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.

Click here: Second Opinion Arthritis Treatment Kit

Most people are able to control their gout symptoms and live productive lives with proper treatment.

The most common gout treatments for an acute attack are nonsteroidal anti-inflammatory drugs (NSAIDs) taken orally (by mouth) or corticosteroids, which are taken orally or injected into the affected joint. NSAIDs reduce the inflammation caused by deposits of uric acid crystals but have no effect on the amount of uric acid in the body. Examples of NSAIDs most commonly prescribed for gout are indomethacin (Indocin) and naproxen (Naprosyn), which are taken orally every day. 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 a corticosteroid, and the attack usually goes away completely within a week or so. Occasionally, steroids need to be injected into an acutely inflamed joint.

If NSAIDs or corticosteroids do not control a gout symptom, the doctor may consider using colchicine. This drug is most effective when taken within the first 12 hours of an acute attack. Doctors may ask patients to take oral colchicine as often as every hour until joint symptoms begin to improve or side effects such as nausea, vomiting, abdominal cramps, or diarrhea make it uncomfortable to continue the drug.

For some patients, the doctor may prescribe either NSAIDs or oral colchicine in small daily doses to prevent future attacks. The doctor also may consider prescribing medicine such as allopurinol (Zyloprim) or probenecid (Benemid) to treat hyperuricemia and reduce the frequency of sudden attacks and the development of tophi.

Allopurinol works 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 so this must be kept in mind.

Other important tips:

• To help prevent future attacks, take the medicines your doctor prescribes. Carefully follow instructions about how much medicine to take and when to take it. Acute gout is best treated when symptoms first occur.
• Tell your doctor about all the medicines and vitamins you take. He or she can tell you if any of them increase your risk of hyperuricemia.
• Plan followup visits with your doctor to evaluate your progress.
• Gout Diet: Maintain a healthy, balanced diet; avoid foods that are high in purines; and drink plenty of fluids, especially water. Fluids help 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 you are overweight, but do not go on diets designed for quick or extreme loss of weight because they increase uric acid levels in the blood.

Two new drugs are pending FDA approval. The first is febuxostat which works like allopurinol, but without many of the nypersensitivity problems associated with allopurinol. Febuxostat is oral. The second is PEG-uricase, which converts uric acid into allantoin, an inactive ingredient that does not provoke gout attacks. PEG-uricase is given intravenously.

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Best treatment for gout