Colchicine

Colchicine is given during a gout attack to relieve the pain, swelling, and inflammation. It works by decreasing the acidity of joint tissue and preventing deposits of uric acid crystals in joints. This medicine may also be taken in smaller doses to help prevent recurrent gout attacks. Colchicine is given either by mouth or by IV in a vein. When taken orally, it should be taken with food or liquids to help prevent stomach upset.

Possible side effects include:

• Diarrhea
• Nausea
• Vomiting
• Abdominal pain
• Kidney failure
• Muscle pain
• Peripheral nerve dysfunction

Consult your doctor before taking colchicine if you:

• Have a gastrointestinal disorder
• Have a history of peptic ulcers or ulcerative colitis
• Drink large amounts of alcohol
• Have heart, liver, or kidney disease
• Will have surgery within two months
• Have a blood disorder

Corticosteroids

Common names include:

• Prednisone
• Prednisolone
• Betametasone (for joint injection)
• Triamcinalone (for joint injection)
• Methylprednisolone (given IV, usually for severe cases)

Corticosteroids can control the pain, swelling, and inflammation of joints caused by gout. The medicine can be given as a tablet or in liquid form or by injection into a joint—or in severe cases, by vein. If taken orally, corticosteroids are best taken at the same time(s) each day and should be taken with liquid or food to lessen stomach upset.

Possible side effects include:

• Acne
• Poor wound healing
• Indigestion, nausea, or vomiting
• Diarrhea
• Headache
• Appetite gain or loss
• Psychiatric disturbances
• Weight gain
• Severe side effects may include:
  • Hives
  • Rash
  • Faintness
• Long term use may cause:
  • Slowed growth in children
  • Glaucoma
  • Cataracts
  • Diabetes
  • Thinning of the skin
  • Weak, fragile bones
  • High blood pressure

Allopurinol

Common names include:

• Zyloprim

Allopurinol is sometimes given to people who suffer repeated gout attacks, especially when tophi deposits, collections of uric acid crystals, develop. This medicine slows the development of uric acid by inhibiting the activity of certain enzymes. It is given in tablet form and should be taken at the same time (or times) each day with food or liquid to help avoid stomach upset.

Possible side effects include:

• Rash, which may progress to a life-threatening condition
• Diarrhea
• Nausea
• Vasculitis (inflammation of blood vessels)
• Bone marrow suppression
• Liver or kidney problems

Consult with your doctor before taking allopurinol if you:

• Have an acute attack of gout
• Have kidney or liver problems
• Have Cancer
• Use diuretics
• Have an allergy to penicillin drugs
• Have recently used immunosuppressive drugs

Uloric

Common name: Febuxostat

This is the first new treatment for gout in more than 40 years. In clinical trials, uloric was more effective than allopurinol in lowering uric acid levels.

Possible side effects include:

• Liver function abnormalities
• Nausea
• Rash
• Joint pain

Probenecid

Common name: Benemid

Probenecid is sometimes given to patients who suffer repeated gout attacks (especially when tophi deposits develop). This medicine forces the kidneys to excrete additional uric acid. It is given in tablet form and should be taken at the same time each day with food or liquid to help avoid stomach upset.

Possible side effects include:

• Headache
• Appetite loss
• Nausea
• Vomiting
• Kidney disease (with prolonged use)
• Kidney stones

Consult your doctor before taking probenecid if you have:

• An acute attack of gout
• Kidney stones or kidney disease
• Peptic ulcer
• A blood disorder
• Cancer

Pegloticase

Common brand name: Krystexxa

Pegloticase has been approved by the Food and Drug Administration (FDA) to treat adults who have severe gout that has not been relieved by other treatments. This medicine works by turning uric acid into a chemical that does not cause gout symptoms. This chemical leaves the body through the urine. Pegloticase is given by injection every two weeks.

Since severe allergic reactions are common with this medicine, a corticosteroid and an antihistamine are given before the injection of pegloticase. Other possible side effects include:

• Flare-up of gout
• Nausea and vomiting
• Constipation
• Bruise at the injection site
• Nasal irritation
• Chest pain

The medicine has not been studied in people who have congestive heart failure.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Common names include:

• Ibuprofen (Apo-Ibuprofen)
• Indomethacin (Indocin)
• Naproxen (Aleve)
• Diclofenac (Cataflam)

NSAIDs are given to treat the pain, inflammation, and swelling caused by gout attacks. They can be purchased over-the-counter or your doctor may prescribe a higher dosage. They work by decreasing prostaglandins, hormones that produce inflammation and pain. The medicine may also be taken in smaller doses to help prevent attacks in patients with recurrent gout attacks. NSAIDs are given in tablet, capsule, or liquid form. They should be taken at the same time (or times) each day and should be taken with food or liquid to help avoid stomach upset.

Possible side effects include:

• Indigestion, ulcers, gastrointestinal bleeding, abdominal pain
• Hives
• Rash
• Intense itching
• Faintness
• Nausea
• Asthma
• Heart disease

Consult your healthcare provider before taking NSAIDs if you have:

• Mental or neurological illness
• Impaired liver or kidney function
• High blood pressure or heart disease
• History of stomach ulcers or reflux disease
• Cardiovascular disease
• Risk factors for cardiovascular disease like high blood pressure, diabetes, high cholesterol, smoking, or a family history of early heart attacks

Corticosteroids and NSAIDS are equally effective for acute gout. But, corticosteroids may have fewer adverse effects.