Rheumatologists will often be involved in the treatment of gout because they specialize in managing this and other forms of arthritis.

A number of medications may be recommended to reduce joint pain and inflammation. To avoid any interactions, patients must advise their physicians if they are taking other drugs.

Medications to treat gout include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). High doses of NSAIDs such as indomethacin or ibuprofen are the most common treatment for acute gouty arthritis. However, aspirin should not be used for this condition because it can elevate levels of uric acid in the blood. Patients who have a history of ulcers or kidney problems, or those taking anticoagulant medication, may be treated with another type of anti-inflammatory medication, or other medications may be used in conjunction with NSAIDs to protect against unwanted side effects.
  
  
• Corticosteroids. These medications are strong anti-inflammatory hormones, which may be given to patients who cannot use NSAIDs. Corticosteroids may be given in pill form (in high doses) or via injections into the swollen joint. Patients usually begin to improve within a few hours of treatment, and the attack often completely subsides within a week or so. When used long term, however, these medications may produce side effects, such as weight gain, osteoporosis (bone thinning), cataracts, glaucoma and diabetes, and may contribute to hardening of the arteries (atherosclerosis).
  
  
• Colchicine. This alkaloid drug is often prescribed when NSAIDs or corticosteroids do not control symptoms. However, it is most effective when taken within the first 12 hours of an episode of acute gouty arthritis. Physicians may prescribe it as often as every hour until joint pain and inflammation begin to improve. When taken orally, side effects may include nausea, vomiting, abdominal cramps or diarrhea.

In addition, colchicine may also be prescribed in low doses to prevent further attacks. When taken in low doses, side effects are less likely to occur. Even though the chronic use of colchicine can reduce or prevent attacks of gout, it does not prevent the accumulation of uric acid crystals that can cause joint damage even without attacks of hot, swollen joints.

Colchicine may also be administered intravenously (I.V.), but this form of therapy should be performed only by a physician experienced in it. When done improperly, I.V. colchicine therapy can have severe side effects, including bone marrow toxicity, kidney failure and, in some cases, even death.

Once the acute gouty arthritis is under control, treatment for gout focuses on preventing recurrent attacks and decreasing the levels of uric acid in the blood. Therapy to lower blood levels of uric acid, which may lead to the formation of uric acid crystals in the tissues and joints of the body, may include:

• Uricosurics. These medications help the kidneys eliminate excess uric acid in the urine. Uricosurics should be taken with plenty of fluid (at least 68 ounces or 2 liters a day) to prevent the formation of uric acid kidney stones. These drugs are usually prescribed when gout is caused by under-excretion of uric acid, which occurs in most cases. However, uricosurics should not be used by patients with reduced kidney function or those with tophaceous gout.
  
  
• Xanthine oxidase inhibitors. These drugs, including allopurinol, decrease the body's production of uric acid and are the most reliable way to lower levels of uric acid in the blood. Common side effects include stomach pain, headache, diarrhea and rashes. In very rare cases, some people can develop an extremely severe allergic reaction that can lead to kidney and liver toxicity as well as become life-threatening. Patients who develop a rash or a fever after use of a xanthin oxidase inhibitor should seek immediate medical care.

To be effective, medications to reduce uric acid in the blood must be taken regularly and long-term. Stopping the medications often results in recurrence of gout later.

In addition, medications to treat hyperuricemia (high blood levels of uric acid) should not be administered during an episode of acute gouty arthritis because they may intensify and/or prolong the attack. They should be administered only after symptoms (e.g., joint pain and inflammation) subside.

In instances of medication-induced hyperuricemia, switching medications under a physician's supervision is often the only course of action necessary.

Surgery is rarely needed for gout unless significant joint damage has occurred from lack of effective and timely treatment. Sometimes surgery may be performed to remove large tophi that are draining (oozing), infected or interfere with normal joint movement. In very severe cases, patients may have to undergo joint replacement surgery (arthroplasty).

Treatment for gout should begin early to prevent long-term complications, such as chronic tophaceous gout, the formation of kidney stones and kidney damage. In secondary gout, treatment of the primary condition causing gout may control the disease.