Gout

Treating the pain and inflammation of attacks

Once an attack of gout has started, it usually gets better with time – even without treatment – over a few days or weeks. Doctors think that this happens because the cells of the immune system stop reacting to the uric acid crystals, which means that the inflammation gets better*. 

Most people need treatment to reduce the pain and inflammation caused by attacks. People who only have occasional attacks, for example every few years, may only need treatment to deal with these attacks. People who have more frequent attacks may need daily medication to reduce the amount of uric acid (urate) in their blood and prevent further attacks or joint damage (see ‘Long-term treatment to lower uric acid and prevent attacks and long-term problems’). 
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Most people find that the earlier they recognise the onset of an attack and take their medication, the better it works for them. People we talked to found it useful to keep a supply of medication, prescribed by their GP, at home so that they could take it as soon as they noticed the first signs of an attack. 
People we talked to had different preferences for the tablets they took to treat the pain and inflammation of attacks. Some found that one drug worked better for them than another. Others could not take certain medication because of the side effects or because they had other health issues such as kidney or heart problems (see ‘Side effects of gout medication’ and ‘Living with gout and other conditions’). 
Two of the most common treatments for attacks are non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine. Steroids (tablets or injections) can also be prescribed. Some people chose to take other painkillers, such as paracetamol or co-codamol (paracetamol and codeine), but others found these were ineffective. People we talked to also found ice packs useful for pain relief.

Non-steroidal anti-inflammatories (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) are used to relieve pain and inflammation. Examples of these drugs include ibuprofen, naproxen, diclofenac, indometacin (indomethacin) and etoricoxib (Arcoxia). 

Ibuprofen can be bought over the counter in a pharmacy, but a doctor can prescribe other drugs and stronger doses. 

Aspirin is not recommended for treating gout, but people who are taking low daily doses (75mg) to prevent heart attacks should continue taking it as usual.

NSAIDs can cause problems such as stomach upsets, indigestion or damage to the lining of the stomach. Drugs that help to protect the stomach can be prescribed to prevent these problems (e.g. omeprazole and lansoprazole). Arthrotec tablets contain an NSAID diclofenac and misoprostol, which prevents the side effects of diclofenac. 
Most people were cautious about the way they took NSAIDs because they were aware of the possible side effects. Peter always takes them after food to avoid stomach problems. Other people made sure that they only took a short course of tablets. 

NSAIDs slightly increase the risk of heart attacks and strokes. This means that these drugs should be used with caution in people who might be at higher risk, for example because of high blood pressure, high cholesterol, diabetes or smoking. NSAIDs are not advised for people with heart or kidney failure.

Colchicine

Colchicine helps reduce the inflammation caused by uric acid crystals in and around joints. In the UK it cannot be bought over the counter but only with a prescription.

Common side effects of colchicine are nausea and/or vomiting and diarrhoea. Most people who took high doses had these side effects. Lower doses are effective and less likely to cause side effects (for more see ‘Side effects of gout medication’).
Steroids 

Steroids are usually only prescribed if NSAIDs and colchicine are not effective in treating an attack, or if these drugs are unsuitable for a particular person. Steroids can be prescribed as an injection into the joint or muscle, or as a course of tablets (usually prednisolone).
Ice packs

An ice pack on the affected joint can reduce swelling, heat and pain. Ice packs can be used in addition to any of the medications for gout. It is best to protect the skin from direct contact with the ice (e.g. by wrapping an ice pack in a towel). Many people we spoke to found ice packs helpful in relieving symptoms during an attack. 
(For more see ‘Decisions and feelings about treatments’).

*Mechanisms of inflammation in gout. Dalbeth N, Haskard DO. Rheumatology (Oxford). 2005 Sep;44(9):1090-6.


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Last reviewed December 2016
Last updated Decemeber 2016

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