Medication treatment for gout usually involves some combination of:

• Short-term treatment, using medicines that relieve pain and reduce inflammation during an acute attack or prevent a recurrence of an acute attack. These medicines may include:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), except for aspirin, which should never be used to relieve pain during a gout attack. Aspirin may change uric acid levels in the blood and may make the attack worse.
  • Colchicine, which may also be used for long-term treatment.
  • Corticosteroids, which may be given in pills or by a shot for cases of gout that do not respond to NSAIDs or colchicines. They may also be given to people who cannot take NSAIDs for other reasons, such as those with chronic kidney failure, heart failure, gastrointestinal bleeding or those using a blood-thinner, such as warfarin.
• Long-term treatment, using medicines to lower uric acid levels in the blood, which can reduce the frequency and severity of gout attacks in the future. This may include:
  • Uricosuric agents, to increase elimination of uric acid by the kidneys.
  • Allopurinol, to decrease production of uric acid by the body.
  • Colchicine, to prevent flare-ups during the first months that you are taking uric acid-lowering medicines.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). These are among the most common treatments for gout pain.� Purchased over-the-counter or by prescription, NSAIDs ¡ª such as aspirin, ibuprofen (Advil or Motrin) and diclofenac ¡ª act quickly to relieve pain. There are more than 30 drugs classified as NSAIDs and each has a slightly different chemical structure, is metabolized differently and seems to work differently among patients. (Other drugs, such as methotrexate, chloroquine, pencillamine and gold salts, work through the immune system and have some anti-inflammatory effects.)

Comments:

• Aspirin is probably the least expensive NSAID available. Its active ingredient is synthesized from salicin, a natural substance found in willow bark and other plants. Americans take more than 30 billion aspirin tablets a year at a cost of $1 billion. However, aspirin has multiple side effects ¨C so many, in fact, that the drug probably would not receive modern-day U.S. Food and Drug Administration approval.� While low doses of aspirin appear to help prevent heart attacks and may help prevent colon cancer and Alzheimer's Disease, Aspirin can cause gastrointestinal problems and trigger life-threatening allergic reactions in some people. (See the Arthritis Library for more information about aspirin.)

•  Long-term use of NSAIDs can cause complications in arthritis patients. These can range from minor bleeding in the gastrointestinal tract, to liver or kidney toxicity (poisoning).� In fact, stomach irritation is so common with frequent NSAID use that some doctors also prescribe misoprostol (Cytotec), a drug that protects the stomach lining.� (Misoprostol has its own potential side effects, including nausea, gas, headaches and vomiting; it can cause miscarriage and should never be given to pregnant women).� One prescription product, approved in just the past few years, combines the NSAID diclofenac sodium with misoprostol and is marketed under the name Arthrotec. One of the newest NSAIDs, celecoxib (Celebrex), is reported to be easier on the stomach than older NSAIDs.

• NSAIDs also can interact with other drugs, even over-the-counter preparations.� Antacids, for example, can decrease the absorption of NSAIDs, reducing their pain-fighting effect.� Prescription medicines also can have adverse effects when mixed with NSAIDs.� NSAIDs can augment the action of diuretics, lithium, oral hypoglycemic agents and phenytoin (Dilantin).

• It is extremely important to follow all the label instructions and cautions when taking NSAIDs and to consult with your health care provider if you have any concerns. (See the Arthritis Library for more information about NSAIDs.)

Colchicine. Once a traditional gout treatment, this agent often is replaced by NSAIDs. Colchicine usually is given orally, but can be given intravenously if it upsets the stomach.

Comments: This drug often causes diarrhea and can prompt more serious side effects including damage to bone marrow.

Corticosteroids. These potent drugs, such as Prednisone, act quickly to relieve pain and swelling. If only one of two joints is affected by gout, doctors sometimes inject a corticosteroid crystal solution through the same needle used to remove fluid from the joint.

Comments: Long-term corticosteroids use can cause side effects, including osteoporosis (brittle bones), cataracts, glaucoma, high blood pressure, stomach bleeding or irritation, weight gain, frequent infections and worsening of diabetes mellitus.

Other Gout Drugs. Once the pain and swelling is controlled,� further treatment of gout depends on finding out the cause of the body's overabundance of uric acid. If the body produces too much uric acid, doctors typically prescribe a drug call allopurinol.� If the body cannot excrete uric acid well, probenecid or sulfinpyrazone is prescribed.