Gout gets its name from two interpretations. The first suggests that during an attack, even a breeze can cause pain when it touches the skin. I once saw a man in his thirties tear up in front of me due to the excruciating pain of gout, indicating how severe it can be. The other interpretation likens the pain to the wind—it comes quickly and leaves just as fast. However, this speed is relative; most acute gout attacks improve within two to three days, but for some with severe or long-term chronic gout, tophi around the joints or even bone damage may extend the duration of pain. So, what are some convenient “self-rescue” methods during an acute gout attack? Let me introduce a few today.
Colchicine
Those with multiple gout attacks under their belt often have a premonition before an attack, feeling an unexplained discomfort or pain in their joints. If you start taking colchicine immediately at this stage, it can greatly reduce the severity or even prevent an attack.
However, when using colchicine, there are several issues to note:
First is the dosage issue. There’s no need to take it to the point of diarrhea as written in the instructions. You can start with 1mg orally on the first day, followed by another 0.5mg 6 to 8 hours later, and then 0.5mg twice daily from the second day onwards. Higher doses won’t increase efficacy but will increase side effects, so there’s no need for large doses. Colchicine comes in 1mg and 0.5mg strengths domestically, so be careful not to mix them up when taking.
Second is the timing of administration. Starting colchicine from the earliest signs of a gout attack yields better results. With a total daily dose of 0.5 to 1mg, taking it for a longer period—3 to 6 months as foreign guidelines suggest—can prevent recurrence. However, most patients I encounter clinically struggle to adhere to such long durations, so I usually recommend half a month to a month. For some chronic gout patients with frequent relapses, the duration can be appropriately extended.
Third is the issue of side effects. Colchicine is a prescription drug, and it’s not advisable for patients with underlying conditions like liver or kidney disease to take it without consultation.
Ice Packs
During an acute gout attack, symptoms such as redness, swelling, heat, and pain occur. Applying ice packs (not heat) promptly can help alleviate local inflammation and reduce pain.
Reducing Local Weight Bearing
Most acute gout attacks occur in weight-bearing joints like the big toe, knee, or ankle. Resting and reducing the load on these joints is also an important measure to prevent worsening pain.
Painkillers
For severe pain, it’s recommended to use an adequate amount of painkillers, such as 120mg of etoricoxib daily, which is quite effective. If etoricoxib isn’t available, consider using other painkillers like diclofenac sodium, celecoxib, or meloxicam. Generally, patients with underlying conditions like stomach ulcers or kidney disease should not use these painkillers without consultation. For elderly patients with a history of coronary heart disease or stroke, etoricoxib is not recommended. For those who cannot use painkillers, I suggest using loxoprofen or flurbiprofen patches locally, which usually don’t pose concerns about side effects.
Hormones
If you manage the above points well, you should be able to get through mild gout attacks. For patients with very severe pain or those who need to relieve pain quickly for work reasons, hormones might be necessary. You can take oral prednisolone acetate once a day, 4 to 6 tablets each time, for 2 to 3 consecutive days. You can also go to the hospital for intramuscular injections of hormones as arranged by a doctor. However, as everyone knows, improper use of hormones carries potential risks and contraindications, so this is only introduced here and not recommended for self-administration.
A Few More Reminders
It must be emphasized again that the “self-rescue” methods introduced above are only suitable for patients without significant underlying conditions to get through difficult times during acute attacks. After the acute phase, you still need to manage your health effectively and use uric acid-lowering drugs as advised by a doctor. For chronic gout patients, a more comprehensive and long-term treatment plan should be developed with a physician.