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Living with gout? Explore your treatment options

The Bottom Line

  • Gout affects many people, but is more common in older adults. Certain diet and lifestyle factors can increase your risk. 
  • Many different treatment options are available to reduce the pain associated with gout or prevent it, each associated with different side effects.
  • Speak to your health care provider about what treatment might be best for you, and if there is anything you can do to help prevent a future gout flare-up. 

What do Queen Anne, Alexander the Great, and Beethoven have in common? Surprisingly, it’s…gout. Once thought to be a disease of the wealthy brought on by too much rich food and drink, gout is now recognized to affect people from all walks of life.(1) Today, around five percent of Canadian men and two percent of Canadian women have gout.(2)

Gout is a type of arthritis that is caused by a surplus of uric acid in the body.(1;3) This excess can trigger the formation of urate crystals in joints, cartilage, tendons, and bones, causing inflammation, swelling, and pain.(3)

Gout flare-ups can be sudden (1) and can increase in frequency, length, and severity in certain people.(3) For some, gout is so severe that it can interfere with everyday activities, work, and family life. It also contributes to multiple doctors visits or even visits to the emergency department.(4)

While many associate gout with being overweight – and this does increase your risk (5) – gout is also linked to kidney disease (6), drinking large amounts of alcohol (7), and eating foods that are high in purines (e.g. meats, seafood, peas, beans, lentils, spinach).(8) Risk for the disease increases with age; and males are at a higher risk than females.(1;2)

New research has explored the best ways to treat a gout attack.

 

What the research tells us

The findings of a systematic review – which align with recommendations in a practice guideline for doctors – determined that several medications are effective in reducing pain from a gout attack, but each comes with specific side effects. While colchicine reduces pain from gout, even in low doses, its common side effects include diarrhea, nausea, vomiting, and cramps.(3;9) Comparison of different nonsteroidal anti-inflammatory drugs (NSAIDs) to one another (3) or to steroids (3;10) found they have similar effectiveness in reducing pain, however steroids produce fewer stomach and intestine related side effects, while NSAIDs cause fewer skin related issues such as a rash.(3;9)

In addition to pain relief, it was found that some medications like febuxostat and allopurinol can lower urate levels and prevent future gout episodes when used long-term.(3) A doctor may recommend this treatment for people who get gout frequently. These medications should not be used, however, after an initial attack of gout or in people who do not get gout often.(3;9)

The current evidence does not support non-drug treatments like traditional Chinese medicine, and changes to lifestyle and diet.(3)

If gout has made an unwelcome appearance in your life, speak with your health care provider about what treatment is best for you. You should discuss the possible benefits, risks, and cost of each medication, as well as your preferences.

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References

  1. Mayo Clinic. Gout [Internet]. Mayo Clinic, 2018. Available from https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897 
  2. Choy G, MacMullan P. What is gout? [Internet]. Arthritis Society, 2018. Available from: https://www.arthritis.ca/about-arthritis/arthritis-types-(a-z)/types/gout
  3. Shekelle PG, Newberry SJ, FitzGerald, JD, et al. Management of gout: A systematic review in support of an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017; 166(1):37-51. doi: 10.7326/M16-0461. 
  4. Li C, Martin BC, Cummins DF, et al. Ambulatory resource utilization and cost for gout in United States. AJMC. 2013. Available from: https://www.ajmc.com/journals/issue/2013/ajpb_marapr2013/ambulatory-resource-utilization-and-cost-for-gout-in-united-states
  5. Choi HK, Atkinson K, Karlson EW, et al. Obesity, weight change, hypertension, diuretic use, and risk of gout in men: The health professional’s follow-up study. Arch Intern Med. 2005; 165(7):742-748.
  6. Krishnan E. Chronic kidney disease and the risk of incident gout among middle-aged men: A seven-year prospective observational study. Arthritis Rheum. 2013; 65(12):327-328. doi: 10.1002/art.38171.
  7. Choi HK, Atkinson K, Karlson EW, et al. Alcohol intake and risk of incident gout in men: A prospective study. Lancet. 2004; 363(9417):1277-1281. 
  8. Choi HK, Atkinson K, Karlson EW, et al. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004; 350(11):1093-1103. 
  9. Qaseem A, Harris RP, Forciea MA, et al. Management of acute and recurrent gout: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017; 166(1):58-68. doi: 10.7326/M-0570. 
  10. Billy CA, Lim RT, Ruospo M, et al. Corticosteroid or nonsteroidal anti-inflammatory drugs for the treatment of acute gout: A systematic review of randomized controlled trials. J Rheum. 2018; 45(1). 

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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