Gout Treatments
Gout treatments involve different medicines or alternative therapies at different stages during your recovery from gout.
It is vital to plan these stages properly, and to be prepared for secondary effects of different gout treatments as you progress.
On this part of the website, I look at the preparation and planning required before you embark on any course of treatment. These are equally important whether you choose the medical or alternative approach to fixing your gout.
I hope it goes without saying that none of this will make sense unless you have a clear diagnosis of gout. If you have any doubts, read the Gout Symptoms section before you go any further. Your diagnosis might be supported by a 24-hour urine test. If that reveals that you are a uric acid under-excreter, then your treatment options increase to include uricosurics, which are gout medicines that encourage uric acid excretion through the kidneys.
Preparation For Gout Treatments
You and your healthcare provider must first decide whether you are taking a short term approach, and concentrating solely on pain relief, or if you wish to remove the risk of future gout flares by eliminating excess uric acid.
Though it seems obvious to me that your first focus should be on uric acid control, there are many who believe that it is not worth the effort, when the occasional gout flare can be treated with a few days pain relief.
If you do opt for uric acid control, you will still need to make provision for pain relief during the first few months of urate lowering therapy. This can be daily as a preventative, or kept on hand to take at the first sign of a gout flare.
Measuring Gout Treatments
This is optional, and I’ve yet to hear from anyone who has done it, but there is a tool to measure how badly affected you are by gout. As part of your gout management plan, you might like to use this to measure your status before, during, and after your gout treatments. For more details, and the download links for the free tool, please see my gout relief page.
Gout Treatments Plan
If you are in the middle of a gout flare, then it is best to take pain relief for a few days, and commence urate lowering therapy once the inflammation has subsided.
You need to make adequate arrangements for uric acid testing. The number for the amount of uric acid in your blood is vitally important, and you need to be sure of it at all times. This is an exact number, not a description such as low, normal, or high, which means absolutely nothing. In the long term, once stabilized, testing once or twice per year is adequate. However, during early stages of treatment, tests are needed every 2 to 4 weeks to establish your correct dose, and to monitor the effects of dosage changes. Ideally, these tests should be done by your doctor. If this is not realistic, home uric acid test kits are available.
Your uric acid lowering plan has different stages:
- Titration Phase. Start with a low dose (100mg allopurinol or 40mg febuxostat) and measure uric acid after 2 to 3 weeks. Increase dosage until uric acid in your blood drops to 5mg/dL (0.30mmol/L), or below. Target levels vary and need to be established by your doctor in the light of your test results and reaction to medication. Lower levels produce faster results, and reduce the length of time for the next phase. 2 to 4 mg/dL (0.12 to 0.24 mmol/L) are usually achievable.
- Urate Elimination Phase. The lower concentrations of uric acid in your blood allow old crystals to dissolve and be excreted by the kidneys. This process does expose crystals to the immune system temporarily as they dissolve, and sufficient volumes of partially dissolved urate deposits may trigger gout flares. For this reason, pain relief may be required during the first two phases. Without investigation through joint fluid analysis, or DECT scan, it is difficult to say when all urate is eliminated, so we assess the end of phase 2 as being six months without a gout flare (with uric acid maintained at or below target for the whole time).
- Maintenance Phase. Dosage may now be relaxed to maintain uric acid no higher than 5mg/dL (0.30mmol/L). Continue testing every year, or whenever your weight or lifestyle changes significantly, or if you take any other medication or supplement.
Please note that, although I mention specific gout medicines, these phases apply equally if you are using alternative gout treatments, or using diet as a treatment.
I describe medicines and alternatives for each phase of gout management elsewhere in this Gout Treatment section.