Is the treatment goal for gout a cure or long-term management?

Let's put it this way: viewing gout as a condition that requires long-term management rather than seeking a "radical cure" will significantly improve your mindset and lead to better treatment outcomes.

You can think of it like high blood pressure or diabetes. If you have high blood pressure, you wouldn't ask "how to cure it completely," but rather "how to control my blood pressure well." Gout is the same principle.

Why can't it be "radically cured"?

The root cause of gout is "hyperuricemia," which means your body has too much uric acid. This usually happens because of a minor metabolic issue—either your body produces too much uric acid, or it doesn't excrete enough. This metabolic problem is chronic and difficult to reverse completely, so uric acid levels tend to remain elevated.

As long as uric acid levels are high, needle-like crystals can form in your joints. When these crystals cause trouble, your joints become red, swollen, hot, and painful—this is what an excruciating acute gout attack feels like.

So, what does "long-term management" involve?

The goal is clear: to lower blood uric acid levels and maintain them below the target value long-term (usually 360μmol/L; if you already have tophi, the target needs to be even lower, such as 300μmol/L).

As long as uric acid levels are within target, no new urate crystals will form, and existing crystals will slowly dissolve. This way, gout attacks will cease, joint damage will be prevented, and your quality of life will be just like that of a normal person.

How to manage it specifically? It's a two-step process:

1. Acute Phase: Rapid "Firefighting"

   • When you're in excruciating pain, the primary task is to reduce inflammation and relieve pain. Your doctor will prescribe colchicine, non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen, etoricoxib), or steroids to quickly alleviate the pain.
   • Note: At this time, absolutely do not start taking uric acid-lowering medication (if you weren't taking it before), as it might worsen the pain or prolong its duration.

2. Remission Phase: Long-term "Uric Acid Control"

   • This is the most crucial step! Not being in pain doesn't mean you're cured; this is where the real treatment begins.
   • You need to take uric acid-lowering medication regularly every day (such as allopurinol, febuxostat). Remember, it's daily, just like a hypertension patient takes blood pressure medication every day. You cannot take it only when you feel pain and stop when the pain subsides.
   • At the same time, incorporate lifestyle adjustments: drink plenty of water (over 2 liters daily), reduce or avoid alcohol (especially beer and spirits), limit sugary drinks, and control high-purine foods (such as organ meats, seafood, rich meat broths). However, understand that relying solely on dietary restrictions is unlikely to bring uric acid to target levels; medication is the main player.

In summary: The goal of gout treatment is not a "one-time cure," but rather to control uric acid within a safe range through long-term, regular uric acid-lowering therapy, thereby preventing future attacks, avoiding joint damage and kidney problems, and allowing you to live a normal life. So, treat it as an old friend that requires your long-term attention and management.