One of the myths that I wrote about in my Top 10 Gout Myths post is: “Once a gout attacks starts, there is nothing you can do but ride it out”. In this post I will talk about what to do when you feel a gout attack coming on.
Gout is caused by an immune response to uric acid crystals forming in the joint (see Gout Basics). This immune response starts a spiral that quickly causes massive inflammation and pain. The key to stopping a gout attack is to break the spiral!
If you interrupt this spiral, you can usually stop a gout attack in an hour or two. Really…
The secret is to take medications to interrupt this cycle as soon as possible after you first notice symptoms. The sooner you act, the more successful this treatment will be. Don’t wait, not even for a minute. Gout attacks build quickly and the sooner you act, the easier it is to break this cycle before it spirals out of control!
Not a DIY
This is the point where I have to stop for a warning. This site, my book, the internet in general are not “do-it-yourself” resources. Gout and the medications to manage gout can be dangerous if you don’t know what you are doing. So please talk to your doctor about any treatments before you take them – your life might depend on it!
First Line Drugs to Stop a Gout Attack
The most commonly prescribed drugs to stop gout attacks are Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). These medications include indomethacin, naproxen and sulindac. There are several others that research has shown are just as effective but these three have been approved for this use on by the US Food and Drug Administration. You will also notice that naproxen is an over-the-counter drug that is found in Aleve® making it a good option if you are not at home when the attack strike (again, ask your doctor first!).
These medications are powerful drugs that block inflammation in the body. If you take them at a high dose, this will interrupt the spiral of a gout attack and will usually stop the attack in its tracks. But remember to talk to your doctor before taking any of these medications and stop taking them as soon as possible! If you have heart problems or stomach problems you are at the highest risk – be sure to tell your doctor!
NSAIDs Used to Stop Gout Attacks
- Indomethacin: Never take for more than 2 days and never take more than 200 mg/day unless directly instructed to do so by a doctor.
- Naproxen: Never take more than 750mg the first day and never take for more than ten days unless directly instructed to do so by a doctor.
- Sulindac: Never take more than 400mg a day and never take for more than seven days unless directly instructed to do so by a doctor.
Other Medications to Stop Gout Attacks
If you have health problems that prevent you from taking NSAIDs to stop a gout attack, don’t worry, there are other options. The most common of these is colchicine. I am not a big fan of colchicine. I have made far too many trips to the bathroom as a result of taking this 4000 year old drug. Also, most doctors are still prescribing it at a high dose, even though a lower dose has been shown to be just as effective. However, over all, I do not think colchicine is anywhere near as effective as NSAIDs or any of the other options, but that’s just me opinion. There is no research that directly compares colchicine with NSAIDs or any other treatment. Another thing to watch out for is the fact that colchicine builds up in the body and is removed very slowly making it easy to overdose. It can become potentially fatal when you take more than 6mg for an attack (that’s just 10 – .6 mg tablets)!
- Take .5 or .6 mg of colchicine three or four times a day until pain subsides. Never take more than 6 mg of colchicine for an attack!
Again, as with all the other treatment, the sooner you get treated the more effective these treatments will be.
Corticosteroids: These can be taken orally, which is about as effective as NSAIDs. They can also be injected which results in much faster action and is probably the most powerful means of stopping an attack. Injected treatments need to be administered by a doctor.
ACTH: This is the synthetic version of a hormone secreted by the pituitary gland. This treatment has fallen out of favor recently, but new research shows that it is very effective. ACTH also needs to be injected.
Anakinra: One very small study recent found that this drug, which is used to treat rheumatoid arthritis, can be an effective medication for treating gout attacks. This medication is also taken orally which makes it a good option if none of the other treatment work for you or you cannot use them because of medical problems. However, more research needs to be done to prove its effectiveness with gout.
The Key to Stopping is Never Starting
Of course, the best way to stop the spiral of a gout attack is to prevent the spiral from starting in the first place. The only way to do this is to lower uric acid levels in your body. If uric acid levels are low, then this spiral can never get started. For most of us, high uric acid levels is a genetic problem (see, Gout Myths and Secondary Gout) and can only be effectively managed through uric acid lowering treatments.
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