Gout medication where you can eat what you want

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 metabolic disease where uric acid is produced in excess.

An initial attack of gout (50% of initial attacks involve the big toe) may last several days and go away even if untreated. Subsequent attacks may not occur for weeks, months, years, or not at all. In severe cases, repeated attacks occur over a long period and cause damage to the joints and loss of mobility. The big toe is affected in 90% of cases. This condition is called “podagra.”

Knowing how to treat gout is important for preventing attacks.

Uric acid levels can become elevated by:

• Eating excessive amounts of purine-rich foods such as meats
• Overproduction of uric acid by the body
• Inability of the kidneys to eliminate excess uric acid

Treatment goals include "breaking" acute gout attacks,preventing future attacks, and avoiding complications such as kidney failure, kidney stones, and joint destruction.

Though gout treatment is most often successful, it becomes difficult if other conditions exist along with gout or if there is poor patient compliance with lifestyle changes or medicines.

Initially, 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 elevated blood uric acid.

Medications used to treat gout include non-steroidal anti-inflammatory drugs (NSAIDS), colchicine, corticosteroids,and adrenocorticotropic hormone (ACTH)for the acute attack, and allopurinol, probenecid, febuxostat and Krystexxa for maintenance of serum uric acid.

NSAIDS are commonly the first medication prescribed to treat acute gout. NSAIDS are effective when started early in an attack. The medication should be continued until pain and inflammation are gone for at least 48 hours. NSAIDS do nothing to lower blood uric acid... and they will not make up for dietary indiscretions.

Colchicine is used to treat acute flares of gouty arthritis and to prevent recurrent acute attacks. Much like NSAIDS, colchicine does not cure gout or lower the amount of uric acid. It prevents or relieves gout attacks by reducing inflammation.

Steroids or adrenocorticotropic hormone (ACTH) 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).

Allopurinol is prescribed for chronic gout or gouty arthritis and works by blocking xanthine oxidase, the enzyme that converts purines to uric acid. It is used to prevent gout attacks, not to treat them once they occur. When taken on a long-term basis and with good control of the serum uric acid, it may allow a patient to consume purine-rich foods. Unfortunately, allopurinol is a drug with many potential toxicities including liver and kidney damage and bone marrow effects.

Probenecid 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 eliminate uric acid. Probenecid is known as a uricosuric agent. It also may allow a patient to eat what they want if the serum uric acid is controlled.

Colbenemid is a gout medication that combines probenecid and colchicine.

Losartan (Cozaar, 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.

Febuxostat is another drug that blocks uric acid metabolism. It is an alternative to allopurinol, and works through the same mechansim of action.

Another drug is PEG-uricase (Krystexxa). It converts purines to allantoin, a relatively harmless by-product. It is administered intravenously.

To summarize, a patient can:

Maintain adequate fluid intake.
Keep weight under control.
Avoid a purine-rich diet.
Reduce alcohol consumption.
Medications can help control pain and inflammation of a gout attack and help prevent future attacks by eliminating excess uric acid or reducing the production of excess uric acid.

For optimal gout control:

Diet low in purines.
Medication to control pain.
Medication to control inflammation.
Medication to control the level of uric acid.

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