Understanding Your Medication Options for Gout

If you’re living with gout, you’re all too familiar with the periodic bouts of pain and swelling in your big toes and other joints. These “gout attacks” happen when uric acid settles into your joints and forms into needle-shaped crystals.

“Without medication, a gout attack can last from one to three weeks,” says rheumatologist Adam Brown, MD. “It’s an extremely painful condition.”

But medication can help lower your uric acid levels and keep gout at bay, in the short and long term.

What are the types of medications for gout?

Gout medications typically take a two-pronged approach.

“You can take medication to treat an acute flare, and then there’s another group of medications we use to help prevent flares,” Dr. Brown explains.

• For acute attacks: When you’re in the midst of a gout attack, the goal is to bring down swelling and ease your pain. This can sometimes be done with over-the-counter options. Other times, you may need a prescription.
• For long-term prevention: Urate-lowering medications are prescription medications that do exactly what their name suggests: They help lower your uric acid levels, which can help you avoid future gout attacks.

Let’s take a deeper look at both types of medications that can help manage gout.

Gout medications for acute attacks

Mild gout attacks may be managed with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen. But you may need something more.

Other medications that can help include:

• Prescription NSAIDs, like indomethacin (Indocin®), celecoxib (Celebrex®) and others can be especially helpful at the start of a gout attack.
• Colchicine (Colcrys®) decreases inflammation and stops your white blood cells from reacting to uric acid crystals.
• Corticosteroids (aka glucocorticoids) are powerful anti-inflammatory medications that can be taken by pill or given as an injection.

“If they’re taken at the start of a gout flare, these medications can offer relief very quickly,” Dr. Brown says.

Gout medications for long-term prevention

To prevent future gout attacks, your healthcare provider may prescribe something to help reduce your uric acid levels going forward. Dr. Brown outlines the possibilities.

Urate-lowering medication

“If we can manage your uric acid levels, we can really manage the disease itself,” Dr. Brown notes. “Urate-lowering medications can get your uric acid level to the point where, hopefully, you never have a gout flare again.”

The most common urate-lowering medication is allopurinol, sold under the brand names Aloprim® and Zyloprim®.

Another option, febuxostat (Uloric®), may bring a slightly increased risk of death from heart disease, so it’s typically only prescribed if there’s some reason you can’t take allopurinol.

Anti-inflammatory medication

For reasons doctors aren’t yet sure of, starting urate-lowering therapy can temporarily trigger a gout attack. So, when you start allopurinol, your provider may put you on one of the following medications for a few months to help prevent an acute flare:

• Colchicine
• An NSAID, like naproxen or ibuprofen
• Prednisone

“When people experience a gout flare shortly after starting allopurinol, they often think that the allopurinol itself is triggering the flare. Then, they want nothing to do with the medication,” Dr. Brown says. “So, patient education beforehand is critical.”

Pegloticase infusions

If your gout is severe and resistant to treatment, your provider may prescribe a medication called pegloticase (Krystexxa®), which is given as an infusion.

“This medication can drastically reduce serum uric acid and drastically reduce the risk of the complications of high uric acid and risk of flares,” Dr. Brown explains.

Don’t stop taking your medications

If you’ve already had an attack of gout, you’re more likely to have others in the future. So, to effectively treat this condition, you’ll need to keep consistently taking your urate-lowering medications.

That’s especially important because gout attacks aren’t just painful — they can also take a toll on your body.

“Over time, gout attacks can become more frequent, last longer and involve multiple joints,” Dr. Brown warns. “Eventually, they can even cause joint damage.”

Lifestyle changes for gout may help keep uric acid levels low, too, so consider following a low-purine diet and doing low-impact exercises that help keep your joints healthy. But on their own, they’re still usually not enough to manage gout.

“Most people with severe gout still need medications aimed at reducing uric acid,” he continues. “But once we’re able to recognize and treat the problem, you hopefully won’t have any flares going forward.”

If you have questions about how to best manage or prevent gout, talk to your provider.

Sudden gout attacks can be debilitatingly painful, taking you out of commission for weeks at a time. But the right medication can bring you the relief you need — and prevent future episodes.