How to Choose a Medical
Treatment For Gout

Choosing a treatment for gout can be difficult.
Medical treatments are covered in this section.

Principles for determining the best treatment are the same for alternative treatments.

Principles for choosing treatments for gout

Just about every course of treatment for gout starts with a visit to the doctor when you have an acute gout attack. Typically, your doctor will deal with this by:

Stop Triggers - if any obvious triggers exist, e.g. gout promoting drugs, you will normally be prescribed alternatives.
Relieve Pain
Prevent Recurrence

Most doctors will also recommend that you improve your lifestyle by reducing weight and taking more exercise. These are dealt with in the Diet and Lifestyle sections.

Pain Relief Treatments

As the pain of gout is mainly due to inflammation caused when uric acid crystals form in the joints, most pain relief treatments are based around reducing inflammation. These may be supported with general pain relief treatments such as acetaminophen (also known as paracetamol - brand names include Tylenol and Panadol). The treatments for gout that are aimed at reducing inflammation are, most commonly, NSAIDs (Non Steroidal Anti Inflammatory Drugs) and also Corticosteroids.

An increasing numbers of qualified medical practitioners are recognizing pain relief treatments that do not involve drugs. These are included in the Alternatives section, but I recommend that you discuss any treatment for gout that you are considering with your doctor, even if it is a non-medical treatment.

Long term treatments for preventing gout attacks are aimed at uric acid management. Specifically, uric acid must be lowered below 6mg/dL to have any effect. Lower doses may slow the spread of gout, but they will not stop uric acid crystals building up to the point where tophi develop and joint damage occurs. Whatever treatment for gout you and your doctor decide upon, it is vital that you have regular uric acid level checks.

Uric acid treatments fall into two camps - those aimed at blocking production of uric acid, and those aimed at encouraging its excretion.

Reducing Uric Acid Production

The most common treatment for gout is to try to prevent the production of uric acid. At the moment, the only significant uric acid inhibitor is Allopurinol, though new drugs are being developed. The new drugs include Febuxostat, which works in a similar way to allopurinol, and Puricase which converts uric acid to a more soluble compound, allantoin.

There is a good summary of currently (2004) available gout treatments in Serum Uric Acid–Lowering Therapies: Where Are We Heading in Management of Hyperuricemia and the Potential Role of Uricase. I report progress on new uric acid reducing drugs on Gout Pal Interactive. You can discuss progress of these new treatments for gout in my Gout Forum.

Allopurinol gout treatment is currently the best there is for curing gout. Do not spoil it by doing it wrong. Learn the 5 crucial points for gout treatment success.

High Uric Acid Excretion

The other type of treatment is aimed at promoting the excretion of uric acid by the kidneys. The medicines used in this type of treatment are known as uricosuric drugs. This type of treatment for gout is not suitable for gout patients with kidney deficiencies.

Treatment For Gout Guidelines

In June 2007, rheumatologists published guidelines for gout management. These are important recommendations for doctors treating gout. I have published a chart showing how these guidelines might affect you, so that you are in a better position to discuss your treatment for gout with your doctor. Simply click on the small image on the left to see the full size chart. The chart contains links back to more information on each guideline.

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