What are the home treatment options for gouty (gout) arthritis?

From the Guidelines

To treat gouty arthritis at home, it is recommended to take anti-inflammatory medications, apply ice, rest, and stay hydrated, as well as avoid triggers like alcohol and purine-rich foods, based on the most recent and highest quality study from 2020 1. The management of gout involves both pharmacologic and nonpharmacologic approaches, with a focus on reducing inflammation and lowering uric acid levels in the body.

• Key home treatment options include:
  • Taking anti-inflammatory medications like ibuprofen (400-800mg every 6-8 hours) or naproxen (500mg twice daily) to reduce pain and inflammation
  • Applying ice to the affected joint for 20-30 minutes several times daily to reduce swelling and discomfort
  • Resting the painful joint and elevating it above heart level when possible
  • Staying well-hydrated by drinking 8-10 glasses of water daily to help flush uric acid from your system
  • Avoiding alcohol and purine-rich foods such as red meat, organ meats, seafood, and high-fructose corn syrup, which can trigger or worsen gout attacks
• For acute attacks, some people find relief with colchicine (typically 0.6mg taken twice daily), though this requires a prescription, as recommended by the American College of Physicians in 2017 1.
• It is also important to note that lifestyle modifications, such as weight loss and exercise, can help manage gout, as emphasized by the EULAR evidence-based recommendations for gout in 2006 1.
• If symptoms persist beyond 3-5 days or are severe, it is recommended to seek medical attention as prescription medications may be necessary for long-term management, according to the 2020 American College of Rheumatology guideline for the management of gout 1.

From the FDA Drug Label

A fluid intake sufficient to yield a daily urinary output of at least 2 liters and the maintenance of a neutral or, preferably, slightly alkaline urine are desirable. Clinical experience suggests that patients with recurrent calcium oxalate stones may also benefit from dietary changes such as the reduction of animal protein, sodium, refined sugars, oxalate-rich foods, and excessive calcium intake, as well as an increase in oral fluids and dietary fiber

The home treatment options for gouty (gout) arthritis include:

• Increasing fluid intake to at least 2 liters per day
• Maintaining a neutral or slightly alkaline urine
• Dietary changes, such as:
  • Reducing animal protein
  • Reducing sodium
  • Reducing refined sugars
  • Avoiding oxalate-rich foods
  • Limiting excessive calcium intake
  • Increasing oral fluids
  • Increasing dietary fiber 2

From the Research

Home Treatment Options for Gouty Arthritis

• Non-steroidal anti-inflammatory drugs (NSAIDs) are the preferred treatment for acute gouty arthritis, and should be initiated as soon as possible 3, 4, 5, 6, 7
• Colchicine can be used to treat acute gouty arthritis, but its use has declined due to frequent adverse reactions and reduced efficacy when administered more than 24 hours after onset of an acute attack 3, 4, 5, 6, 7
• Corticosteroids, such as intra-articular corticosteroid therapy, oral corticosteroids, and parenteral corticosteroids, can be used to treat acute gouty arthritis, particularly in patients with polyarticular attacks or those who cannot tolerate NSAIDs or colchicine 3, 4, 5, 6, 7
• Urate-lowering therapy, such as allopurinol, can be used to treat chronic gouty arthritis and prevent recurrent episodes of gout, but should only be initiated after the acute attack has resolved 3, 4, 5, 6, 7
• Lifestyle modifications, such as reducing serum urate levels through dietary changes and increasing fluid intake, can help prevent recurrent episodes of gout 5, 7
• Non-pharmacological treatments, such as topical ice and rest of the inflamed joint, can be useful in managing acute gouty arthritis 7

Considerations for Specific Patient Populations

• In elderly patients, gout may present differently, and treatment options may need to be adjusted due to co-morbid conditions or renal impairment 3, 5
• In patients with renal impairment, allopurinol is the treatment of choice for urate-lowering therapy, but doses must be adjusted 3, 5, 7
• In patients with peptic ulcer disease, selective COX-2 inhibitors may be a treatment option 5
• In patients allergic to allopurinol, uricosuric drugs may be used as an alternative treatment option 3, 7