Arthritis Treatment: The 3 Stages of Gout and How to Treat Them

Gout is a disease due to an overabundance of uric acid (UA) in the body. Under normal circumstances, purines, which are natural constituents of many foods, are converted into UA, and then excreted.

With gout, UA is either produced in overabundance or the body has difficulty getting rid of it fast enough.

There are three stages of gout. The first is called asymptomatic hyperuricemia. What that means is that the body has too much UA on board. The UA level in the blood is high. But the patient has no symptoms. During this period, UA builds up in body tissues. The patient may or may not ever get gout symptoms. People who have this condition may have other medical problems such as elevated cholesterol, obesity, diabetes, and high blood pressure.

If this condition lasts long enough, the patient will enter the phase of acute gout. This is when severe, painful attacks of gouty arthritis can develop. The attacks usually present in the ankles and feet. The pain is so severe the patient won't even be able to bear the weight of a bed sheet on top of the affected area. Once this acute attack goes away, the patient will remain symptom free until the next attack. The second attack and subsequent attacks may not occur for many months or even years.

The last stage of gout is advanced gout where acute flares occur with regularity. The time periods between acute attacks are no longer pain free. Accumulations of UA build up near the joints and under the skin. These are called tophi.

While these deposits may be evident because of their location, other deposits of UA in internal organs may not be so visible. But these invisible deposits are even more serious because they can lead to complications such as kidney failure.

The treatment of gout at each stage is not always straightforward. Asymptomatic hyperuricemia is not always treated unless the blood UA level is exceedingly high.

Once an acute attack occurs, though, things change.

The goals of treatment are to relieve the symptoms of the acute attack but also to lower the UA burden in the body.

The acute attack is treated with either non-steroidal-anti-inflammatory drugs (NSAIDS) or colchicine. In patients with kidney problems, sometimes steroids given orally or directly into the inflamed joint may be used in order to avoid the potential side effects of the anti-inflammatory drugs or colchicine.

In general, UA lowering drugs are not started during an acute attack because they make the attack worse.

Once the acute attack is successfully treated, the patient will then start UA lowering treatment with medication. They will also receive low doses of colchicine or anti-inflammatory medicines to act as prophylaxis against acute attacks that can develop during the first six months of UA lowering treatment. The aim is to keep the blood UA below 6.0 mg/dl.