Diagnosis And Management Of Gout

Content

• Signs And Symptoms
• Health Solutions
• How Do You Stop Gout Pain At Home?

Care must be taken to rule out infection prior to injecting steroids into the joint; this may mean performing separate joint aspiration and injection. Men can be three times more likely than women to get it because they have higher levels of uric acid most of their lives. Previous participation in the CONTACT trial during a previous acute attack of gout. Corticosteroids, taken either orally or by injection into a joint, offer short-term relief of acute symptoms. The drugs work by suppressing inflammation and tempering the immune system as a whole and are generally not used as a form of ongoing therapy. The pain during the early part of the attack will typically be the worst.

Signs And Symptoms

This trial will be the first direct comparison of the effectiveness and side effects of a NSAID and low-dose colchicine to treat acute gout in primary care. Naproxen will be used in this trial because it has been shown to be as effective as oral prednisolone for the treatment of acute gout, is safer than other commonly used NSAIDs such as diclofenac and indomethacin, and is inexpensive. 18 ] for prophylaxis are those used to treat acute gout, but at a lower dosage.

What is the best treatment for acute gout?

Drugs used to treat gout flares and prevent future attacks include:Nonsteroidal anti-inflammatory drugs (NSAIDs).
Colchicine.
Corticosteroids.

Underexcreting patients are candidates for uricosuric therapy with probenecid. The dosage is increased at monthly intervals until the uric acid level is lowered to target. Urinary alkalization and ingestion of copious amounts of fluid are adjunctive recommendations. Corticosteroids can be given to patients with gout who cannot use NSAIDs or colchicine.

Health Solutions

The drug's effectiveness may be offset, however, by side effects such as nausea, vomiting and diarrhea. The ACR and EULAR guidelines recommend talking to patients about their diet and the need to avoid organ meats, beverages, and foods with high-fructose corn syrup, as well as overuse of alcohol. Patients should limit serving sizes of red meats, seafood, table sugar, and salt and should consume more vegetables, the ACR and EULAR said. However, according to the ACP guideline, there is insufficient evidence for gout-specific dietary advice or therapies to improve symptomatic outcomes. For recurrent gout, ACP, ACR, and EULAR recommend one of the xanthine oxidase inhibitors, either febuxostat or allopurinol, as first-line ULT.

The same authors point out some reasons to explain refractory disease, such as delayed or insufficient dosing of urate lowering therapy and poor patient compliance or intolerance to medication . In the case of our patient, urate lowering therapy was initiated early, in a proper dose and with good compliance. Therefore, we believe that particular factors related to gout pathophysiology and/or particular metabolic mechanisms may have played an essential role in this patient, resulting in a difficult to treat attack, despite adequate therapy. Acute polyarticular gout may occur in 15% to 40% of patients, especially women . These individuals tend to have long disease duration, insidious, ascending, and asymmetrical attacks, similar to our patient , who presented not only a refractory and polyarticular arthritis, but also normal uric acid levels.

The temptation to treat patients without a proven diagnosis must be resisted. Septic arthritis may clinically resemble gout or pseudogout, and unrecognized septic arthritis can lead to loss of life or limb. Distinguishing septic arthritis from crystal-induced arthritis is not possible without an examination of joint fluid. Corticosteroids – These drugs can be taken by mouth or injected into an inflamed joint to quickly relieve the pain and swelling of an acute attack. Corticosteroids usually start working within 24 hours after they are taken.

But, by treating gout early, you can relieve pain and help prevent future problems. While lowering serum urate levels should minimize clinical gout sequelae, the exact target level has yet to be formally evaluated in randomized controlled trials, and guidelines vary in the recommended target levels. The buildup of uric acid in the joints and soft tissue is called tophus.

For More Information On Gout

Gout is typically diagnosed using clinical criteria from the American College of Rheumatology. Diagnosis may be confirmed by identification of monosodium urate crystals in synovial fluid of the affected joint. Acute gout may be treated with nonsteroidal anti-inflammatory drugs, corticosteroids, or colchicine. To reduce the likelihood of recurrent flares, patients should limit their consumption of certain purine-rich foods (e.g., organ meats, shellfish) and avoid alcoholic drinks and beverages sweetened with high-fructose corn syrup. Consumption of vegetables and low-fat or nonfat dairy products should be encouraged. The use of loop and thiazide diuretics can increase uric acid levels, whereas the use of the angiotensin receptor blocker losartan increases urinary excretion of uric acid.

However, reviews of evidence should not be construed to represent clinical recommendations or guidelines. If these medications are in chronic use at the time of an attack, it is recommended that they be continued. Levels that cannot be brought below 6.0 mg/dl while attacks continue indicates refractory gout. The triggers for precipitation of uric acid are not well understood.

The CONFIRMS trial demonstrated the efficacy and safety of febuxostat in lowering hyperuricemia. By 6 months, the primary endpoint—a serum uric acid level of less than 6.0 mg/dL—was achieved in 45% of subjects on febuxostat 40 mg/day, 67% on febuxostat 80 mg/day, and 42% on allopurinol. In subjects with renal impairment, the primary endpoint was achieved in 50% of subjects on febuxostat 40 mg/day, 72% on febuxostat 80 mg/day, and 42% on allopurinol. Ultrasonography is more sensitive (although operator-dependent) and specific than plain x-rays for the diagnosis of gout.

How do you treat an acute gout flare up?

Oral corticosteroids, intravenous corticosteroids, NSAIDs, and colchicine are equally effective in treating acute flares of gout. 20 NSAIDs are the first-line treatment. Indomethacin (Indocin) has historically been the preferred choice; however, there is no evidence it is more effective than any other NSAID.

A joint infection must be excluded, however, as glucocorticoids worsen this condition. Dietary causes account for about 12% of gout, and include a strong association with the consumption of alcohol, sugar-sweetened beverages, meat, and seafood. Among foods richest in purines yielding high amounts of uric acid are dried anchovies, shrimp, organ meat, dried mushrooms, seaweed, and beer yeast.

Each gout attack during a 1-year period was treated; during each treatment course patients were treated and observed for 5 hours before release. Seventy-six patients completed the study protocol; in these patients, the mean interval to relief from pain was significantly shorter among those assigned to ACTH than among those who received indomethacin . No adverse effects were observed among patients who received intramuscular ACTH. In contrast, a broad range of side effects – including gastrointestinal and neurologic adverse events – were observed among patients who received indomethacin. Rheumatologists should be involved in the care of patients with difficult gout, as advised in the ACR guidelines.

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