Treatments for Gout are broken down into two broad categories. The first is what we use for in acute attacks and the second group is really what we use to prevent attacks coming up.
Treating Acute Gout
Most patients who have Gout in it’s early stages get attacks once in a while (for example affecting a big toe or an instep) and the trick is to prescribe an anti-inflammatory medication (for example Diclofenac or Naproxen) as early as possible to settle down an acute attack. These usually lasts for a few days, so five to seven days of anti-inflammatory is enough for most people.
Most patients with Gout in it’s early stages will get an attack maybe once a year or once every two years. But in some patients it can become more frequent than that.
Some patients can’t take anti-inflammatory medications as they can upset their stomach (they also need to be avoided in patients with kidney failure or those on warfarin). An alternative is a drug called Colchicine and doctors sometimes use steroids (which are particularly effective). These can be given as tablets, intramuscular injection occasionally by injection directly into a painful joint (not as painful as it sounds).
Keeping a stash of anti-inflammatories in the bathroom cabinet
I tend to give patients back up prescriptions for anti-inflammatories to keep in their bathroom cabinet as attacks sometimes come on at night.
Most patients who have experienced Gout get very good at sensing attacks in their early stages and take their anti-inflammatory quickly to abort an attack. There is also some evidence that if you drink lots of water that you can abort an attack in about 20% of the time (but most patients, in my experience, need some medications to help)
For patients who are getting very frequent attacks, we tend to use preventative treatments. There is no hard an fast rule for when to start these except to say, that most people who have more than a couple of attacks a year, or where attacks drag on for weeks at a time, will be keen to consider prevention. And this effectively means taking something everyday for the rest of your life to prevent these attacks.
Typically we use a drug called Allopurinol which is designed to reduce the amount of uric acid in a blood strain and in turn the amount of uric acid which is in your joints, which in turn causes the Gout. It reduces the amount of uric acid that your own body makes and tends to do so fairly effectively depending on the dosage that is used. And where Allopurinol doesn’t work, it’s quite often because the dosage that’s used isn’t high enough.
Gout may initially get worse with treatment
A word of warning, when we start patients off on a drug like Allopurinol the joints can get a little bit worse initially and we would normally try prevent this happening by prescribing along with the Allopurinol an anti-inflammatory or possibly a drug called Corticosteroids for the first month to six weeks. But it is important though when you start Allopurinol and if you do get an attack within those first few weeks that you stick with the Allopurinol and rheumatologist or family doctor to treat the acute attack of Gout.
The Allopurinol can be very effective use in the correct tools, what we tend to do is increase the dosage until we get your uric acid to low level where the uric acid is unlikely to crystallize in your joints and this can take a few months. For patients who are in tolerant of Allopurinol for example very, very occasionally we see patients who have allergies to it, we can use a drug called Febuxostat which can be very effective as well.