The classic gout attack occurs in an overweight man who has been drinking a little too much and has let his cholesterol get out of control. He may also have high blood pressure and diabetes. The gout attack will wake him up in the middle of the night with severe pain in the joint of a big toe. Of course, not all gout attacks play out this way. Women get gout, too, especially after menopause, and gout can also attack in other places.
"The big toe was the most common place to get gout, but now gout is as likely to be seen in the knee, wrist, or fingers," explains James C.C. Leisen, MD, head of rheumatology at Henry Ford Hospital in Detroit. "In my hospital-based practice, gout is the most common type of arthritis I see, even more common than rheumatoid arthritis."
10-Point Plan: Easing an Acute Gout Attack
"A gout attack can be extremely painful. The affected joint becomes swollen, warm to the touch, and very red. Even slight pressure on the joint can be very painful. Fortunately, a gout attack is self-limited and will clear in time," explains Dr. Leisen. Here are 10 steps you can take to manage a gout attack:
- See your doctor. "The first thing you need to do is make sure it's gout. If there is any doubt about the diagnosis, the best test for gout is to remove fluid from the joint and examine it under a microscope," says Leisen.
- Rest. The best place to be during a gout attack is in bed.
- Ice it down. Putting ice on the affected joint will reduce the inflammation.
- Get naked. At least the part that hurts. Keep the foot bare, and probably your leg, too. The weight of any clothing or bedding material probably will add to your pain.
- Watch your diet. Gout can be aggravated by a diet high in animal protein and by alcohol, so limit your intake of meat and avoid alcohol completely during a gout attack.
- Stay hydrated. "It's important to drink enough water during a gout attack,” advises Leisen. This can help flush the uric acid crystals that cause gout out of your system.
- Take over-the-counter pain medication. Ibuprofen (Motrin) is a typical non-steroidal anti-inflammatory drug (NSAID) used for management of acute gout pain. "If you don't have renal disease, NSAIDs are the best drugs for pain management," says Leisen.
- Try steroids. The steroid drug prednisone can be used for patients who can't take NSAIDs. Prednisone is usually given by mouth with the dose tapered down over 10 to 14 days. If you’re hospitalized, steroids can be given intravenously.
- Ask your doctor about gout-specific drugs. Colchicine (Colcrys) is taken orally to relieve an acute gout attack. It works by blocking the uric acid crystals that lodge inside your joint and cause gout. Colchicine is usually effective if taken within 12 to 24 hours of a gout attack. Allopurinol (Zyloprim) may be given to people who have repeated attacks of gout; it interferes with the development of uric acid. Probenecid is a medication that works by helping your kidneys get rid of uric acid. For more on newer drugs to treat gout, see “Get the Latest on Gout Medications.”
- Be patient. "Sometimes the best advice is to be patient and wait it out. A gout attack usually clears up within a few days. Take the medicine prescribed by your doctor and stay in bed. You will get better soon," says Dr. Leisen.
Many patients will go a long time between attacks. In fact, for 62 percent of patients the next attack will be more than a year away, and some won't have another attack in the next 10 years. However, if you begin to have more frequent attacks, talk to your doctor about which long-term drug therapy might be helpful for you.
The sooner you start treatment and pain management, the more quickly you will be back on your feet.
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