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Treatment | Gout
The first thing is don’t panic. Take a deep breath. Although you might have been diagnosed with gout, you are not alone. Luckily, there are effective treatments available to help you keep levels of uric acid in the healthy range.
If you have gout or think you may have gout, see your family doctor. In some cases, he or she will be able to help you manage your gout. If your gout attacks start becoming more frequent, or if you develop tophi, then your family doctor should refer you to a rheumatologist. A rheumatologist is a specialist doctor who is an expert in treating arthritis. This type of doctor is in the best position to help you manage your condition. Many people with inflammatory types of arthritis who see their rheumatologist regularly benefit from the highest level of care.
One thing to remember about gout is that it tends to happen in people who have other health problems. For example, gout is more common in people who have high blood pressure, high cholesterol, heart disease, diabetes and in those who are overweight or obese. So if you have gout, it’s a good idea to look at your overall health. Make sure you do everything you can to keep your blood pressure and cholesterol at healthy levels. If you have diabetes, keep your blood sugar under control. And if you are a smoker, quitting can be one of the best things you can do for your overall health.
Here are some recommendations on what you should do if you have gout:
- Learn as much as you can about this disease. Education is very powerful and we’ve aimed to develop this RheumInfo website to be accessible and easy to understand for everyday people living with gout and other forms of inflammatory arthritis
- Attend your appointments regularly
- Get your blood tests done as suggested by your doctor
- Learn about the medications used to treat gout. The RheumInfo website has many interactive and valuable tools to help you understand these medications and their impact on your disease
Medications for Gout
People with gout can lead active and productive lives with the right kinds of treatment. Imagine we’re back at the sink and it is full of water because the drain is plugged. Think of uric acid in the same way – the levels are really high (like the water in the sink) because the kidneys aren’t getting rid of it. When the water in the sink overflows and down onto the floor then that is like an attack of gout. So there are two main strategies to treat gout: 1) Mop up the Water: Treat gout attacks to reduce acute pain and inflammation, and 2) Lower the Uric Acid Levels: Keep uric acid at healthy levels to prevent further attacks.
1. Mopping up the Water
Before you start playing with the taps you have to mop up all of the water first. In other words, treat the attack of gout completely before trying to lower the uric acid. This is really important. There are a lot of different ways to treat an acute attack.
A good way to start is by using the RICE method – Rest, Ice, Compression, and Elevation. This is how athletes treat acute injuries. If your foot is affected, put it up on a chair with a pillow, apply a cold pack (if you can tolerate it), and rest it.
The most common medicines used to treat gout are NSAIDs. To learn more about NSAIDs you can visit our NSAID page. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are one of the best remedies for gout. They work really well as long as you take enough to do the job. The most used NSAID is indomethacin. Other common NSAIDs used for gout are Celebrex, naproxen (which is Aleve), ibuprofen (Advil or Motrin), and diclofenac (Voltaren). NSAIDs can affect the kidneys and irritate the stomach so it is always best to check with your doctor before taking them.
An older but very effective therapy for gout is colchicine. Colchicine is a natural remedy that actually comes from the meadow saffron. In older times, this plant was used to cleanse the bowels resulting in diarrhea. So, if you take too much colchicine you’ll get diarrhea – for sure! The most people typically tolerate is 0.6 mg taken three times a day.
Prednisone is also a very effective treatment for gout. High doses of prednisone taken for a week or two will often clear up gout attacks nicely. The issue with prednisone is it will raise blood sugar levels in people with diabetes. Check with your doctor.
Finally, joints can be injected with cortisone. This is a very effective remedy and a local therapy for a local disease.
2. Lowering the Water in the Sink
After the water is all mopped up you have to move on to the sink to lower the levels of uric acid. Changes in your diet can affect the uric acid levels but it is difficult. See the section below on Diet and Gout.
There are two good medications to lower the uric acid levels: Allopurinol and Febuxostat. They both work the same way except that you get rid of allopurinol through the kidneys and febuxostat through the liver. Talk with your doctor about which one is best for you. The thing to remember is when you start or stop one of these medicines it can cause an attack of gout. So, here’s the rule: Once you start allopurinol or febuxostat you never stop if you have an attack of gout. You treat the attack of gout (mop up the water) with different medicines. If you try to stop the medicine it can make things worse.
Exercises for Gout
There aren’t any special exercises specifically for gout. If you have an acute attack it is best to rest and elevate the joint. As gout is associated with heart disease and stroke it’s best to consider 30 minutes of moderate exercise every day.
Natural or Home Remedies for Gout
There’s a ton on the internet about natural or home remedies for gout. Just remember what your mom said, “If it sounds too good to be true then it probably is.” The reality is there are very effective and safe proven therapies for gout. You don’t need to rely on, “so called” natural therapies.
Diet for Gout
Uric acid comes from animal proteins that you eat. Therefore you need to reduce the amount of meat or seafood you eat. If you’re not sure, just ask yourself a simple question, “Did it have a mother?” If what you’re eating once had a “mother” then you should avoid it.
Recent research has shown that all vegetables are absolutely fine. In the old days we used to think that vegetables high in purines were harmful. However, these are plant purines and won’t affect your gout.
Alcohol (especially beer) is bad for gout. Try to reduce the amount of alcohol you drink.
Smoking and Gout
As gout is associated with heart disease and stroke it’s best to stop smoking.
Gout is a type of arthritis that can destroy your joints over time. Joint damage from gout can be completely avoided with current medications. If there was an easy natural remedy for gout we would be the first to recommend it. But the fact is that conventional medicines work much better than any natural therapies.