January 20, 2020

Gout Attacks? Here’s Why You Might Want to Consider Medication to Lower Your Uric Acid Levels

Learn how this gout treatment can improve your quality of life

woman with elbows affected by gout

If you’re among the 9 million Americans who live with gout — a form of inflammatory arthritis — you’re all too familiar with the periodic attacks of pain and swelling in your big toes and other joints.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

And you may know that these attacks happen when you have a high level of a substance called uric acid. Uric acid is a waste product of natural processes in your body, which is eliminated through your GI tract and kidneys. But if not enough uric acid is gotten rid of, it can accumulate in your blood. And once levels exceed 6.8 milligrams per deciliter (mg/dL), uric acid can leave your bloodstream and settle in joints, tendons and under your skin.

In your joints, uric acid can form needle-shaped crystals. From time to time, these can cause the swelling, redness and pain that you know as a “gout attack.”

Why treating gout takes a 2-pronged approach

Gout treatment takes a two-pronged approach:

  1. Individual gout attacks are usually treated with non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or corticosteroids. These bring down swelling and ease your pain.
  2. To prevent future attacks, you need a drug that will reduce your uric acid levels. These are called urate-lowering drugs, and the most commonly used one is allopurinol (Aloprim®, Zyloprim®). Another option is febuxostat (Uloric®). (But because of a slightly increased risk for death from heart disease, it’s used only when allopurinol can’t be used.)

Urate-lowering drugs are a good option that not enough people use

Allopurinol is inexpensive and very effective. Yet, it isn’t used as often as it perhaps should be. “Too few people are started on the medication,” says rheumatologist Brian Mandell, MD, PhD. “And when people are started on therapy, many are not monitored for the lowering of the uric acid and treated to the effective target level.”

Advertisement

A recent study published in Arthritis & Rheumatology found that fewer than 38% of those with gout achieved the target uric acid level of less than 6 mg/dl. And another study found only 37% of people with gout took allopurinol — and only half of those with frequent flares regularly used this drug.

Even among people who do start on a drug, many stop taking it. “People with gout may not realize that this is a chronic disease, and we can cure it,” Dr. Mandell notes.

Don’t stop taking your uric-acid lowering drug

To effectively treat gout, you have to take urate-lowering therapy consistently. “If you are having frequent flares and you want to treat the disease, you need to dissolve those deposits,” Dr. Mandell says.

If you’ve already had an attack of gout, you are more likely to have others. Over time, gout attacks can become more frequent, last longer and involve multiple joints. Eventually, you can have joint damage.

Your doctor should take blood tests to check that your uric acid levels remain at the target. “People with gout should know their uric acid level,” Dr. Mandell says.

Advertisement

In the past, doctors advised their patients with gout to avoid foods high in purines, which the body metabolizes into uric acid. Steak, shellfish and seafood were all off-limits. However, research hasn’t shown any dramatic benefit of adopting that kind of restrictive diet.

“The idea that you’re going to stop eating red meat and your uric acid level is going to plummet to the point where the crystals dissolve is very unlikely,” Dr. Mandell explains. A heart-healthy diet is never a bad idea. But to ultimately stop future attacks, you need to stick with medication.

This article was adapted from Cleveland Clinic Arthritis Advisor.

Related Articles

Person holding a bowl
January 3, 2022
6 Truths About Gout Diet Myths

What you should and shouldn't eat to avoid flare-ups

Aspirin poured onto table from bottle
December 7, 2023
Why You Are Sensitive to Aspirin

A reaction to the medication may trigger preexisting asthma and result in sinus or skin reactions

Person lifting up their sweater, showing ostomy bag in mirror's reflection
December 6, 2023
Adjusting to Life With an Ostomy Bag: What To Expect

It can be hard to get used to the bags, but the freedom they provide is worth the challenge

Happy caucasian woman hiking in forest
December 6, 2023
Forest Bathing: What It Is and Its Potential Benefits

Immersing yourself in nature can improve both your mental and physical health

Woman looking in mirror and pulling skin until wrinkles disappear
December 6, 2023
Should You Add Collagen Supplements to Your Skin Care Routine?

Though popular with influencers and celebrities, there’s little research to back up claims that they work

A vaccine syringe in front of a passport for international travel.
December 5, 2023
Which Vaccines Are Required To Travel?

Plan early — getting the right vaccines can help you stay healthy on your travels

Person overheated lying on chair on the beach; heart rythym next to him
December 5, 2023
How the Heat Can Affect Your Heart

Sizzling temperatures force your heart to work much harder

nocovaine needle entering mouth with dental mirror
December 4, 2023
How Long Does Novocaine Last?

The numbness and tingling should wear off in about two hours

Trending Topics

group of hands holding different beverages
November 14, 2023
10 Myths About Drinking Alcohol You Should Stop Repeating

Coffee won’t cure a hangover and you definitely shouldn’t mix your cocktail with an energy drink

Person applies moisturizer as part of their skin care routine after a shower.
November 10, 2023
Korean Skin Care Routines: What You Need To Know

Focus on the philosophy — replenishing and respecting your skin — not necessarily the steps

glass of cherry juice with cherries on table
November 8, 2023
Sleepy Girl Mocktail: What’s in It and Does It Really Make You Sleep Better?

This social media sleep hack with tart cherry juice and magnesium could be worth a try

Ad