Gout cause and cure

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 is a particularly common form of arthritis that is due to excessive amounts of uric acid in the body.

Uric acid is present in the blood as a result of the breakdown of purines. The excess can be caused by:

•increase in production of uric acid by the body.
•by under-elimination of uric acid by the kidneys.
•by increased intake of foods which contain purines which are metabolized to uric acid in the body.

Certain meats, seafood, dried peas, and beans are very high in purines. Alcohol also can increase uric acid levels and precipitate gout attacks.

Elevated levels of uric acid in the blood may result in deposits of sharp needle-like crystals of monosodium urate in and around the joints. Uric acid also can collect under the skin as lumps, called tophi, or in the urinary tract as kidney stones.

The definitive diagnosis of gout hinges on finding uric acid crystals in joint fluid during an acute gout attack. Uric acid levels in blood alone can be misleading, as they can be normal or low. It should also be mentioned that uric acid levels often are elevated in people who do not have gout.

Gout usually affects a single joint suddenly. The episode begins with redness, heat, swelling, and pain - the classic signs of inflammation. Less commonly, gout can develop more slowly, involving multiple joints, resembling rheumatoid arthritis. The big toe is commonly affected first. This condition is referred to as podagra.

Gout can be treated successfully and without complications. However, it may be challenging because:

•Gout patients often have more than one medical condition
•Poor patient compliance may be a problem

Dietary alterations are recommended, such as avoiding a purine-rich diet. Other preventive measures include maintaining adequate fluid intake, weight reduction, reduction in alcohol consumption, and medications to reduce hyperuricemia.

Medications used for gout include non-steroidal anti-inflammatory drugs (NSAIDS), colchicine, corticosteroids, and adrenocorticotropic hormone (ACTH) for acute attacks. In order to get gout into remission and lower serum uric acid levels other medicines such as allopurinol, probenecid, febuxostat (Uloric), and Krystexxa are used.

NSAIDS (non steroidal anti-inflammatory drugs) are commonly the first medication prescribed to treat acute gout. NSAIDS are initially prescribed at maximum dosage and reduced as symptoms subside. The medication should be continued until pain and inflammation are non-existent for at least 48 hours.

Colchicine is used to treat acute flares of gouty arthritis and to prevent recurrent acute attacks. Colchicine does not cure gout nor take the place of other medicines that lower the amount of uric acid in the body. It prevents or relieves gout attacks by reducing inflammation.

Corticosteroids or adrenocorticotropic hormone can be used for patients who cannot take NSAIDS or colchicine. Patients with acute gout typically receive daily doses of prednisone (20-40mg) or its equivalent for 3 to 4 days, then it is tapered gradually over one to two weeks. ACTH is administered as an intramuscular injection (an initial dose and subsequent doses over several days as needed). Steroids may also be directly injected into an inflamed joint to help with an acute attack.

Analgesic painkillers are also used to relieve the intense pain of gout.

Allopurinol (Zyloprim) is prescribed for chronic gout or gouty arthritis and works by affecting the enzyme that manufactures uric acid in the body. It is used to prevent gout attacks, not to treat them once they occur. In fact, allopurinol should not be used during an acute attack- it may make the attack worse!

Probenecid (Benemid) is prescribed for chronic gout and gouty arthritis. It is used to prevent attacks related to gout, not treat them once they occur. It acts on the kidneys to help the body eliminate uric acid. Probenecid is known as a uricosuric agent. It is not effective in patients who do not have relatively normal kidney function.

ColBenemid is a gout medication that contains Probenecid, which is a uricosuric agent, and Colchicine, which has anti-gout properties. It offers convenience.

Sulfinpyrazone (Anturane) is also known as a uricosuric agent and is used to treat gouty arthritis. It works by lowering the amount of uric acid in your blood, preventing gout attacks. The drug helps prevent attacks but is not used to treat an attack once it has started. This is not a commonly used medication any longer.

Uloric is a drug that works on the same enzyme as allopurinol. It appears to have less toxicity, though.

Kyrstexxa is an intravenously administered drug that converts uric acid to allantoin, an inert ingredient that is rapidly removed from the body through the urine. It is reserved for patients who don't respond to other medicines or who have numerous tophi.

There are some medicines that are used to treat other medical conditions and which may also be beneficial for gout.

Losartan, (Cozaar and Hyzaar), is not specifically a gout medication but is an angiotensin II receptor antagonist, antihypertensive drug that may help control uric acid levels. Fenofibrate, (Tricor), is not a specific gout medication but it a lipid-lowering drug that may help uric acid levels.

Other helpful advice …

1.Maintain adequate fluid intake.
2.Keep weight under control. Obesity has been linked to gout.
3.Dietary changes can help prevent gout attacks. Avoid a purine-rich diet. Reduce alcohol consumption.
4.Medications can help control pain and inflammation of a gout attack and help prevent future attacks by eliminating excess uric acid or affecting the production of excess uric acid.
5.Be compliant with the treatment plan your doctor recommends.

Natural types of treatments that are worth looking into include omega 3 and omega 6 fatty acids which are anti-inflammatory and cherry juice which has an apparently beneficial effect on gout.

Again… there is no cure; however, there are multiple effective therapies.

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