Your treatment plan
If you have gout, your treatment plan will have two goals:
- to relieve the symptoms of a gout attack
- to prevent further attacks from occurring
During a gout attack, it is important to rest, elevate (raise) your limb and avoid accidentally knocking or damaging the affected joint.
Keeping the affected joint cool should help improve your symptoms. To cool the joint, remove any clothing from around the joint and apply an ice pack. You can buy ice packs from a pharmacist, or you can use a bag of frozen peas or some ice wrapped inside a towel.
Apply the ice pack to your joint for approximately 20 minutes. Do not apply ice directly to your skin and do not apply it for more than 20 minutes at a time because this could damage the skin.
Non-steroidal anti-inflammatory drugs (NSAIDs) are a type of painkiller usually recommended as an initial treatment to relieve the symptoms of gout. NSAIDs work by reducing the levels of pain and inflammation. NSAIDs often used to treat the symptoms of gout include:
If you have been prescribed NSAIDs for gout, it is best to keep them near you at all times so that you can use them at the first sign of a gout attack. Continue to take your medication throughout the attack and for 48 hours after the attack has finished.
If you are unable or do not want to take NSAIDs, or if NSAIDs are ineffective at treating your symptoms, colchicine can be used instead. Colchicine works by helping to reduce the build up of uric acid in your bloodstream.
While colchicine is usually an effective treatment for gout, it is no longer widely used because it can cause troublesome side effects, including:
- abdominal pain
Colchicine can be very poisonous if it is taken in too high a dose. It is very important to follow the recommended dosage schedule. For most people, this means taking two to four tablets a day.
Corticosteroids are a type of steroid. They are sometimes used to treat severe cases of gout that do not respond to the treatment above.
The relief provided by corticosteroids is often rapid, although these medicines can rarely be used in the long term. This is because long-term use can often cause the following side effects:
- weight gain
- fluid retention
- osteoporosis (thinning of the bones)
- muscle weakness
- thinning of the skin
Corticosteroids can also worsen diabetes and glaucoma (an eye disease that is caused by blocked fluid in the eye).
Do not take corticosterodis if you have:
- bone marrow disease
- impaired kidney function
- impaired liver function
- heart failure
Do not take corticosteorids if you are pregnant or breastfeeding.
There are two methods that can be used to try to prevent further attacks of gout. These are:
- using medication to reduce your uric acid levels
- making lifestyle changes to reduce your uric acid levels
If you experience two or more attacks of gout within a year, you will usually be prescribed a medication to help prevent further attacks. This will usually be a medication called allopurinol.
Allopurinol helps lower your uric acid levels by disrupting the enzyme responsible for converting purines into uric acid. However, allopurinol is not a painkiller and will have no effect during a gout attack.
If you are prescribed allopurinol, you will have to take it once a day. It usually has to be taken for two to three months before you see any effects. If you are prescribed allopurinol, you will usually have to take it indefinitely. However, you may only be able to stop taking the medicine if you have a normal serum uric acid level for many years and have no attacks of gout during this time.
When you start taking allopurinol, it can sometimes cause a gout attack. This is because it usually raises the level of urate before lowering it. Therefore, this type of treatment is usually prescribed one to two weeks after an attack of gout has settled down.
Because you may experience a return of gout symptoms when you start taking allopurinol, you will usually be prescribed a low-dose NSAID for six weeks or low-dose colchicine (if you are unable or unwilling to take an NSAID) for six weeks to six months to help prevent your symptoms returning.
In certain people, such as people who are over 65 years of age or who have a history of stomach ulcers, the long-term use of NSAIDs can increase the risk of developing stomach ulcers. If this is the case, you may also be prescribed a medication known as a proton pump inhibitor (PPI) to help prevent you developing stomach ulcers. See Treating stomach ulcers for more information about PPIs.
A skin rash is the most common side effect of allopurinol, affecting around 1 in 10 people. In most cases, the skin rash is mild and soon goes away. However, in a small number of cases, a skin rash can be a sign of a more serious allergic reaction. If you develop a skin rash while taking allopurinol, stop taking the medication immediately and contact your GP as soon as possible for advice.
A small number of people also have symptoms of dizziness, loss of balance and drowsiness when they start taking allopurinol. Exercise caution when driving or operating heavy machinery until you are sure that you are not affected by these side effects.
Some foods are high in purines. Avoiding eating them can help reduce your risk of having a gout attack. You may want cut out the foods below altogether, or at least eat only a moderate amount:
- meat, particularly kidney, liver, veal, turkey and venison
- seafood, particularly anchovies, herring, mackerel, sardines, fish roe, mussels and scallops
- certain types of vegetables, such as asparagus, kidney beans, lima beans, lentils and spinach
- foods or supplements that contain yeast extract, such as Marmite and Quorn
If you are overweight, the levels of uric acid in your blood often rise. Losing weight will help reduce your uric acid levels significantly.
If you need to lose weight, it is important to follow a balanced, calorie-controlled diet. Do not crash diet. A high-protein, low-carbohydrate diet should be avoided because high-protein foods often contain high levels of purines.
Ensure that you get plenty of regular exercise. Not only will this reduce your urate levels and decrease your risk of developing gout, but it will also leave you feeling more energised and healthier.
If you have a gout attack, you need to keep the joint rested and elevated (raised). Avoid exercise that puts strain on the affected muscles or joints. Swimming is a good way to stay fit without putting pressure on your joints as the water supports your weight.
It is important to drink plenty of water. Aim to drink about 1.2 litres (six to eight glasses) a day, or more if you are exercising or when it is hot. Keeping yourself well hydrated will reduce the risk of crystals forming in your joints.
Some types of alcohol are high in purines. Beer, stout and port contain the highest levels of purines. Spirits, such as vodka and whisky, also contain purines. Studies have shown that wine, which is lower in purines, should not contribute to an attack of gout. The exception is fortified wine, which has high levels of purines due to the way it is fermented.
If your diet contains a lot of alcohol that is high in purines, consider cutting back on or, ideally, cutting out these drinks. Getting drunk or 'binge drinking' on any type of alcohol can interfere with your body's ability to deal with uric acid. Men should not drink more than three to four units of alcohol a day and women no more than two to three units a day.
Other medical conditions can increase your risk of developing gout. These include:
If you have one of these conditions, it is important to manage and treat it as fully as possible. If you manage a condition, such as psoriasis, effectively, it will help prevent gout from recurring.