The First Line of Defense

A gout attack is the result of a buildup of uric acid in the blood, which forms crystals in the joints. At the onset of a gout attack – characterized by an inflamed joints (usually the big toe), that’s reddened and warm to the touch, your doctor will give you one or more of the following medications to address pain and inflammation.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Your doctor may prescribe indomethancine (Indocin), ibuprofen (Advil) or naproxen sodium (Aleve), which can help relieve pain and inflammation within the first 24 hours after a gout attack. However, these can have side effects such as stomach upset or ulcer, or heart disease risk. People with gastrointestinal, kidney or heart problems should not take them.

Colchicine. This anti-inflammatory is most effective taken within 12 hours of an attack. It helps prevent the buildup of uric acid crystals in the joints Colchicine is sometimes taken in addition to NSAIDs for six to 13 months until uric acid levels are stabilized by other long-term medication. (See below.)

Corticosteroids. Corticosteroids, such as prednisone work by suppressing the inflammation of an acute attack, usually within 24 hours. When patients can’t tolerate NSAIDs or colchicine, corticosteroids may be injected into the painful joint. If a number of joints are involved, the medication may be injected into the muscle or taken orally. They can make it more difficult for people with diabetes to control their blood sugar, and they can cause temporarily blurry vision.

Long-Term Treatment

The goal of long-term treatment  is to reduce and stabilize the level of uric acid in your blood. Uric acid is a waste product made by the body as it breaks down purines – compounds found in foods, particularly those high in protein. If uric acid builds up in the bloodstream, crystals may form in joint tissue, triggering the pain and inflammation associated with gout attacks.

Over time, accumulated uric acid crystal deposits (called tophi) can damage tissues and lead to lumps under the skin, joint deformity, or can also accelerate degeneration in the joint that can lead to osteoarthritis. When uric acid is very high, gout can affect the kidneys. About 20 percent of people with gout develop kidney stones, which can damage the organs and ultimately lead to kidney failure.

Before a doctor can prescribe long-term medication, he will need to determine whether your body overproduces or underexcretes uric acid. You’ll be given a blood test to measure your level of uric acid. A high uric acid level means you have hyperuricemia; however, having hyperuricemia does not necessarily mean you have – or will develop – gout.