Treatment for gout usually involves medications. What medications you and your doctor choose will be based on your current health and your own preferences.
Different medications are prescribed to:
• Treat acute gout attacks and prevent future attacks
• Reduce the risk of gout complications, such as the deposits of urate crystals that cause nodules to form under the skin (tophi)
Drugs used to treat acute attacks and prevent future attacks include:
• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may control inflammation and pain in people with gout. Your doctor may prescribe a higher dose to stop an acute attack, followed by a lower daily dose to prevent future attacks.
NSAIDs include over-the-counter options such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others), as well as more powerful prescription NSAIDs such as indomethacin (Indocin). NSAIDs carry risks of stomach pain, bleeding and ulcers.
• Colchicine. If you're unable to take NSAIDs, your doctor may recommend colchicine, a type of pain reliever that effectively reduces gout pain — especially when started soon after symptoms appear. The drug's effectiveness is offset in most cases, however, by intolerable side effects, such as nausea, vomiting and diarrhea.
After an acute gout attack resolves, your doctor may prescribe a low daily dose of colchicine to prevent future attacks.
• Corticosteroids. Corticosteroid medications, such as the drug prednisone, may control gout inflammation and pain. Corticosteroids may be administered in pill form, or they can be injected into your joint. Corticosteroids are generally reserved for people who can't take either NSAIDs or colchicine.
Side effects of corticosteroids may include thinning bones, poor wound healing and a decreased ability to fight infection. To reduce the risk of these serious side effects, your doctor will try to find the lowest dose that controls your symptoms and prescribe steroids for the shortest possible time.
Drugs used to prevent the complications associated with frequent gout attacks include:
• Medication that blocks uric acid production. Drugs called xanthine oxidase inhibitors, including allopurinol (Zyloprim, Aloprim) and febuxostat (Uloric), limit the amount of uric acid your body makes. This may lower your blood's uric acid level and reduce your risk of gout. Side effects of allopurinol include a rash and low blood counts. Febuxostat side effects include rash, nausea and reduced liver function.
Xanthine oxidase inhibitors may trigger a new, acute attack if taken before a recent attack has totally resolved. Taking a short course of low-dose colchicine before starting a xanthine oxidase inhibitor has been found to significantly reduce this risk.
• Medication that improves uric acid removal. Probenecid (Probalan) improves your kidneys' ability to remove uric acid from your body. This may lower your uric acid levels and reduce your risk of gout, but the level of uric acid in your urine is increased. Side effects include a rash, stomach pain and kidney stones.