How To Treat Gout Flare-Ups

For some reason, more and more people in the United States are experiencing acute episodes of gout, an inflammatory type of arthritis. Painful joint symptoms associated with gout are caused by the deposit of uric acid crystals in the joint and in the surrounding soft tissues. The most typical pattern is an attack that affects the big toe but other joints such as the elbow, wrist, fingers, and even the shoulder can be involved.

Anyone who has ever suffered an attack of gout knows just how painful it can be. The red, tender, and swollen joint can be so painful that even the touch of a sock or sheet can be excruciating.

Before starting treatment, the physician will make sure the problem isn't a case of joint infection from cellulitis or septic arthritis. If there is any doubt about the diagnosis, a small amount of fluid can be drawn out of the joint. The fluid will be analyzed in the lab in order to make the final diagnosis. If it's really gout, there will be urate crystals seen under the microscope. Sometimes those crystals are visible around the painful joint so the lab test isn't needed.

Treatment is determined based on whether this is an acute episode or more of a chronic problem with recurring episodes. Chronic gout is defined as having more than two acute attacks in a 12-month period of time.

In the acute phase, patients are reminded not to drink alcohol (beer or liquor) or eat foods with purines in them (e.g., red meat, sea food). It is important to stay hydrated as dehydration is a risk factor for acute flare-ups. The use of diuretics for any reason (control blood pressure, weight loss) can contribute to dehydration. Patients must be aware of these facts and act accordingly.

Medications such as antiinflammatories, corticosteroids, colchicine, or interleukin 1 inhibitors may be prescribed. The choice of medication depends on the patient’s age, severity of the gout attack, and other health factors such as the presence of diabetes and kidney function.

Older adults are at greater risk for heart problems so some of the medications may not be appropriate for them. Anyone who has gastrointestinal problems or who is already taking antiinflammatory medications may do better with one of the newer medications (e.g., colchicine). Sometimes an injection of cortisone is very helpful. There must be no infection present in the joint and only one joint involved. The physician will evaluate each individual patient when making recommendations for the use of medications.

For patients with chronic gout, a slightly different approach may be taken. There are medications available that will lower the urate level. Allopurinol is one of those medications. If allopurinol isn't a good choice (say someone has kidney disease and can't take allopurinol), then there are some back up choices (e.g.,probenecid, febuxostat).

Most cases of gout flare-ups go away on their own with a few days time. Patient self-management of diet and lifestyle to prevent flare-ups is really the first and most important step in managing acute gout that can become chronic. Physicians looking for typical pharmaceutical (drug) regimens for the management of gout will find a table in this article useful. The table compares drugs used in the treatment of acute or chronic gout, adverse effects to watch out for, and when to avoid using each one.

Reference: 

Peter C. Chimenti, MD, and Warren C. Hammert, MD. Medical Management of Acute Gout. In The Journal of Hand Surgery. October 2012. Vol. 37A. No. 10. Pp. 2160-2164.

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