Embarrassing Illnesses

There are a number of treatments and medicines that can be used to treat gout. Most treatments for gout aim to reduce the symptoms of pain and swelling. During an attack of gout, it is best to try and rest the affected joint as much as possible. You should also try to keep the joint elevated. Make sure that you drink plenty of fluids, such as water, squash or juice, to ensure that you stay well hydrated. Avoid drinking any alcohol during a gout attack.

Other treatments and medicines that may be used are outlined below.

Ice

If you are suffering from an attack of gout, the pain can be intense and severe. One of the most immediate ways you can treat the pain is to apply ice to the affected joint.

You can do this by applying ice to the affected, either using a bag of frozen peas, or some ice wrapped in a towel. Apply the ice to your joint, and leave it there for approximately 20 minutes. However, do not apply ice directly to your skin and never apply ice for more than 20 minutes at a time. If you want to apply ice to your joint more than once, you need to wait until your joint has returned to a normal temperature before reapplying it.

After using ice, it is best to try and keep the joint cool. If it is your big toe which is affected, try not to wear socks. If possible, you should avoid covering up, or clothing, any other joints which may be affected. Even a duvet or bed cover can be painful when resting on a joint affected by gout so, if possible, avoid using one during a gout attack.

Medication

Your GP will ensure that any medication you are prescribed is tailored to your individual needs. In order to work out what treatment will be best for you, they will consider your age, general health and any conditions you may already have. If your symptoms of gout are mild, and you experience severe side effects of medication, you may wish to consider treating your condition without the use of prescribed medication. For some people, the downsides of medication can outweigh the benefits. However, this is something you will have to discuss carefully with your GP. You should never stop taking any prescribed medication before speaking to your GP first.

If you are taking any of the medication listed below, you should always return to your GP if your medicine has failed to ease your symptoms after three to four days. It may be that you have to be prescribed a different type of medicine in order for your gout to be treated effectively. You should also see your GP immediately if your symptoms start to worsen after taking medication.

Non-steriodal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) aim to reduce the pain and inflammation experienced with gout. If you have been prescribed NSAIDs, then it is best to keep them to hand so that they can be used at the first sign of a gout attack. You should continue to take your NSAID throughout the duration of your attack, and for 48 hours after the attack has finished. Some of the more commonly prescribed NSAIDs include diclofenac, indometacin and naproxen

Used on a short-term basis, there are usually few side effects when taking NSAIDs. However, when taken in high doses, or over a long period of time, NSAIDs can cause complications, such as digestive problems, stomach bleeding, stomach ulcers, kidney and liver damage, tinnitus (ringing in your ears) and high blood pressure.

Cox-2 selective inhibitors are a newer type of NSAID which are designed to be less harmful to the stomach. However, research has linked use of Cox-2 inhibitors to an increased risk of strokes, raised blood pressure, heart disease and heart attacks. It is therefore important to tell your GP if you have a history of high blood pressure, or high cholesterol, or if you smoke. Etoricoxib is the Cox-2 selective inhibitor normally prescribed to treat gout.

Colchicine

Colchicine works by helping to reduce the build up of urate in your bloodstream. It is usually only used when NSAIDs fail to work, or if you develop severe side effects after taking NSAIDs. Colchicine is available in tablet form and is usually taken every two to six hours. However, it is not widely used because it frequently causes nausea, vomiting, and diarrhoea.

You should not take colchicine if you have :

• bone marrow disease,
• impaired kidney function,
• impaired liver function,
• heart failure, or
• if you are pregnant or breastfeeding.

Corticosteroids

Corticosteroids are a type of steroid, and they sometimes are used in severe cases of gout. Corticosteroids are usually only prescribed when NSAIDs and colchicine do not work. In some cases, a corticosteroid can be injected directly into the affected joint. The type of corticosteroid you receive will depend on the size of your affected joint.

The relief provided by corticosteroids is often rapid, but these medicines can rarely be used on a long term basis. Long-term use can often cause the following side effects:

• weight gain,
• fluid retention,
• osteoporosis (thinning of the bones),
• bruising, muscle weakness, and
• thinning of the skin.

Corticosteroids can also make diabetes and glaucoma (an eye disease caused by blocked fluid in the eye) worse.

Allopurinol

If you experience two or more gout attacks within a year, you may be prescribed medicine to help prevent further attacks. Allopurinol is the most commonly prescribed medicine and works by lowering the amount of urate in your blood. However, it is not a painkiller and will have no effect during a gout attack.

If you are prescribed allopurinol, you will have to take it once every day. It usually has to be taken for two to three months before you will start to see any effects. Once you are prescribed allopurinol, you will usually have to take it indefinitely. However, you may only be able to stop taking the medicine if you have a normal serum uric acid level for many years, with no attacks of gout during that time.

When you first start taking allopurinol it can sometimes cause a gout attack. This is because allopurinol usually raises the level of urate before lowering it. This type of treatment is therefore prescribed one to two weeks after an attack of gout has settled down. Side effects are very rare with this medicine, even when taken for long periods of time.

Carers

If you are looking after someone who suffers from gout that affects them so much that they need you to help them with their activities, Carers Direct can help you. On Carers Direct you can find out all about how to get help with caring for the person you look after, your legal and employment rights, andgetting benefits on Carers Direct.