Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
While some medications are used to treat the hot, swollen joint, other medications are used to prevent further attacks of gout. With any of these medications, call your doctor if you think you are having problems from them or if they are not working.
Medicines used to treat acute gout and/or prevent further attacks are as follows:
High doses of anti-inflammatory medications are needed to control the inflammation
and can be tapered off within a couple of weeks.
Tell your doctor about your other health problems, particularly if you have a history of peptic ulcer disease or intestinal bleeding,
if you are taking warfarin (Coumadin),
or if you have problems with your kidney function.
The primary complications of these medications
include upset stomach, bleeding ulcers, and decreased kidney function.
This medication is given in two different ways,
either to treat the acute attack of arthritis or to prevent recurring
To treat the hot, swollen joint, colchicine is given rapidly (generally, two tablets at once followed by another tablet an hour later).
To help prevent an attack from coming back,
colchicine can be given once or twice a day. While the chronic use of colchicine can reduce
the attacks of gout, it does not prevent the accumulation of uric acid that
can lead to joint damage even without attacks of hot, swollen joints.
Tell your doctor if you have any problems with your
kidney or liver function.
Corticosteroids such as prednisone (Meticorten, Sterapred, Sterapred DS) are
generally given when your doctor feels this is a safer approach than using
When given by mouth, high-dose corticosteroids are used initially and tapered off within a couple of weeks. It is important to take these
medications as prescribed to avoid problems.
Some complications with the short-term use of corticosteroids include altered mood, elevated blood pressure, and problems with control of glucose in patients with diabetes.
Corticosteroids can also be injected into the
swollen joint. Resting the joint temporarily, after it is injected with
steroids, can be helpful.
Occasionally, corticosteroids or a related
compound, corticotropin (ACTH), can also be injected into the muscle
or given intravenously.
Medicines in addition to low-dose colchicine used to prevent further attacks
of gout and lower the level of uric acid in the blood include the following.
This medication helps the body eliminate excess
uric acid through the kidneys and into the urine.
You should drink at least 2 liters of fluid a day while taking this medication (to help prevent uric acid kidney stones from
Advise your doctor if you have kidney problems or a history of kidney stones or if you are taking aspirin. You may need to take allopurinol
There are a number of drug interactions with probenecid, so you should advise your doctor of your other medications. If you are prescribed a new medication, let your doctor know that you are taking probenecid.
This medication decreases the formation of uric acid by the body and is a very reliable way to lower the blood uric acid level. Allopurinol is currently the gold standard of maintenance therapy.
Advise your doctor if you have kidney problems.
Allopurinol can be still used, but the dose may need to be adjusted.
Common side effects include stomach pain, headache, diarrhea, and rash.
Discontinue allopurinol if you develop a rash or a fever, and call
A very rare risk of allopurinol hypersensitivity exists. This problem can cause a severe skin rash, fever, kidney failure, liver failure, bone marrow
failure, and can be fatal.
Febuxostat is first new medication developed specifically for the control of gout in over 40 years.
Febuxostat decreases the formation of uric acid by the body and is a very reliable way to lower the blood uric acid level.
Febuxostat can be used in patients with mild to moderate kidney impairment.
Febuxostat should not be taken with 6-mercaptopurine (6-MP), or azathioprine.
It is important to understand that these maintenance medications are used to lower the uric acid well below normal to prevent recurrent gouty arthritis attacks. Generally, doctors want the blood uric acid level to be below 6.0 mg/dL. This level of uric acid is referred to as the "target level" or "goal" of therapy.
Gout is a common disorder of uric acid metabolism that can lead to deposition of monosodium urate (MSU) crystals in soft tissue, recurrent episodes of debilitating joint inflammation, and, if untreated, joint destruction and renal damage.