Drugs to relieve 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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For the acute attack, drugs such as colchicine, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs) are used.
Colchicine is an oral drug that is taken in a dose of one tablet two times a day. Colchicine, while effective, is a potentially toxic drug and should not be used in patients with kidney or liver function dysfunction, 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. Examples of NSAIDS include indomethicin, ibuprofen, naproxen, nabumatone, etodolac, diclofenac, oxazoprocin, meloxicam, and celecoxib. All NSAIDS are helpful. Again, patients who are allergic to these types of drugs or who have contraindications against the use of NSAIDS should not take them.
Corticosteroids may be taken by mouth, injected intramuscularly, or directly injected into an affected joint. These compounds are very effective for relieving gout attacks. These are used in patients who have contraindication to the use of colchicines or NSAIDS.
Canekinumab is an investigational agent. It is administered intravenously and blocks the effects of interleukin-1, which appears to be the cytokine that generates the inflammation in a gout attack. While it is very effective, it is also very expensive.
Long term therapies such as probenecid which helps lower uric acid by causing an increased excretion through the urine is used in the younger patient with normal kidney function who has a baseline urine uric acid excretion in the normal range.
Colbenemid is a drug that combines probenecid and colchicines. It is good 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.
Febuxostat (Uloric)is a drug that works in a similar fashion to allopurinol (xanthine oxidase inhibitor)but appears to be less toxic.
Neither allopurinol or probenecid should be used to treat acute attacks.
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 as therapy.
PEG-uricase (Krystexxa) is an intravenous medicine that converts purines to a harmless substance called allantoin.It is effective but not indicated for an acute attack.
Dietary precautions regarding food and drink containing high levels of purines are indicated as well.
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