Why is treatment for gout so important?
Gout attacks tend to increase in length and frequency without treatment and can even become chronic. The ongoing presence of uric acid crystals in and around the joint can lead to destruction of the joint and the soft tissues around it.
Fortunately, with proper medical attention and treatment, few patients progress to this advanced stage. Most people living with chronic gout can control the condition with medication. Lifestyle changes are an important part of treatment and can help prevent and manage flares. Early identification and treatment can reduce the chance of permanent joint damage and the number and severity of attacks.
How is gout treated?
Treatment for gout consists of three main steps:
Step 1: Treat active gout attack.
Step 2: Lower uric acid levels in the bloodstream (if indicated).
Step 3: Add a prophylactic treatment if a medication is given to lower the uric acid in the bloodstream.
When having an attack
When having a gout attack, take these steps to bring pain and swelling under control:
Ice, elevate and rest the joint.
Take colchicine, anti-inflammatory medication, or prednisone as soon as possible, as advised by your doctor.
Drink plenty of water and fluids. Remember alcohol, pop, or sugary drinks can trigger gout attacks, so avoid those.
Keep track of which joints are involved, the intensity and any changes in pain, and the length of the attack.
Call your doctor to make an appointment to be assessed.
Avoid stress as much as possible. Added stress can make a gout attack feel more intense. Consider using relaxation techniques such as mindfulness meditation to relax your body’s response to pain.
Heat and cold
During a gout attack, using cold can help reduce pain. Cold reduces blood flow to the injury, which helps reduce swelling and inflammation. Cold should not be applied for longer than 20 minutes at a time. As a general rule, 20 minutes on, 20 minutes off, works well. Always use a protective barrier, such as a towel, between any cold pack and the skin.
Using a commercial cold pack or a homemade one (from crushed ice, ice cubes or a bag of frozen vegetables) can be helpful.
Cold is ideal for:
Heat should not be used during a gout attack since applying heat can make symptoms worse. However, between attacks, taking a warm shower and using warm packs (such as hot water bottles or microwavable heating pads) are great ways to help reduce general pain and stiffness.
Heat is ideal for:
relieving pain and stiffness
relieving muscle spasms and tightness
enhancing range of motion
IMPORTANT: Do not use heat on an already inflamed joint, as it can make symptoms worse.
Relaxation techniques and skills
Developing good relaxation skills can help you maintain balance in your life, giving you a greater feeling of control over your gout and a more positive outlook. Relaxing the muscles around a sore joint can help to reduce pain, though it is not always easy to relax when feeling pain. Gout attacks tend to be very painful, but there are techniques you can learn to help you refocus your mind, and help relax your muscles during a painful attack.
Visualization techniques, such as imagining burning sensations being put out by cold water, or concentrating on imagining what your pain might look like can also help to draw focus away from the pain itself, and help you reframe your experiences of pain or discomfort.
Other techniques to consider include mindfulness meditation, deep breathing exercises, listening to a podcast or audio book, narrated relaxation exercises, or soothing music.
A key to developing relaxation skills is to also practice the techniques that feel most comfortable for you even when you are not experiencing pain. This can be especially helpful for forms of meditation and visualization.
Medications to treat an acute gout attack
A number of medications do a good job of preventing pain and swelling in the short-term. Depending on the severity of the gout attack, medications can be given individually, or in combination.
Lowering uric acid in the bloodstream
After a first gout attack, your doctor will discuss with you whether you may benefit from medications to help lower the level of uric acid in your bloodstream. Your doctor will consider the following indications to help make this decision:
Two or more gout attacks within the span of 12 months
A history of kidney stones
Chronic kidney failure
Bone erosion on x-ray
Presence of tophi (uric acid crystals under the skin – pronounced toe-fi)
When working with you to lower your bloodstream uric acid levels, your doctor will want to help you reach the following target uric acid levels in your bloodstream.
If you have no erosion or tophi present, uric acid levels should be less than 360 µmol/l.
If there is erosion or tophi present, uric acid levels should be below 300 µmol/l
Medications that reduce uric acid levels
To achieve lower bloodstream levels of uric acid, your doctor may prescribe a medication. Medications that reduce uric acid levels will prevent future gout attacks and keep the condition from becoming chronic.
Taking medications that regulate uric acid levels is often a long-term treatment option since starting and stopping these medications can trigger a gout attack. Your doctor may wait to introduce this type of medication to first determine how frequently you experience gout attacks, and if they can be controlled through other treatment options. If you experience two to three attacks per year, your doctor may wish to explore this medication option with you.
Since starting a medication to lower uric acid levels can also trigger a gout attack, your doctor will likely also prescribe another medication, usually an NSAID or colchicine, to take daily for the first few months to help prevent further gout attacks while your body adjusts to taking a uric acid lowering medication.
Once you start a medication to lower uric acid levels, you may not notice any benefit right away. In some cases it could take years to achieve target uric acid levels, and for the uric acid crystals in joints and soft tissues to disappear.
The following medications are commonly used to help lower uric acid levels in the bloodstream:
For more information about medications, consult our Medication Reference Guide.
Surgery is rarely required for gout. Occasionally, surgery is considered for people who have suffered from gout over a long period of time to remove problematic tophi or to repair badly damaged joints. However, with proper medication and treatment, these situations are generally avoided.
This gout resource was reviewed in October 2022 with expert advice from:
Dr. Jean-Philip Deslauriers
Clinical Professor at the University of Sherbrooke
Bathurst, New Brunswick