Gout treatment consists of managing the gout attack and preventing recurrences and possible complications. It is taken for life; regular medical follow-up is necessary.
The Goal of Gout Treatment
The aim of gout treatment is to treat the gout attack and to eliminate the pain.
It also allows, thanks to a basic treatment, to prevent :
- the recurrence of gouty attacks
- the formation of tophi ;
- joint complications;
- the appearance of kidney stones.
Background treatment is effective if the uricemia falls below a threshold value in order to obtain the dissolution of urates (salts of uric acid).
Gout is a chronic disease that requires lifelong treatment and multidisciplinary management, involving the treating physician, a rheumatologist, a cardiologist, a nephrologist, etc. This is to control the gout but also the associated cardiovascular risk.
Treatment of the Gout Attack
The first step in treatment for calming the inflammation of the joint is to rest the joint affected by gout (resting the foot if a toe joint is affected, for example). A device, such as an orthosis, can be proposed to relieve the joint (for example, the wrist).
In order to reduce the inflammation, it is recommended to cool the joint with ice. The ice should not be placed directly on the skin to avoid the “burning” sensation caused by the cold. It is preferable to put it in a clean cloth before putting it on the inflamed joint (often the big toe). The operation can be repeated at home, every 4 hours; this shortens the duration of the gouty attack.
Background Treatment of Gout
The aim of background treatment is to keep uricemia (blood uric acid levels) below a threshold value. This lifelong treatment includes lifestyle changes and often medication.
Hygienic and dietary measures for gout
Diet and hygiene measures have a moderate effect on lowering the level of uric acid in the blood. However, they are still important in terms of overall health, given the co-morbidities frequently associated with gout, and the cardiovascular risk.
In the case of gout, it is therefore necessary to :
- to lose weight gradually (between 5 and 15%) in case of overweight or obesity ;
- regular physical exercise, adapted to the state of health;
- reduce the consumption of alcoholic beverages. It is essential to stop drinking : beer, which is very rich in purines, even when it is alcohol-free; strong alcohol.
- stop drinking sugary soft drinks and fruit juices rich in fructose;
- to adopt a balanced diet and reduce the consumption of products rich in purines: meat, offal, fish, seafood, preferring lean meat;
- increase the intake of low-fat dairy products (skimmed milk) which helps the kidneys to eliminate uric acid. Eating cherries also has the advantage of ;
- to consume coffee and vitamin C (in the absence of contraindication) which have a hypo-uricemic role.
Basic hypo-uricemic treatment
The hypo-uricemic treatment is indicated in case of recurrent gouty attacks (at least twice a year), tophi or gouty arthropathy. However, this background treatment is prescribed after the first gout attack in the following cases
- the person is under 40 years of age;
- the uricemia is very high;
- the person has associated cardiovascular diseases (angina pectoris, hypertension, etc.) or renal insufficiency.
It is not prescribed in cases of symptomless hyperuricaemia, i.e. when the patient has not had a gout attack.
Background hypo-uricaemic therapy should be started at the lowest possible dose and then gradually increased until the target uricaemia is achieved and maintained for life. The aim is to achieve a blood uric level of less than 360 mmol/L (60 mg/L), or 300 mmol/L in severe gout.
During the first months of hypo-uricemic treatment, gout attacks may occur. Preventive treatment of gout attacks (low-dose colchicine, NSAIDs) is therefore offered to the patient during the first 3 to 6 months.
Management of Gout-Related Diseases and Cardiovascular Risk Factors
To ensure good management, all associated diseases should be treated. This is the case if the person has:
- chronic kidney disease ;
- high blood cholesterol or triglycerides
- High blood pressure;
- coronary artery disease;
- arteritis of the lower limbs;
- It is also important for smokers to stop smoking, but also to stop drinking alcohol.
Medical follow-up is important!! Gout is a chronic disease and requires regular medical consultation. You should not stop your treatment, even if you no longer have gout attacks. Stopping the basic treatment would cause a recurrence.
As gout is most often associated with a high cardiovascular risk, it is also necessary to follow the dietary advice given by your doctor. This will prevent the occurrence of cardiovascular complications: stroke, myocardial infarction, etc.