Cure for gout pain

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

Gout pain was described to me by one patient as being like "someone jammed a piece of glass into his foot and kept twisting it."

While there is no cure for gout, there are effective treatments to relieve the pain.

For the acute attack, drugs such as colchicine, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs) are used.

Colchicine is an oral drug. At one time, the recommendation was to take one tablet every two hours until the attack broke or until side effects including abdominal cramps and diarrhea occurred. That no longer is the recommendation because colchicine is such a toxic drug. It may be taken, at most, twice a day to help with pain and is often effective. Colchicine should not be used in patients with limited kidney or liver function, those who have blood disorders, and the elderly.

NSAIDS are anti-inflammatory drugs that also are effective in relieving the pain of an acute attack. All NSAIDS are helpful. Again, patients who are allergic to these types of drugs or who have contraindications against NSAIDS should not take them.

Corticosteroids taken by mouth, injected intramuscularly, or injected directly into an affected joint using ultrasound needle guidance can relieve gout attacks. This latter approach is also good because joint fluid can be obtained at the time of injection to look for uric acid crystals that can confirm the diagnosis.

Long term therapies such as probenecid which lowers uric acid by causing increased excretion by the kidneys is advised in younger patients with normal kidney function who have baseline urine uric acid excretion in the normal range.

Colbenemid is a drug that combines probenecid and colchicine. It is appropriate for young healthy patients with gout.

Allopurinol is a drug that lowers uric acid by reducing the body’s ability to produce it. This drug is used in patients who overexcrete uric acid in the urine and in older patients who do not have normal kidney function. This drug has many potential serious side effects and needs to be monitored carefully.

Losartan (Cozaar) is an anti-hypertensive drug that is uricosuric (increases uric acid excretion through the urine). Its effects are mild but in a gout patient with hypertension, it is a good choice.

Febuxostat (Uloric) is a drug that works similar to allopurinol but with fewer side effects.

Allopurinol, probenecid, and febuxostat should not be used to treat acute attacks.

Krystexxa is an intravenously administered drug that converts uric acid to allantoin, an inert ingredient that the body is able to excrete easily. Krystexxa is used in hard-to-treat gout patients who have either not responded to or have developed toxicities with allopurinol or febuxostat.

Prohibitions against foods and drinks containing high levels of purines are also wise… at least until the gout is under control.

Interleukin-1 is a cytokine(protein messenger) that plays a major role in the inflammation that accompanies acute gout. Drugs that block interleukin 1 (an example is canakinumab)are being investigated as possible alternative treatments for acute gout.

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