Best treatment for gout

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Gout can be treated with a number of therapies. The goals of gout treatment are to relieve the pain of acute attacks, to prevent future attacks, and to avoid the formation of tophi (large deposits of uric acid)and prevent deterioration of kidney function. Successful gout treatment can reduce both the discomfort caused by gout symptoms as well as prevent long-term damage to affected joints. Treatment will also help to prevent disability.

The most common gout treatments for an acute attack are non-steroidal anti-inflammatory drugs (NSAIDs) taken orally, colchicine, or corticosteroids, which are taken either orally or are injected into the affected joint. NSAIDs reduce the inflammation caused by deposits of uric acid crystals but have no effect on the level of uric acid in the body. Examples of NSAIDs most commonly prescribed for gout are indomethacin (Indocin) and naproxen (Naprosyn), which are taken on a daily basis.

Colchicine is most effective when taken within the first 12 hours of an acute attack. In the old days, doctors would ask patients to take oral colchicine as often as every hour until joint symptoms began to improve or side effects such as nausea, vomiting, abdominal cramps, or diarrhea made it uncomfortable to continue the drug. Colchicine is potentially toxic and this approach is not used any more. It can be taken once or twice a day but this sometimes is not enough to break an acute attack.

Corticosteroids are strong anti-inflammatory hormones. The most commonly prescribed corticosteroid is prednisone. Patients often begin to improve within a few hours of treatment with corticosteroid medication, and the attack usually goes away completely within a week or so. Occasionally, steroids need to be injected into an acutely inflamed joint.

Either NSAIDs or oral colchicine, in small daily doses, can be started to prevent future attacks. In addition, initiation of uric acid lowering therapy should be begun once the acute attack has resolved.Drugs such as allopurinol (Zyloprim), febuxostat (Uloric), or probenecid (Benemid) can be used to treat hyperuricemia and reduce the frequency of sudden attacks and the development of tophi.

Allopurinol and febuxostat work by reducing uric acid production by the body. Probenecid works by increasing the amount of uric acid excreted in the urine. People who have had kidney stones in the past should not go on probenecid. Another older drug that might be considered is Anturane. This drug works like probenecid to increase the amount of uric acid excreted in the urine. Anturane also has anti-platelet effects.

Other important tips:

• Carefully follow instructions about how much medicine to take and when to take it. Acute gout is best treated when symptoms first occur.
• Tell the doctor about all the medicines and vitamins you take. He or she can tell you if any of them increase the risk of hyperuricemia.
• Maintain a healthy, balanced diet; avoid foods that are high in purines; and drink plenty of fluids, especially water. Water helps remove uric acid from the body.
• Avoid low doses aspirin and thiazide diuretics which can increase blood levels of uric acid and negate the effects of uric acid lowering therapy.
• Exercise regularly and maintain a healthy body weight. Lose weight if overweight, but do not go on diets designed for quick or extreme loss of weight because rapid changes in body weight can trigger acute gout.

Pegloticase (Krystexxa) is a relatively new drug that is given intravenously to lower uric acid levels. It helps melt away tophi.The drtug works by converting uric acid into allantoin, an inactive ingredient that does not provoke gout attacks.

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