How to Get Rid of Gout and Other Gout Remedies
Gout is a condition that, when left untreated, can develop into chronic, recurring symptoms that significantly affect quality of life. Gout is caused by the buildup of uric acid crystals in a joint and, as the condition progresses, multiple joints are often affected. These needle-like crystals cause intense pain, swelling, redness, and warmth at the affected site. The big toe is the most commonly affected joint, but gout is also found in the mid-foot joints, ankles, knees, and wrists.
Unfortunately, there are currently no known gout cures available to patients. However, there are many remedies for gout that can significantly decrease the severity and duration of gout attacks. It is important to act fast when the symptoms of gout appear so that interventions can be taken before the pain and discomfort intensifies. Early treatment can also prevent bone, nerve, and tissue damage that is associated with severe, chronic gout. Read on to find out how to get gout relief.
How Do You Know if You Have Gout?
Gout has several distinctive qualities that can help distinguish it from similar conditions such as rheumatoid arthritis and septic arthritis. Primarily, a gout attack will have a very rapid onset, generally developing and worsening over a few hours. It is common for a gout attack to creep up in the middle of the night, causing pain intense enough to wake you up from dead sleep. If your joint pain has developed slowly over days or weeks, it is unlikely that you have gout.
The affected joint or joints can also give you clues as to whether you have gout. If the big toe is affected, and especially if it is the only joint affected, you can suspect that you experiencing a gout attack. If multiple joints are affected, especially if the same joints on both sides of your body are affected, it is more likely that you suffering from a different condition, such as rheumatoid arthritis.
You can also look at your recent past for events that tend to precede a gout attack. Minor trauma to the joint can disturb uric acid crystal deposits and trigger an attack. Additionally, a long weekend of indulging in alcohol and foods high in purines (e.g. red meat, organ meat, oily fish, high fructose corn syrup) can trigger a gout attack.
How is Gout Diagnosed?
The most accurate test examines the synovial fluid of the affected joint through a procedure known as arthrocentesis. Your physician will use a needle to extract a sample of your synovial fluid, and then it will be sent to a laboratory to be examined for the presence of uric acid crystals. The test or medical center may refer to these crystals as monosodium urate (MSU) crystals. If, instead of MSU crystals, arthrocentesis reveals calcium deposits, a different disease called pseudogout is the more likely culprit. Alternatively, if arthrocentesis reveals the presence of bacteria, it is a likely indicator of an infection or septic arthritis.
A blood test can also be administered to check uric acid levels. This diagnostic test is less accurate, but it is also less invasive and may be favorable for some patients. The test is usually done during the asymptomatic period between gout attacks in order to get the most accurate reading.
In some cases, primarily when a recurrent gout attack is suspected, x-rays may be taken to look for the presence of tophi (more information on tophi below). These clumps of uric acid crystals will appear on an x-ray before they are readily apparent to the naked eye.
How Long Does a Gout Attack Last?
Once a gout attack begins, the symptoms tend to intensify over the next eight to twelve hours. Once the symptoms have reached their peak, they will ease after a few days and ultimately resolve within a week to ten days. Initial attacks will generally resolve with or without treatment. Subsequent attacks tend to require dedicated treatment. Regardless, it is recommended that you seek treatment as soon as you suspect you may be dealing with gout in order to help relieve symptoms and manage pain, and to avoid potential long term damage to the joint.
Gout Treatments and Medications
Since there is no cure for gout, the majority of gout treatments during a flare up focus on the alleviation of pain and the control of inflammation. Your doctor can prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) such as:
- Celecoxib (Celebrex)
- Diclofenac (Voltaren, Cambia, Solaraze)
- Ibuprofen (Advil, Caldolor, Motrin)
- Indomethacin (Indocin)
- Meloxicam (Mobic, Vivlodex)
- Naproxen (Aleve, Naprosyn)
- Sulindac (Clinoril)
Never take aspirin (e.g. Bayer) as a pain reliever during a gout attack – it can affect the levels of uric acid in the body and ultimately worsen an attack.
If you suffer from chronic gout, your primary care physician may prescribe you a gout specific medication such as:
- Allopurinol (Aloprim, Zyloprim) – used to help control uric acid levels by reducing the amount made by the body. This medication does not relieve pain, so you may continue taking NSAIDs, as well. Allopuriol can take several weeks before it begins to be effective. While your body is adjusting to the medication, be aware that you may see a temporary increase in gout attacks, but this does not necessarily mean that it is not working.
- Colchicine (Colcrys) – used to both treat episodes and prevent future flare-ups. Colchicine lowers uric acid levels and decreases swelling. Fascinatingly, treatment involving this extract from the autumn crocus (Colchicum autumnale) has been around for centuries, with it first being described as a treatment for gout in the first century AD.
- Febuxostat (Uloric) – Febuxostat is a xanthine oxidase inhibitor that was just approved for use by the FDA in 2009. This drug inhibits xanthine oxidase, which is an enzyme that is involved in the metabolism of purines or creation of uric acid. By inhibiting the conversion of purines into uric acid, it decreases the amount of uric acid produced by the body.
- Probenecid (Benemid, Probalan) – used to prevent gout; it will not help treat an active episode and may make it worse. Probenecid is part of a class of medications known as uricosurics. These types of medications lower the levels of uric acid in the body by acting on the kidneys and increasing their ability to process uric acid.
- Pegloticase (Krystexxa) – used to treat severe, refractory (treatment resistant) gout when other treatments have been unsuccessful or cannot be tolerated. It converts uric acid into allantoin which can then be excreted in the urine. Pegloticase is administered by a healthcare practitioner through an injection.
What Happens When Gout is Left Untreated?
When gout is left untreated for several years, or when medical interventions prove unsuccessful, the uric acid deposits may accumulate into large clumps known as tophi. Approximately 12-35% of patients with gout ultimately develop tophi. Tophaceous gout ranges from mild to severe cases, with mild cases growing slowly and only affecting one joint, and severe cases often affecting 4 or more joints with rapid growth and ulceration of the overlying skin. In severe cases, the patient is at additional risk of developing infections within the joint. Additionally, tophi that are left untreated can deform bones, damage tissue, and compress nerves.
For many tophaceous gout patients that have not sought out treatment previously, the introduction of one of gout-specific medications that lower uric acid, listed above, can help with breaking down and getting rid of the tophi. However, a subset of patients have shown not to respond to these treatments. In other cases, the tophi may be particularly severe and debilitating, making waiting for medicinal treatment to become effective too hard (e.g. risk of permanent joint destruction or neuropathy/nerve damage). In these scenarios, surgery is often recommended.
Remedies for Gout Pain
In addition to the medication interventions that your doctor recommends, there are several non-medicinal remedies that can help to relieve symptoms and help prevent recurring attacks:
- Keep the affected area warm – while using a cold pack may provide temporary pain relief, and you will often see it recommended on various healthcare sites, studies show that cold temperatures actually facilitate the development of uric acid crystallization. If you choose to use cold packs for pain relief, be aware that you may be exchanging long term benefits for temporary relief.
- Rest – resting the joint will help prevent the pain from worsening. Stay off of your feet as much as possible, and considering using a cane or crutch to help support your weight when moving around.
- Elevate – if your foot or other lower extremities are affected, elevate the affected site above your heart while you are resting.
- Hydrate – not only will staying well hydrated help to flush uric acid from your system, it will also help to prevent the development of kidney stones.
- Relax – stress can aggravate your gout and contribute to the severity of the gout attack.
Preventing Recurring Attacks
Lifestyle changes have the greatest potential to decrease the incidence of recurring attacks. If you have experienced gout, especially more than a single episode, you can benefit from changes to your daily habits and diet:
- Strictly adhere to any medication regimens that your doctor prescribes.
- Stay active and exercise. If you are obese, losing weight will lower your risk as well. Consult with your doctor to discuss safe ways of slowly losing weight.
- Avoid foods high in purines, such as red meat, organ meat (e.g. liver or kidney), high fructose corn syrup and other foods high in fructose, oily fish, and shellfish
- Limit alcohol intake and stay well hydrated.
- Eat cherries or drink cherry juice – cherry juice has been shown to decrease the likelihood of recurrent gout attacks. This is due to anthocyanins, which are a pigment in the plant with powerful antioxidant and anti-inflammatory properties.
- Manage stress – activities such as yoga or meditation can help you keep your daily stress levels in check, and avoid triggering a recurrent gout attack.
While the treatments listed above all have proven effectiveness, consulting a physician for an accurate diagnosis before using home treatment is usually the best course of action. If you or a loved one are experiencing gout-like symptoms, you can make an appointment with your primary care physician or visit an urgent care center in order to be properly diagnosed.