Immediate Gout Pain Relief

In this article you will find out everything you need to know about immediate gout pain relief with the most effective treatments available.

Our skeleton, consisting of 206 bones, is indeed one of the body’s strongest parts. The entire strength and flexibility of this part of the body are imparted through its very components – the bones. 

Our bones are indeed one of the most important parts of the skeleton because, without them, our bodies would be nothing but a jelly-like mass of muscle only. But unfortunately, there are certain instances when the integrity and function of the skeleton become compromised, and the person ultimately has to suffer the consequences. 

This happens mostly when a disease process is involved or when a chronic condition sets in. In the case of a disease, the person must be aware that once the symptoms get resolved, they will feel fine and well all again. But with chronic conditions involving the bones, this is not always possible due to the flare-ups and ongoing symptoms that only make the situation worse, if not better. 

Gout is one of such inflammatory conditions that, once it sets in, has to be taken care of, for gout flare-ups are something that nobody wants to face, given the pain and discomfort it brings. [1]

What Is Gout?

Gout is one of the most prevalent types of chronic inflammatory arthritis worldwide. It is a very, very old disease. Because of this, it is ultimately one of those rare types of arthritis that are well-understood and explained in the rheumatology literature everywhere. 

Gout is the deposition of monosodium urate (MSU) crystals in the soft tissues, bones, and joints. It occurs due to too much uric acid levels in the blood, ultimately leading to their crystallization and then deposition in different areas of the body as there is nowhere where they could get excreted.  

Gout is reflected by the presence of hyperuricemia (high levels of uric acid in the blood). There are significantly increased uric acid levels, reaching up to 6.8 mg/dl, leading to the diagnosis of gout. As a result, an extremely painful joint inflammation makes it difficult for the affected person to get through the day. 

What Causes Gout? 

It is already evident that gout occurs due to high uric acid levels in the blood. This means that there is either an overproduction of this uric acid or a defect anywhere in the excretion mechanism that is involved in it that causes these excessive levels of uric acid to get accumulated within the body. [2]

It is mostly seen that the risk for developing gout increases with age, with mostly older males being predisposed to develop the condition over time. 

However, one thing is to be kept in mind at all times. Although hyperuricemia is indeed an established factor behind the occurrence of gout, not all people with hyperuricemia are definitely supposed to develop gout. [3]

Now, this is where other factors, such as the genetic and environmental factors, come into the equation. For example, many people are predisposed to develop gout due to their positive family history and so ultimately develop it when their age comes. 

Others are predisposed to develop this condition due to other comorbidities or chronic diseases that they are suffering from and hence, develop it. [4]

Some of the major chronic diseases that are involved in the pathogenesis of gout include chronic kidney diseases, hypertension, diabetes mellitus, obesity, and congestive heart failure. All these diseases have their particular mechanism of playing their role in the pathogenesis of gouty attacks. 

How Does Gout Present? 

Being a disease that affects the joints only, it is important to know how it presents and manifests itself because there are several other joint-related diseases as well that might easily get confused and thus, become prone to misdiagnosis. 

To understand gout, it is also important to first understand that there are various stages through which a person passes to reach the symptomatic phase of the disease.

Therefore, given below here is a description of the various phases of gout that a person ultimately develops over time.

Stage I – Asymptomatic Hyperuricemia: 

This is the initial stage of gout. When this stage begins, there are usually no classic gout symptoms – neither mild nor moderate- present in the patient. 

In most cases, this stage is either missed or diagnosed accidentally on blood tests when uric acid levels are found to be above 7 mg/dl at this stage. Therefore, in case a person gets diagnosed with these high uric acid levels, it is better to get them started on the precautionary measures and make sure that their condition does not get exacerbated. [5]

Stage II – Acute Gouty Attack:

Now, this is the stage where most people become aware that they have developed some sort of ’painful’ condition and that it will not go away so soon. This is also the stage where several people come to the clinics to check themselves and assess what is wrong with them. 

Although this stage marks the beginning of the manifestation of gout attacks, the gout pain is usually monoarticular in nature, meaning that it affects only a single joint, which in most cases is the big toe. 

Although other joints such as those of the hands, ankles, knees, and wrists can also get involved, in most cases, it is only the first metatarsophalangeal (MTP) joint of the big toe that gets inflamed first. [6]

During an acute gouty attack, the affected area is influenced by the main inflammatory symptoms such as redness, swelling, tenderness, and pain. In this stage, NSAIDs or Colchicine are prescribed as soon as possible to waive off the symptoms.  

Stage III – Intercritical Period: 

This stage can easily be referred to as the ‘resting’ or ‘quiescent’ stage of the gouty attack. This stage is called the critical period because if proper treatment was not given during attacks of gout, it is very common for gout flare-ups to be seen. 

Gout flare-ups are common and could be very problematic for the person suffering from them. These flare-ups could be extremely painful for the patient and could even become a routine, especially in those cases where no treatment was given. In addition, in cases of gout flare-ups, there may be more than one joint involved. [7]

Stage IV – Chronic Tophaceous Gout: 

In case the person still resists treatment or the disease has progressed way beyond getting impacted by treatment, it is seen that the joint pain then takes up the shape of joint destruction along with the development of palpable ‘tophi’ in the affected areas. [8]

These ‘tophi’ or ‘tophus’ are a collection of accumulated uric acid crystals that build up inside the joint spaces due to chronic, untreated gout. These tophi are composed of white, chalky material, and their presence indicates that the disease has now gotten out of hand. [9]

The presence of tophi will always indicate the presence of gout, although it usually develops late in the course of the disease, and at that stage, the disease has already been diagnosed through other means. 

As far as the presentation of gout pain is concerned, this pain usually presents in the form of gouty flares or gout attacks during early morning and night times. The maximum intensity of the pain can be felt over the next 24 hours, whereas the pain takes some time to properly manifest itself in the body of the patient. 

Sometimes, the gout pain is so severe that it wakes the patient up from their sleep. In extreme cases, the inflammation also spreads beyond the joint, giving rise to conditions such as dactylitis (sausage fingers). 

Immediate Pain Relief Modalities For Gout

Since this has become an established factor that gout pain is unbearable and severe enough to make a person extremely uncomfortable, it will also be obvious now that no matter how many home remedies a person tries, they will not provide them the rest or comfort that they would be looking out for. 

Therefore, some of the commonly used gout treatment options that exist for gout pain and gout flare-ups have been discussed as follows: 

Lifestyle Modifications for immediate gout pain relief

As this fact is already known that not only every patient with hyperuricemia will proceed to develop gout, it ultimately becomes known that prevention will work better than any other medicine, especially in those cases where it is still unsure whether gout will take place or not. 

Several lifestyle changes could help prevent gout and even treat it in the early stages. We know this because, in many cases, gout develops due to already existing conditions such as obesity, cardiovascular disorders, metabolic syndrome, etc. [10]

It is always best to visit a healthcare professional for medical advice regarding the do’s and don’ts of a gout-preventing lifestyle. 

However, generally speaking, dietary modifications should be the foremost priority for preventing gout. It is best to avoid foods that are high in fructose or other sugars, alcohol, carbonated and sugary drinks, red meat including organ meat, beef and pork, and seafood including sardines, scallops, anchovies, mussels, tuna, and turkey as well. These foods all give rise to the worsening of gout symptoms.  [11]

Along with avoiding these food items, it is equally important to take some other food items to lower the risk of gout. Using these preventive measures is much better than opting for medicines straight away. One should take care and drink plenty of water. Along with this, using Vitamin C also helps prevent the development of gout. 

Medical Treatment

Various treatment options and methods are used medicinally or to treat gouty attacks and flare-ups. It is up to a rheumatologist to assess and prescribe the appropriate drugs as per the patient’s condition and severity of symptoms and pain.  

Some popular medicines used for pain relief in gout include:  

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): 

As a first-line treatment therapy, usually over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) are given to the patient. Ibuprofen and Naproxen are some of the commonly used options. [12]

It is seen that these treatment therapies work best if combined with some home remedies such as cold or ice packs to relieve the severe pain that gouty attacks bring along with them.

Indomethacin and Ibuprofen are seen to work best during acute gout attacks. However, it is recommended that they should be stopped as soon as the symptoms resolve to avoid side effects such as increasing the risk of bleeding and gastrointestinal ulcers.

Corticosteroids: 

Systemic glucocorticoids (corticosteroids) are also used to treat acute gouty attacks. These corticosteroids become the first line of therapy in those patients who cannot intake NSAIDs due to their possible side effects or because they have been contraindicated in a given patient.  

Oral Prednisone or Prednisolone is the recommended steroid for acute gouty attacks. [13]

Some of the most common side effects that a person might experience due to these corticosteroids are blood vision, mood changes, stomach aches, and an increased risk of developing osteoporosis in the long run. 

Colchicine: 

Although not as forcefully recommended as the other drugs, Colchicine is among the prioritized gout drugs. It works by reducing the inflammatory symptoms that are caused due to the crystals of gout. Therefore, Colchicine mostly works when the damage due to gout has already set in. [14]

However, people need to understand that Cocxinice is not used for relieving gout pain. Instead, it simply works to reduce the inflammation of the affected joint, and once this happens, the pain automatically gets toned down. 

The common side effects that a person might develop due to Colchicine include black stools, bleeding disorders, fever, muscle weakness, etc.

Allopurinol: 

Allopurinol is a specific drug that has been designed to treat kidney stones and gout. The main mechanism of action of Allopurinol is to reduce the levels of excess uric acid in the body. 

It is a Xanthine Oxidase inhibitor, and this enzyme is responsible for converting xanthine into uric acid. Thus, by inhibiting this enzyme, Allopurinol works to reduce uric acid levels in the body. But, again, Allopurinol does not work to prevent gouty attacks. It simply works to treat those attacks when the damage has already started to set in. 

Diarrhea, drowsiness, skin rash, and swelling of the face are some of the side effects that this drug can cause in a person. 

Febuxostat: 

Febuxostat is also a Xanthine Oxidase inhibitor. It has a similar mechanism of action to Allopurinol and works to reduce uric acid levels in the body. 

However, Febuxostat is associated with an increased risk of exacerbating pre-existing conditions such as uncontrolled blood pressure and other heart-related disorders. Therefore, it is only used when other uric-acid lowering agents such as Allopurinol do not work in the body of individuals. 

The course of Febuxostat is also started once gout has manifested in an individual’s body and works to decrease the intensity of these attacks.

The most common side effects associated with using Febuxostat include liver enzyme abnormalities, myocardial infarction, numbness in the extremities, and general weakness. 

It is usually seen that the condition could be managed well with the appropriate prescription of medicines in no time. Patients could enjoy a symptom-free interval, but it is also upon them to avoid their trigger factors and opt for strategies that work to induce gout and its flare-ups. 

Conclusion

Gout is a very painful condition that mainly affects the small joints of the body. Although a condition that mainly affects the elderly, it is a condition that could be prevented using the correct precautionary measures. 

People can continue living a normal life with gout too. Although the condition usually returns, still, the correct intervention at the right time can help you steer clear of any unwelcome and unhealthy reminders. 

References

1. Fenando A, Rednam M, Gujarathi R, et al. Gout. [Updated 2022 Mar 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546606/
2. Ragab, G., Elshahaly, M., & Bardin, T. (2017). Gout: An old disease in new perspective – A review. Journal of advanced research, 8(5), 495–511. https://doi.org/10.1016/j.jare.2017.04.008
3. Hainer, B. L., Matheson, E. M., & Wilkes, R. T. (2014). Diagnosis, treatment, and prevention of gout. American family physician, 90(12), 831-836.
4. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Gout: Overview. 2015 Mar 11 [Updated 2018 May 17]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK284934/
5. Yip, K., Cohen, R. E., & Pillinger, M. H. (2020). Asymptomatic hyperuricemia: is it really asymptomatic?. Current Opinion in Rheumatology, 32(1), 71-79.
6. Igel, T. F., Krasnokutsky, S., & Pillinger, M. H. (2017). Recent advances in understanding and managing gout. F1000Research, 6, 247. https://doi.org/10.12688/f1000research.9402.1
7. Abhishek, A. (2017). Managing gout flares in the elderly: practical considerations. Drugs & Aging, 34(12), 873-880.
8. Chhana, A., & Dalbeth, N. (2015). The gouty tophus: a review. Current Rheumatology Reports, 17(3), 1-9.
9. Sriranganathan, M. K., Vinik, O., Falzon, L., Bombardier, C., van der Heijde, D. M., & Edwards, C. J. (2014). Interventions for tophi in gout: a Cochrane systematic literature review. The Journal of Rheumatology Supplement, 92, 63-69.
10. Saag, K. G., & Choi, H. (2006). Epidemiology, risk factors, and lifestyle modifications for gout. Arthritis research & therapy, 8 Suppl 1(Suppl 1), S2. https://doi.org/10.1186/ar1907

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