5 Signs It's Time to Try a New Gout Treatment

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Gout is a type of inflammatory arthritis that can affect a single joint, often the big toe, or several other joints in the foot or leg. Gout develops when too much uric acid builds up in the tissues or blood, and the body is unable to adequately eliminate it. The body’s immune system targets the affected area, which leads to inflammation.

It may be painful when it flares up, but fortunately, gout is very treatable. Typically, people with gout learn to combat their disease with a dual-pronged approach. They develop a strategy for handling acute gout attacks, which usually includes anti-inflammatory medications like nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. They also develop a preventive strategy that will lessen the chances of experiencing future acute episodes, which often includes medications to lower their bodies’ production of uric acid or improve their bodies’ ability to excrete excess uric acid in their urine.

As with many medical conditions that cause painful flare-ups, it’s always better to prevent a gout attack from occurring. But you may not be able to stick with the same gout medication forever. At some point, you may realize it’s time to try a new gout treatment. Or you may develop other health conditions or experience side effects that warrant a switch.

One Treatment Is No Longer Effective by Itself

Perhaps your doctor originally prescribed an oral medication like allopurinol (Zyloprim) to lower your body’s production of uric acid and prevent future gout attacks. And for awhile, it worked well. But you’re finding you’re unable to keep your uric acid levels at your target level—or worse, you’re experiencing some gout flares. It may be time to add a second gout medication to your regimen. Your doctor might prescribe a drug to treat high uric acid levels like lesinurad (Zurampic) to take in combination with your original medication. Or if other standard gout treatments are just not working effectively enough, your doctor may prescribe pegloticase (Krystexxa), which is administered intravenously to lower uric acid levels.

1. You need to take medications that interact with your gout treatment.

Your doctor may need to adjust your gout treatment if you need to take certain medications for other health conditions. For example, you may take a medicine called colchicine (Colcrys), which decreases your body’s inflammatory response to uric acid crystals. It’s used to treat both acute gout attacks and in gout prevention. But if you do take colchicine, you may need to switch to a different gout treatment regimen if you’re taking any other medications that might interact with it.

2. You experience serious side effects.

Some mild side effects from medication are normal. You may be able to put up with some side effects, especially if they’re fairly short-lived. But you may begin to experience intolerable side effects from a preventive medication for your gout, like persistent nausea or vomiting. Or you may begin to experience rare but serious side effects like bloody urination, unusual fatigue, severe abdominal pain, numbness or tingling in the extremities, and bruising or bleeding that might warrant a trip to the doctor. If the side effects are severe or they don’t lessen on their own, it may be time to try another gout treatment. Your doctor may also switch medications if you develop rare side effects like the nerve and muscle damage that can occur with long-term use of colchicine.

3. You experience an allergic reaction.

It’s possible, although rare, to develop an allergic reaction to a medication.. Signs of an allergic reaction include difficulty breathing, hives, and swelling or your tongue, lips, mouth or throat. If any of these signs occur, get emergency help right way. And if you experience other signs of a possible allergic reaction like a skin rash, let your doctor know right away so you can determine the best way to proceed. Your doctor may switch you to another preventive drug to reduce the amount of uric acid made in your body.

4. You develop kidney stones.

People with a history of kidney stones need to be especially vigilant about preventing future kidney stones from developing. This might require more aggressive treatment of gout. It may also require you to avoid certain medications, like those which helps the kidneys excrete uric acid but can increase the likelihood of kidney stones.

5. You develop bone damage.

If left untreated—or not treated adequately—gout can sometimes lead to bone damage. Once damage to your bones occurs, though, your doctor may want to ramp up your gout treatment and work even harder to reduce your body’s uric acid levels. This may require more intensive treatments.

If you feel that something isn’t quite right with your gout medications, trust your instinct and contact your doctor. Your instinct may be telling you  something is off and your doctor may want to investigate further. Lots of people with gout have to change medications, and you may just be one more.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Mar 1
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