What Is a Cure?
Merriam-Webster Dictionary defines cure as "recovery from a disease; remission of signs or symptoms of a disease especially during a prolonged period of observation."
In accordance with that definition, a cure for gout suggests that treatment effectively prevents the recurrence of gout attacks. To be cured, gout patients would have to respond well to the treatment and be compliant with the long-term treatment plan.
A gout attack develops as excess uric acid accumulates in the body and uric acid crystals (monosodium urate monohydrate crystals or MSU) form and are deposited in the joints and soft tissue that surround the joints. The deposition of the crystals is tied to acute and chronic inflammation.
Not all people with hyperuricemia develop gout: it's estimated that up to two-thirds of people with hyperuricemia never develop crystals or gout symptoms. Still, the goal of long-term treatment is to keep serum uric acid below 6 mg/dl. At that level, new crystals don't form, existing crystals can dissolve, acute gout attacks are prevented, and tophi shrink and disappear. Essentially, when uric acid is maintained below 6 mg/dl, and all crystal deposits are dissolved, gout is cured — although without continued treatment, most people will have a relapse.
Untreated Gout Attacks
With the initial onset of gout, pain and inflammation are most intense within the first few hours. Even if untreated, symptoms typically improve within days, possibly taking a couple of weeks. For some people, subsequent gout attacks may be infrequent, with years between attacks. As time goes on, though, gout attacks usually increase in frequency. Each attack may last longer and may involve more joints.
Managing Gout and Preventing the Recurrence of Attacks
A combination of medications and dietary changes is typically used to prevent the recurrence of gout attacks, or in some cases, to decrease the frequency of gout attacks. Lowering uric acid levels is frequently the goal.
People who have infrequent or mild gout attacks may not require long-term preventive medications, and they may get by with treating acute attacks as they occur. But people whose gout attacks are frequent, long in duration and disabling may require medication to control the recurrence.
NSAIDs (nonsteroidal anti-inflammatory drugs) are considered the first line of defense against a gout attack, unless the drugs are contraindicated due to allergy or a history of bleeding ulcers, for example. Typically, NSAIDs can bring a gout attack under control within 24 hours.
Glucocorticoids, also called corticosteroids, are an effective second line of defense against an acute gout attack. Often, these drugs are prescribed at a high dose initially, then tapered over 10 to 14 days. Because of potential side effects, corticosteroids are a short-term solution, not long-term.
Colchicine was once the drug of choice to treat acute gout attacks. Because of the time it takes to control an attack and the potential for toxicity, colchicine is no longer recommended for treating acute gout attacks, but it's still used to prevent them.
If it's determined that a patient should be treated with a urate-lowering drug, there are a couple of choices. Allopurinol is a xanthine oxidase inhibitor which reduces the production of uric acid. Probenecid is one of the uricosuric agents which increase the excretion of uric acid.
Uloric (febuxostat) is a drug prescribed for the management of chronic hyperuricemia in gout. Uloric lowers serum uric acid by blocking xanthine oxidase (the enzyme involved in uric acid production).
Krystexxa (pegloticase) is a biologic drug available to patients who cannot take, or who were not helped by, conventional gout treatments. Krystexxa works by breaking down uric acid.
Patient information: Gout (Beyond the Basics). UpToDate. Michael A. Becker. March 29, 2012.
Treating to target: a strategy to cure gout. Fernando Perez-Ruiz. Rheumatology. 2009.
Primer on the Rheumatic Diseases. Klippel, J. et al. Published by the Arthritis Foundation. Thirteenth Edition.