From the Guidelines
Nicotine is not recommended as a treatment for gout. The standard treatments for gout include medications such as colchicine for acute attacks, NSAIDs like naproxen or indomethacin for pain and inflammation, and urate-lowering therapies such as allopurinol or febuxostat for long-term management, as recommended by the American College of Physicians 1 and the American College of Rheumatology 1. During an acute gout attack, the typical approach includes resting the affected joint, applying ice to reduce inflammation, and taking prescribed medications.
While some preliminary research suggests nicotine might have anti-inflammatory properties, there is insufficient evidence supporting its use for gout treatment, and it carries significant health risks including addiction, cardiovascular problems, and respiratory issues, as noted in various studies 1. Additionally, smoking (a common nicotine delivery method) may actually worsen gout by increasing uric acid levels and triggering inflammation.
The most recent and highest quality study, published in 2020 by the American College of Rheumatology 1, provides guidance for the management of gout, including indications for and optimal use of urate-lowering therapy (ULT), treatment of gout flares, and lifestyle and other medication recommendations. This study recommends a treat-to-target management strategy with ULT dose titration guided by serial serum urate measurements, with an SU target of <6 mg/dl.
If you're experiencing gout symptoms, consult with a healthcare provider for proper diagnosis and evidence-based treatment rather than attempting to self-medicate with nicotine. The American College of Physicians recommends that clinicians choose corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine to treat patients with acute gout, and use low-dose colchicine when using colchicine to treat acute gout 1.
Key points to consider in the management of gout include:
- Initiation of ULT for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout flares
- Allopurinol as the preferred first-line ULT, including for those with moderate-to-severe chronic kidney disease (CKD; stage ≥3)
- Using a low starting dose of allopurinol (≤100 mg/day, and lower in CKD) or febuxostat (≤40 mg/day)
- A treat-to-target management strategy with ULT dose titration guided by serial serum urate measurements, with an SU target of <6 mg/dl
- Concomitant antiinflammatory prophylaxis therapy for a duration of at least 3–6 months when initiating ULT.
From the Research
Nicotine and Gout
- There is no direct evidence in the provided studies to suggest that nicotine is used as a treatment for gout 2, 3, 4, 5, 6.
- The studies focus on various pharmacotherapies for gout, including colchicine, NSAIDs, corticosteroids, and urate-lowering therapies such as allopurinol and febuxostat 2, 3, 4, 5, 6.
- Lifestyle modifications are also mentioned as part of gout prevention, but nicotine is not discussed in this context 4.
- The provided evidence does not support the use of nicotine for gout treatment, and standard treatments for gout flares and urate-lowering therapy are well-established 2, 3, 4, 5, 6.
Gout Treatment Options
- Standard pharmacotherapies for gout flares include colchicine, NSAIDs, and oral or intramuscular corticosteroids 2, 3, 4.
- Urate-lowering therapies aim to prevent gout flares, with an emphasis on treat-to-target strategy, and include allopurinol and febuxostat as initial treatments 2, 3, 4, 5.
- Emerging therapies, such as novel uricosurics and IL-1β antagonists, are also being developed for gout treatment 4.
- Patient characteristics, such as comorbidities and health care utilization, can influence the choice of treatment for gout 5.