An acute gout attack can be excruciatingly painful, making it feel like your joint is on fire. Gout is a complex form of arthritis that causes hot, red and swollen joints. It most commonly affects the great toe, according to Foot Health Facts. It is more prevalent in men than women and occurs when there is a buildup of uric acid crystals within the tissues of the joint. An acute attack is most painful for the first 12 to 24 hours.
Nonsteroidal Anti-Inflammatory Drugs
The goal of treatment is to eliminate the pain and swelling in the affected joint. Nonsteroidal anti-inflammatory drugs, or NSAIDs, are the first line of treatment for an acute gout attack. According to the American Academy of Orthopaedic Surgeons, NSAIDs work by preventing two enzymes, COX-1 and COX-2, from working and this reduces inflammation. Initially, strong NSAIDs, such as nabumetone or indomethacin, are used to rapidly decrease inflammation and pain but may be changed to milder NSAIDs, such as ibuprofen or naproxen, to lessen the chances of side effects. The side effects of NSAIDs include reduced blood clotting and gastrointestinal upset.
Colchicine
Colchicine may be prescribed for those who cannot take NSAIDs, according to PubMed Health. Colchicine is not a pain reliever but is classified as an anti-gout medication. Colchicine is usually used in a smaller dose to treat chronic gout but can be used in a higher dose for an acute gout attack. It is most effective when it is started within the first 12 hours after symptoms appear. The side effects include extreme nausea, stomach cramps and diarrhea, notes PubMed Health.
Corticosteroids
Corticosteroid medication, such as prednisone, may be used to treat an acute gout attack when NSAIDs and colchicine cannot be taken, according to MayoClinic.com. Corticosteroids are strong hormones used to reduce pain and inflammation. They may be given orally or by injection directly into the affected joint. In oral form, corticosteroid treatment must be tapered off over a period of seven to 10 days under a doctor's care. The side effects of corticosteroid treatment include weakness, insomnia and mood changes, reports MayoClinic.com.
Fluids and Rest
Acute gout attacks occur when too much uric acid accumulates in the blood and is not excreted by the kidneys. According to MayoClinic.com, uric acid is produced from the breakdown of purines, which are found in the body naturally and in some foods, including anchovies, organ meats and asparagus. It is important to drink plenty of water during a gout attack in order to flush out the kidneys. Alcohol should be avoided during an attack, as it increases uric acid production. The affected area, usually the foot, should be elevated and movement limited until the symptoms of the attack begin to subside.
Anti-Gout Medications
According to Gout.com, urate-lowering medications, such as allopurinal and probenecid, should not be started during an acute gout attack. Sudden changes in uric acid levels---an increase or decrease---can cause more crystals to precipitate into the joint tissues, causing a longer and more severe attack. However, if you are already on anti-gout medication at the time of the attack, consult your doctor and continue taking it.
