The Inflammatory Process Of Gout And Its Treatment

Content

• American College Of Physicians Releases Clinical Practice Guidelines For Acute Gout
• Asymptomatic Hyperuricemia
• Treatment Of Acute Attacks

Dosing recommendations for colchicine in the treatment of acute gout have undergone modifications as awareness of its toxicities has increased. Newer recommendations trend toward lowered daily and cumulative doses. Therapy to control the underlying hyperuricemia generally is contraindicated until the acute attack is controlled . Starting therapy to control hyperuricemia during an acute attack may intensify and prolong the attack. If the patient has been on a consistent dosage of probenecid or allopurinol at the time of the acute attack, however, the drug should be continued at that dosage during the attack. Like allopurinol, it’s started at a lower dose, which may be increased if uric acid levels remain high.

Diagnosis of gout may be confirmed by the presence of crystals in the joint fluid or in a deposit outside the joint. Gout, a form of inflammatory arthritis known for causing excruciating pain in the big toe, stems from a buildup of uric acid in the body that crystallizes and settles in one or more joints. While medications like naproxen or colchicine can reduce pain and inflammation during an acute gout flare-up, they don’t do anything to address the underlying problem.

American College Of Physicians Releases Clinical Practice Guidelines For Acute Gout

Although more expensive than allopurinol, febuxostat is an option for patients who cannot take probenecid or allopurinol. These types of medications are used to reduce uric acid levels to less than 6 mg/dL. People with tophi may have a greater benefit with levels that are less than 5 mg/dL. If uric acid levels remain high over a long period of time, deposits can develop around joints and tendons. These chalky deposits, called tophi, look like white toothpaste and create visible lumps under the skin. The evidence was too limited to determine if dietary and lifestyle changes are effective in managing gout.

Asymptomatic Hyperuricemia

Despite the use of colchicine as one of the first-line therapies for the treatment of acute gout, evidence for its benefits and harms is relatively limited. You may need to take daily medicines such as allopurinol , febuxostat or probenecid to decrease the uric acid level in your blood. Lowering the uric acid to less than 6 mg/dL is needed to prevent deposits of uric acid. If you have visible tophi, the uric acid should be lower than 5 mg/dL.

A third type of crystal-induced arthritis, hydroxyapatite deposition disease, has a type of crystal that needs special studies for identification. Gout can develop in a person either because they are producing too much uric acid or because they are unable to put enough of it into the urine . The most common cause of gout (about 90% of cases) is the inability to excrete enough uric acid in the urine. The most common is a genetic defect in substances referred to as organic anion transporters in the kidney, which leads to an excessive reabsorption of uric acid from the kidney – and thus too much uric acid in the blood. However, a defect in excretion of uric acid can also occur due to medications, such as diuretics, low dose aspirin, or alcohol.

All About Gout

There is a rare effect on the nerves and muscles with long-term use of colchicine, and a blood test from the muscle is monitored at approximately six-month intervals in patients taking colchicine on a regular basis. Colchicine also has a major role when patients are beginning therapy with allopurinol to prevent the increase in gout attacks that can happen when allopurinol is begun. The colchicine, in that case, is often withdrawn at about six months, assuming no gout attacks have occurred. Patients with gout should avoid excess ingestion of alcoholic drinks, particularly beer, because alcohol use elevates uric acid levels and thus can precipitate attacks of gout.

When initiating ULT, comorbidities and the benefits and harms of prophylactic agents should be considered (e.g., possible contraindications of NSAIDs in patients with cardiovascular disease, renal disease, or both). Diagnostic clinical algorithms such as the Diagnostic Rule and Clinical Gout Diagnosis need to be validated more broadly in primary care, emergency care, and urgent care settings. After 12 months of ULT, the frequency of gout attacks was reduced . If gout is not treated, the inflammation can cause damage to joints and tendons. Crystal deposits on tendons can cause the skin to wear down, which can lead to infection.

Figure 1 illustrates a simplified schematic of urate handling and the factors that can have both a negative and positive impact in the context of gout management. If the gout attack is mild, anti-inflammatory drugs available without a prescription may relieve pain. Because there are serious side effect of using non-steroidal anti-inflammatory drugs — even the over-the-counter strength — be sure to check with your doctor before taking them.

Is Chicken OK for gout?

Meats like fish, chicken, and red meat are fine in moderation (around 4 to 6 ounces per day). Vegetables: You may see veggies like spinach and asparagus on the high-purine list, but studies show they don't raise your risk of gout or gout attacks.

Anti-inflammatory steroids are very different in action and side-effects as compared to male hormone steroids. Anti-inflammatory steroids have long-term risks, such as bone thinning and infection, but their risk for short-term (for example, 3-7 days) therapy is relatively low. These agents can raise blood pressure and blood sugar, so can be a problem for those with uncontrolled hypertension or uncontrolled diabetes mellitus.

Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. The choice for prophylactic treatment of gout depends on co-morbidities, tolerance and coprescriptions.

No trials reported function of the target joint, patient-reported global assessment of treatment success, health-related quality of life or withdrawals due to adverse events. We identified no studies comparing colchicine to non-steroidal anti-inflammatory drugs or other active treatments such as glucocorticoids . 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. Both trials included a placebo and a high-dose colchicine arm, although the colchicine regimens varied. In one trial 0.5 mg colchicine was given every two hours until there was either complete relief of symptoms or toxicity and the total doses were not specified.

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