A complex form of arthritis, gout commonly affects the joints at the base of the big toe, instep, wrists, elbows, knees and ankles. The intense pain of a gout attack results when high levels of uric acid, a byproduct of protein metabolism, crystallize into urate and form deposits in vulnerable joints. The sharp crystals inflame the joints causing intolerable burning pain, redness and swelling. According to the Mayo Clinic, the pain of an acute gout attack peaks in the first 12 to 24 hours.
Non-steroidal Anti-inflammatory Drugs
Non-steroidal anti-inflammatory drugs, or NSAIDs, control inflammation, as the name suggests. NSAIDs can resolve the pain of an acute attack of gout and reduce the inflammation by interfering with a molecule called COX. Over-the-counter NSAID options such as naproxen, ibuprofen and acetaminophen help some gout sufferers and have the advantage of being readily available. If these medications are not strong enough, a doctor might prescribe indomethacin, says the Mayo Clinic. According to the Merck Manual, the pain-relieving effect of NSAIDs should start within a few hours, but patients should continue to take them for a few days after the pain and inflammation subside to prevent a relapse. NSAIDs can cause side effects such as gastrointestinal bleeding and ulcers, fluid retention and ion imbalances, so not everyone can take them.
Colchicine
Patients who can not take NSAIDs for an acute attack of gout might be prescribed colchicine instead. Colchicine effectively treats gout pain, especially if taken at the start of an episode. Taking colchicines by mouth can alleviate gout pain within 12 to 24 hours. However, up to 80 percent of patients taking oral colchicines develop diarrhea, according to the Merck Manual. The Mayo Clinic further warns that the unpleasant side effects of colchicines can outweigh their use for pain relief. Administered intravenously, colchicine has a much lower incidence of intestinal side effects, but it can irritate the site of the intravenous line. In addition, the Merck Manual warns that certain medical conditions such as kidney or liver disease can make this treatment too dangerous to consider because of the risk of bone marrow effects as well as shock or death.
Corticosteroids
Corticosteroids have a strong anti-inflammatory effect. While they can treat acute gout, their use is controversial, according to the Merck Manual, because they mask continuing inflammation. Corticosteroids such as prednisolone or prednisone can be taken orally or injected. Corticosteroids enhance the side effects of NSAIDs so they should not be taken together. As with NSAID therapy, corticosteroids should be taken for a few days after symptoms of an acute gout episode abate to prevent a relapse.
