If you experience several gout attacks each year or if your gout attacks are less frequent but particularly painful, your doctor may recommend medication to reduce your risk of future gout attacks. You usually begin taking preventive medications once your acute gout attack has subsided. Options include :
- Medication that blocks uric acid production. Allopurinol (Zyloprim, Aloprim) limits the amount of uric acid your body makes. This may lower your blood's uric acid level and reduce your risk of gout. Side effects include a rash and low blood counts.
- Medication that improves uric acid removal. Probenecid improves your kidneys' ability to remove uric acid from your body. This may lower your uric acid levels and reduce your risk of gout, but the level of uric acid in your urine is increased. Side effects include a rash, stomach pain and kidney stones.
If you are at risk for gout, you should :
- Eat a low-cholesterol, low-fat diet. People with gout have a higher risk for heart disease. This diet would not only lower your risk for gout but also your risk for heart disease.
- Slowly lose weight. This can lower your uric acid levels. Losing weight too rapidly can occasionally precipitate gout attacks.
- Restrict your intake of alcohol, especially beer.
- Stay hydrated.
- Adjust your intake of dairy products, such as nonfat milk and yogurt, because they can lower the frequency of gout attacks.
If you have had an attack of gouty arthritis, you should do all of the above and follow the regimen prescribed by your physician. The adequate prevention of gouty arthritis may involve lifelong medical therapy
Identifying and not doing the things that bring on an attack of gout are an essential part of your overall treatment plan.
For example, you :
- Shouldn't eat foods that are very high in purine such as liver, kidneys and seafood (especially oily fish such as mackerel, sardines and anchovies), and certain vegetables (asparagus, beans, cauliflower, lentils, mushrooms, oatmeal and spinach) ask your doctor or a dietitian for advice
- Shouldn't drink too much alcohol especially beer, stout, port and fortified wines
- Should eat a well-balanced diet and exercise to lose excess weight
- Should drink up to two litres of water a day unless you have been advised not to
If you have repeat attacks of gout, there are also medicines that can help to prevent it.
A medicine called allopurinol, taken long-term daily, prevents gout by stopping the formation of uric acid from purines. You may also be given a medicine such as sulphinpyrazone (eg Anturan) to increase the amount of uric acid your kidneys remove from your blood. These medicines aren't used to treat an acute attack of gout and are usually prescribed once an attack is over.
Allopurinol may actually cause an attack of gout when it's first taken, because the level of urate will rise a bit before it falls. To help prevent this happening, your doctor may prescribe NSAIDs, colchicine or steroid tablets alongside allopurinol for up to three months. You should make sure that you drink lots of fluids when taking these medicines.
