares and improving overall well-being.

Beyond adopting a broader healthy eating pattern like the Mediterranean diet, specific dietary adjustments are essential for managing uric acid levels and preventing gout flares [3]. It is crucial to avoid or severely limit all forms of alcohol, especially beer, due to its high purine content and its ability to hinder uric acid excretion. Additionally, high-purine foods, such as anchovies, sardines, haddock, bacon, and turkey, should be avoided or consumed in very limited quantities [7]. Furthermore, fructose-sweetened beverages are known to impair uric acid excretion and should be strictly avoided to prevent uric acid buildup.

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Over-the-Counter Medication

For alleviating milder gout pain, over-the-counter (OTC) pain relievers can offer valuable relief. Acetaminophen, commonly found in products like Tylenol, can effectively ease some of the discomfort associated with a gout flare [2]. However, it is crucial to avoid aspirin, as it paradoxically increases uric acid levels and can worsen a gout attack. While nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) and naproxen (Aleve) are generally effective for gout pain, a significant caution applies.

Individuals with kidney disease should stringently avoid taking NSAIDs, including Advil and Bayer (aspirin), as these medications can further impair kidney function [8]. Given that kidney disease and gout frequently coexist, this is a critical consideration. However, if you do not have pre-existing kidney disease, NSAIDs can be a suitable option for pain relief during a gout flare [9]. Always consult with your healthcare provider to determine the most appropriate OTC pain reliever for your specific condition, especially if you have any underlying health issues.

Prescriptions

While dietary and lifestyle adjustments can provide significant relief for many individuals, they may not always be sufficient, particularly if gout flares become chronic or if there is evidence of progressive joint damage. In such instances, prescription medications become a necessary component of a comprehensive treatment plan. These medications are broadly categorized into two main types: those designed to reduce inflammation during an acute attack, and those that work to lower the body's overall uric acid levels, addressing the root cause of gout.

Anti-Inflammatory Drugs

Prescription anti-inflammatory medications are crucial for managing the acute pain and swelling characteristic of gout flares. These drugs can be prescribed for ongoing preventive use or taken as needed to quickly subdue acute symptoms. Their primary role is to dampen the body's inflammatory response, thereby alleviating the severe discomfort that defines a gout attack. Choosing the right anti-inflammatory depends on the severity of the flare, the patient's overall health, and potential side effects.

Colchicine is an oral anti-inflammatory drug frequently used to prevent and treat acute gout attacks [10]. It is particularly effective when taken at the very onset of symptoms. While it can be prescribed alone, colchicine is often used in conjunction with uric acid-reducing medications like allopurinol, especially during the initial stages of uric acid-lowering therapy, to prevent flares. Common side effects of colchicine include gastrointestinal issues such as diarrhea, nausea, and abdominal cramps, which typically subside as the body adjusts or with dose modification.

Corticosteroids, administered either orally or via injection directly into an affected joint, provide potent, short-term relief from acute gout symptoms [11]. These medications work by profoundly suppressing inflammation and dampening immune system activity. While highly effective for rapid symptom control, they are generally not recommended for long-term, ongoing therapy due to their extensive side effect profile. Oral treatment, typically with prednisone, may be prescribed for several days to weeks to control a flare.

Overuse of corticosteroids can lead to a range of adverse effects, including weight gain, easy bruising, osteoporosis, elevated blood pressure, eye problems (like cataracts), and an increased susceptibility to infections [11]. Corticosteroid injections are particularly valuable when only one or two joints are involved, or when there is a need to avoid the systemic, body-wide effects that oral corticosteroids can induce [12]. Careful monitoring and judicious use are paramount with these powerful anti-inflammatory agents.

Uric Acid-Reducing Drugs

When lifestyle changes and anti-inflammatory drugs alone are insufficient to control gout or prevent recurring flares, healthcare providers typically turn to uric acid-reducing medications. These drugs work by either decreasing the body's production of uric acid or enhancing its elimination from the body. The 2020 American College of Rheumatology guideline strongly recommends urate-lowering therapies (ULTs) as the primary treatment option for most patients diagnosed with gout, underscoring their importance in long-term disease management [13].

Currently, five drugs are approved by the U.S. Food and Drug Administration (FDA) specifically for lowering uric acid levels [14]. These medications are foundational for preventing recurrent gout attacks and halting the progression of joint damage. The choice of ULT depends on individual patient factors, including kidney function, co-existing medical conditions, and potential drug interactions. Adherence to these medications, even when symptoms are absent, is key to long-term success in managing gout.

Zyloprim (allopurinol) is a xanthine oxidase inhibitor (XOI) that effectively reduces the body’s production of uric acid [10]. It is taken once daily and is typically considered the first-line treatment for the majority of gout patients due to its efficacy and generally favorable safety profile [13]. It's important to note that symptom flares can occur during the initial stages of treatment as the body adjusts; therefore, allopurinol is often started at lower doses and gradually increased. To mitigate the short-term risk of a gout attack, allopurinol is frequently prescribed alongside colchicine during the initial phase of therapy [13]. While side effects may include stomach upset and, rarely, severe skin reactions, these are generally less extensive compared to other uric acid-reducing drugs, and stomach issues often resolve as the body adapts.

Uloric (febuxostat) represents another XOI treatment option that also works by reducing the body’s uric acid production [10]. It is primarily prescribed for individuals who may not tolerate or respond adequately to allopurinol. Taken daily, Uloric can significantly reduce both the severity and frequency of gout attacks. Similar to allopurinol, flare-ups can be common when initially starting treatment with febuxostat; however, it is crucial to continue taking the medication as prescribed during these episodes. Common side effects include nausea, joint pain, and muscle aches. It's important to note that Uloric should not be taken concurrently with azathioprine (used for rheumatoid arthritis) or mercaptopurine (used for lymphoma, Crohn's disease, or ulcerative colitis).

Krystexxa (pegloticase) is a more recently developed biologic drug, administered intravenously (IV) directly into a vein [10]. This powerful medication is reserved for severe cases of gout where other treatments have proven ineffective. Krystexxa functions uniquely by converting uric acid into a more soluble substance called allantoin, which the body can then easily eliminate. Administered every two weeks at a clinic, it is considered a specialized treatment for the most challenging forms of gout. Common side effects can include short-term flare-ups, nausea, bruising, sore throat, constipation, chest pain, and vomiting. Due to the potential for serious allergic reactions after repeated doses, vigilant monitoring during infusions is essential [15].

IL-1 inhibitors represent a class of drugs recommended for individuals whose gout symptoms are unresponsive to, poorly tolerated, or contraindicated with conventional anti-inflammatory medications [13]. This category includes medications such as anakinra and canakinumab, which target specific inflammatory pathways to reduce the severe inflammation associated with gout. These drugs are typically used in more complex cases, often under the guidance of a rheumatologist.

Additionally, certain complementary drugs, although not primarily prescribed for gout, can assist in lowering uric acid levels. For instance, Cozaar (losartan), an antihypertensive medication, can also aid in uric acid excretion. Similarly, Tricor (fenofibrate), a lipid-lowering drug, has been observed to help reduce blood uric acid levels [5]. These medications may be part of a broader treatment plan for patients with co-existing conditions like high blood pressure or dyslipidemia.

Summary

Gout treatment is a comprehensive process focused on managing acute pain and inflammation while systematically reducing blood uric acid levels to prevent future flares. During an acute gout attack, over-the-counter pain relievers such as Tylenol (acetaminophen) can offer relief, and NSAID pain relievers like Advil (ibuprofen) or Aleve (naproxen) may be used by those without chronic kidney disease. For individuals with obesity or overweight status, targeted weight loss can significantly lower uric acid levels and alleviate joint pain by reducing mechanical stress. When lifestyle changes and OTC medications are insufficient, prescription drugs, including anti-inflammatory agents like colchicine and corticosteroids, alongside uric acid-reducing therapies such as allopurinol and febuxostat, become essential for effective, long-term management.

A Word From Verywell

Given the intense pain associated with gout flares, it is natural to prioritize immediate pain relief during an attack. However, it is crucial to understand that gout management should not cease once symptoms subside. The period of remission is an opportune time to focus on proactive lifestyle changes and consistent adherence to uric acid-lowering therapies. Embracing healthy habits and continuing prescribed medications, even when feeling well, is paramount for preventing future flares, mitigating the risk of long-term complications like irreversible joint damage, and significantly improving your overall quality of life.

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].

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.

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12. Johns Hopkins Arthritis Center. Treatment of gout.
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14. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Gout: Diagnosis, treatment, and steps to take.
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