Gout Medications: Effects and Side Effects

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Gout is a chronic form of inflammatory arthritis caused by elevated serum uric acid and the deposition of urate crystals in joints. Pharmacologic management is central to both acute flare treatment and long-term prevention. However, understanding the benefits and potential side effects of these medications is crucial for optimizing outcomes and ensuring patient safety.

According to the World Health Organization, gout and related musculoskeletal conditions contribute significantly to global disability and require long-term pharmacological management to prevent complications (WHO, 2023).

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1. Medications for Acute Gout Flares

a. Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Examples: Naproxen, indomethacin, ibuprofen

Effects:

• Reduce inflammation and relieve pain during acute attacks
• Most effective when started early in a flare

Side Effects:

• Gastrointestinal bleeding, ulcers, dyspepsia
• Increased cardiovascular risk
• Renal impairment, particularly in elderly or those with pre-existing kidney disease
  (Khanna et al., 2012)

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b. Colchicine

Effects:

• Inhibits neutrophil activity and reduces joint inflammation
• Most effective if taken within 12–24 hours of symptom onset

Side Effects:

• Diarrhea, nausea, abdominal pain
• Myopathy and bone marrow suppression in high doses or in renal impairment
• Significant drug interactions with CYP3A4 inhibitors (e.g., clarithromycin, some statins)
  (Terkeltaub et al., 2013)

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c. Corticosteroids

Examples: Prednisone (oral), triamcinolone (intra-articular)

Effects:

• Rapid anti-inflammatory effect for monoarticular or polyarticular flares
• Suitable for patients intolerant to NSAIDs or colchicine

Side Effects:

• Hyperglycemia (especially in diabetic patients)
• Weight gain, fluid retention
• Osteoporosis and increased infection risk with long-term use
  (Richette & Bardin, 2010)

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2. Medications for Long-Term Uric Acid Control

a. Xanthine Oxidase Inhibitors (XOIs)

Examples: Allopurinol, febuxostat

Effects:

• Decrease uric acid synthesis by inhibiting xanthine oxidase
• First-line agents for urate-lowering therapy

Side Effects:

Allopurinol:

• Skin rash (common)
• Rare but severe hypersensitivity reactions (Allopurinol Hypersensitivity Syndrome)
  – risk increased in patients with HLA-B*58:01 allele
• Liver enzyme elevation
  (Stamp et al., 2016)

Febuxostat:

• Generally well tolerated
• May carry increased risk of cardiovascular death in some patients (as seen in the CARES trial)
  (White et al., 2018)

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b. Uricosuric Agents

Examples: Probenecid, lesinurad (withdrawn in some markets)

Effects:

• Increase renal excretion of uric acid
• Useful in patients with underexcretion of uric acid

Side Effects:

• Nephrolithiasis (kidney stones)
• Ineffective in patients with renal impairment
• GI upset and hypersensitivity reactions
  (Khanna et al., 2012)

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c. Recombinant Uricase (Biologic Therapy)

Example: Pegloticase

Effects:

• Converts uric acid into allantoin, a more soluble compound
• Used in refractory chronic tophaceous gout

Side Effects:

• Infusion-related reactions
• Anaphylaxis
• Development of anti-drug antibodies reducing efficacy
  (Sundy et al., 2011)

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Frequently Asked Questions (FAQ)

Which medication is best for long-term gout management?
Xanthine oxidase inhibitors like allopurinol or febuxostat are first-line options due to efficacy and broad tolerability.

Is colchicine safe for long-term use?
It may be used as a short-term prophylactic during the initiation of urate-lowering therapy, but chronic use is not generally recommended due to GI and neuromuscular toxicity.

Should patients with kidney disease use NSAIDs?
No. NSAIDs should be avoided or used with extreme caution in patients with renal insufficiency.

What are signs of allopurinol hypersensitivity?
Fever, rash, liver enzyme abnormalities, and renal dysfunction. Patients with HLA-B*58:01 genotype are at higher risk.

Gout Relief – Natural Power Against Joint Pain

Gout is a painful and progressive form of inflammatory arthritis caused by excess uric acid, often striking suddenly with swelling, redness, and intense joint pain. If left untreated, it can lead to joint damage, kidney stones, and serious complications. Gout Relief offers a natural, safe, and effective solution—without the side effects of conventional drugs.

Why Gout Relief Works

This advanced herbal formula is designed to regulate uric acid levels, reduce inflammation, and protect long-term joint and kidney health. Results may be felt within just 3–7 days of consistent use.

Key Actions:

• Promotes natural uric acid elimination via liver and kidneys
• Relieves joint pain and inflammation during flare-ups
• Prevents kidney damage and chronic complications

100% Natural, Clinically-Inspired Formula

Each 750mg tablet blends time-tested medicinal herbs:

• Gnetum & Perilla Leaf: Reduce uric acid and inflammation
• Smilax glabra & Phyllanthus: Detoxify and protect kidneys
• Cat’s Whiskers & Lemongrass: Support uric acid excretion
• Amomum: Enhances metabolism to prevent uric buildup

Ideal for individuals with gout, high uric acid, or lifestyle risk factors like high-protein diets, alcohol use, and obesity.

Feel better naturally—choose Gout Relief today.

Real People. Real Results.

“Pain eased within a week. Swelling gone. Life-changing.” – Marcus R.
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References

Khanna, D., Fitzgerald, J. D., Khanna, P. P., Bae, S., Singh, M. K., Neogi, T., … & Terkeltaub, R. (2012). 2012 American College of Rheumatology guidelines for management of gout. Part 1: Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care & Research, 64(10), 1431–1446. https://doi.org/10.1002/acr.21772

Richette, P., & Bardin, T. (2010). Gout. The Lancet, 375(9711), 318–328. https://doi.org/10.1016/S0140-6736(09)60883-7

Stamp, L. K., Chapman, P. T., & Barclay, M. L. (2016). Allopurinol hypersensitivity: Investigating the cause and the role of HLA-B*58:01. Arthritis & Rheumatology, 68(7), 1844–1853. https://doi.org/10.1002/acr.22941

Sundy, J. S., Baraf, H. S., Yood, R. A., Edwards, N. L., Gutierrez-Urena, S. R., Treadwell, E. L., … & Becker, M. A. (2011). Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: Two randomized controlled trials. The New England Journal of Medicine, 364(13), 1191–1201. https://doi.org/10.1056/NEJMoa1012405

Terkeltaub, R., Furst, D. E., Bennett, K., Kook, K. A., Crockett, R. S., & Davis, M. W. (2013). High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis & Rheumatism, 62(4), 1060–1068. https://doi.org/10.1002/art.27327

White, W. B., Saag, K. G., Becker, M. A., Borer, J. S., Gorelick, P. B., Whelton, A., … & CARES Investigators. (2018). Cardiovascular safety of febuxostat or allopurinol in patients with gout. The New England Journal of Medicine, 378(13), 1200–1210. https://doi.org/10.1056/NEJMoa1710895

World Health Organization. (2023). Musculoskeletal conditions. https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions