New Gout Guidelines And 'treat To Target'

Content

• Updates On Arthritis And Rheumatic Diseases You Need To Stay Informed About Your Health
• Pharmacology Of The Therapeutic Approaches Of Gout
• The Four Stages Of Gout
• Acute Gout Attack

In addition, we have seen different results on the impact of gout flare treatment on renal function in case reports and case series. For instance, 12 studies reported deteriorated renal function with colchicine use , whereas 7 other studies reported stable renal function with colchicine use . As a result, given the underlying risk of bias on study quality for these studies, we cannot sufficiently conclude on the efficacy and/or safety outcomes on colchicine use for people with gout and concomitant CKD. In the AGREE clinical trial, low-dose colchicine use was as comparably effective as the high-dose colchicine in gout flare with minimal side effects, and therefore, low-dose colchicine has been recommended for use in gout flare prophylaxis and therapy .

Acute treatment of proven crystal-induced arthritis is directed at relief of the pain and inflammation. Nonsteroidal anti-inflammatory drugs , corticosteroids, colchicine, adrenocorticotropic hormone , and anakinra are treatment options. The choice is based primarily on whether the patient has any concomitant health problems . Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PL, van Weel C, Janssen M. A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. Gout attacks should be treated immediately with pharmacologic treatment when contraindications are absent. First-line treatment options include NSAIDs, colchicine, and systemic glucocorticoids.

Updates On Arthritis And Rheumatic Diseases You Need To Stay Informed About Your Health

Once this level is achieved and maintained, patients can be seen every 6-12 months and their serum uric acid monitored to help assess efficacy and adherence. The lipid-lowering drug fenofibrate, a fibric acid derivative, lowers serum uric acid levels while reducing very-low-density lipoprotein , total cholesterol, and triglyceride levels. However, the creatinine level increases, and all effects are negated once the drug has been discontinued. Vitamin C, with its uricosuric effect, may reduce the serum concentration of uric acid. In one study, 500 mg/day for 2 months reduced uric acid by a mean of 0.5 mg/dL in patients without gout.

Is Orange Juice Good for Gout?

Orange Juice and Gout Risk
Many sugar-sweetened juices can increase your risk for gout, but naturally-sweetened juices like orange juice may also be a gout risk trigger.

Because of cost considerations, allopurinol is certainly more commonly prescribed in my practice. Table 1 reviews these and the other available options very nicely – and it highlights the limited utility of the alternate options in more advanced CKD and ESRD. Two RCTs were included in this updated review, including one new RCT. We considered one trial to be at low risk of bias, while we considered the newly included trial to be at unclear risk of bias.

Pharmacology Of The Therapeutic Approaches Of Gout

However, gout patients appear to be less responsive to such a low dose of ascorbate. Vitamin C treatment should be avoided in patients with nephrolithiasis, urate nephropathy, or cystinuria. Febuxostat, a nonpurine selective inhibitor of xanthine oxidase, is a potential alternative to allopurinol in patients with gout. Febuxostat is administered orally and is metabolized mainly in the liver. In contrast, allopurinol and its metabolites are excreted primarily by the kidney.

Are eggs bad for gout?

Eggs are a good protein source for people with gout, because eggs are naturally low in purines.

Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. Patients taking febuxostat should consider switching to a different drug if they have cardiovascular disease or a history of it. Patients with tophi , joint damage that’s visible on imaging tests, or frequent flares should be taking urate-lowering medication. Having a chronic disease like arthritis affects many aspects of daily living and can cause stress.

But on several secondary endpoints such as patient and physician assessments of global response, anakinra was preferred. "Consistent with current treatment guidelines, anakinra can be considered as an effective option in the treatment of gout flares when conventional therapy is unsuitable," the investigators wrote online in Arthritis & Rheumatology. Febuxostat is only recommended in those who cannot tolerate allopurinol. There are concerns about more deaths with febuxostat compared to allopurinol.

Although Sulindac or nonacetylated salicylates are theoretically renal sparing, they still should be used with caution in this population. At low doses, salicylates can cause elevation in uric acid levels. If you are taking allopurinol and still experiencing gout flares, talk with your doctor. Your doctor will be able to offer treatment options that best meet your individual needs and may help you prevent future gout flares.

Rheumatoid Arthritis And Gout: Whats The Difference?

Although data from randomized controlled trials supporting a treat-to-target approach are lacking, decades of experience by rheumatologists support that approach to care, Dr. O'Dell said. Much is known and undisputed about how uric acid works in the body, particularly that a serum uric acid level above about 6.8 mg/dL is supersaturated and leads to gout crystal deposition in tissues, he said. Only one trial included reduction of inflammation as part of a composite measure comprising pain, tenderness, swelling and erythema, each graded on a four-point scale to derive a maximum score for any one joint of 12.

When To Contact A Medical Professional

Dose reduction or alternatives should be considered for the prophylaxis of gout flares in patients with severe renal impairment. Patients who are undergoing hemodialysis should be monitored carefully for colchicine toxicity. Proper treatment of acute attacks and lowering uric acid to a level less than 6 mg/dL allows people to live a normal life. However, the acute form of the disease may progress to chronic gout if the high uric acid is not treated adequately.

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