Treatment Options for Severe Gout

Medically Reviewed By William C. Lloyd III, MD, FACS
Senior patient undergoing medical treatment
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Gout, a kind of arthritis, causes painful, sudden attacks of inflammation in your joints. Left untreated, gout can lead to joint damage and deformity. The good news is doctors can manage most cases of gout with medicine that lowers your uric acid levels. In some people, though, the most commonly used drugs may not work well enough, and your doctor may try other approaches.

Do I Have Severe Gout?

Your doctor may consider your gout “severe” if you begin to have more frequent painful flares that last longer than they used to, even when you are taking your gout medicine. You may also experience gout pain in parts of your body that were not previously affected. Some people with severe gout may develop bumps under the skin, called “tophi” which appear most commonly on your hands, elbows and ears. If you develop kidney stones or even kidney failure, it may be linked to severe gout.

What Treatments Can Help Severe Gout?

The key to managing severe gout is similar to less serious forms of the condition—lowering your uric acid levels. If the most commonly used gout medicines—like allopurinol—aren’t reducing your uric acid levels enough to prevent attacks, look to these other medications and treatments your doctor can use to relieve your severe gout

  • Pegloticase (Krytexxa) is given by infusion every two weeks to reduce your uric acid levels quickly and to lower levels than some other gout medicines.

  • Anakinra (Kineret) is typically used to treat rheumatoid arthritis, but your doctor may prescribe it for severe attacks of gout to quickly relieve pain and inflammation.

  • Corticosteroids are an option if you have sensitivities to other gout medications. Your doctor may recommend corticosteroid injections into the affected joint.

  • Combined medications can be more effective at controlling severe gout if your current medicine is not enough. Your doctor may add a second medication to your regimen, such as colchicine and an NSAID (nonsteroidal anti-inflammatory), or colchicine and a steroid.

  • Surgery is rarely necessary, but your doctor may propose it to remove the bumps (tophi) that can form under your skin if they become infected, cause joint deformity, or press on your spine.

The number of people with gout is on the rise in the United States, and it’s linked to higher rates of obesity and other lifestyle factors. Thankfully, you can control most cases of severe gout with powerful and effective medicines. But, equally important is to maintain a healthy weight, eat a balanced diet, and exercise regularly to naturally decrease your risk of developing this painful condition.

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  2. Gout Treatment. Arthritis Foundation. https://www.arthritis.org/about-arthritis/types/gout/treatments/types.php
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  4. Gripped by Gout. NIH News in Health. https://newsinhealth.nih.gov/2014/02/gripped-gout
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Aug 11
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