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Short Summary
Main recommendation: Talk with your healthcare provider to choose a gout attack treatment, since colchicine, NSAIDs, anti-inflammatory steroids, and joint, muscle, or bloodstream injections each have different advantages, side effects, and suitability depending on your health. These treatments calm the immune response and ease pain during an attack, but they do not remove the uric acid crystals that cause future attacks.
Key Points
- The sooner any gout attack treatment starts after symptoms begin, the more helpful it is in stopping the attack.
- Gout pain and swelling come from immune cells reacting to disturbed uric acid crystals in the joint, causing inflammation.
- Attack treatments end the current flare but leave the crystals in place, so another attack can still occur.
- No single treatment is best for everyone, because some may interact with other medications or health conditions.
- According to the video, keeping blood uric acid below 6 mg/dL allows crystals to dissolve and prevents new attacks.
Details Worth Noting
- Concrete instructions: Speak with your healthcare provider to determine which treatment is right for you, and start treatment as early as possible once an attack begins. Ask your provider how to take NSAIDs (including over-the-counter ones such as ibuprofen or naproxen) to get the best results with the fewest side effects. To lower uric acid, the video directs viewers to the "Curing Gout" chapter for methods, which the transcript does not detail.
- Colchicine comes from the autumn crocus plant and works best when started at the very beginning of an attack; nausea, vomiting, and diarrhea are its most common side effects, and it is not a good choice for people with kidney disease.
- NSAIDs commonly cause stomach pain and heartburn and can temporarily raise blood pressure or affect the kidneys; they may need to be avoided with heart or kidney disease or bleeding/clotting problems.
- Anti-inflammatory steroids such as prednisone or Medrol are often used when other treatments cannot be used; they can raise blood sugar (a concern for people with diabetes), and side effects like irritability, mood swings, appetite increase, sleep trouble, and higher blood pressure become more likely with higher doses and longer use.
- Injections can be given directly into a joint (steroid injection by a provider in the office, which targets inflammation locally but causes pain during the injection) or into a muscle (ketorolac/Toradol, an NSAID that releases slowly over a few days).
Bottom Line
Gout attack treatments relieve pain fast, but controlling uric acid levels is what prevents attacks from recurring.
