Treatments For Gout

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• Lead Gout
• What Is Gout?
• Medicines For Gout Prevention And Complications
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This medication is an enzyme that works by turning uric acid into a chemical that does not cause gout symptoms. Systemic corticosteroids have been used for the treatment of acute gout since 1952. As with other treatments for gout, systematic studies of the efficacy of corticosteroids – both systemic therapy and intra-articular therapy – are lacking. However, at least at relatively large doses, systemic corticosteroid therapy appears to be associated with good responses and few important side effects. Neutrophils accumulate in both the joint fluid and the synovial membrane, where a small fraction of these cells actively phagocytose MSU crystals and release mediators. The model for the innate immune inflammatory response that drives the acute gouty attack was recently reviewed in detail .

Fortunately, there are many low-cost self-management strategies that are proven to improve the quality of life of people with gout. Treatment for flares consists of nonsteroidal anti-inflammatory drugs like ibuprofen, steroids, and the anti-inflammatory drug colchicine. All information contained within the Johns Hopkins Arthritis Center website is intended for educational purposes only.

Lead Gout

Individual doses greater than 75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe the patient for response. Treatment of pain and inflammation can be achieved with NSAIDs, colchicine, or corticosteroids (systemic or intra-articular). The choice of which treatment is the right one for a particular patient should be made on the basis of the patient’s co-morbid medical conditions, other medications, and side effect profile. Taking NSAIDs can lead to kidney disease over time or make kidney disease worse.

Since uric acid can fall during an attack, the uric acid may not be elevated at that time. Some doctors may wait until several days after the attack to order a blood test. Nearly all people with gout have elevated uric acid in this case, although not all people with elevated uric acid have gout. Therefore the blood uric acid is only one part of making the diagnosis. Pharmacists play an integral role in patient education and improving the care of patients with gout.

What Is Gout?

Urate crystals — Crystals formed by high levels of uric acid in the blood. Gout appears to be on the increase in the American population. According to a study published in November 2002, there was a twofold increase in the incidence of gout over the 20 years between 1977 and 1997. It is not yet known whether this increase is the result of improved diagnosis or whether it is associated with risk factors that have not yet been identified. Actually, the prevalence of gout in type 1 and 2 diabetes was, respectively, 1.9% and 10.12% .

Preventive medications will have to be taken on a regular basis. It is typically associated with hyperuricemia, but can also occur if uric acid levels are normal. If acute gout is recognized at an early stage and treated correctly, the development of the chronic form can generally be prevented. Weight should be kept within normal limits, and increasing daily intake of liquids is beneficial because it encourages urine production.

What fruit is bad for gout?

Fructose is what gives some fruits (and vegetables) their natural sweetness. Researchers report a correlation between foods high in fructose and gout symptoms, which can include chronic pain. These fruits include apples, peaches, pears, plums, grapes, prunes, and dates.

Gout may be secondary to sleep apnea via the release of purines from oxygen-starved cells. Diuretics have been associated with attacks of gout, but a low dose of hydrochlorothiazide does not seem to increase risk. Other medications that increase the risk include niacin, aspirin , ACE inhibitors, angiotensin receptor blockers, beta blockers, ritonavir, and pyrazinamide. The immunosuppressive drugs ciclosporin and tacrolimus are also associated with gout, the former more so when used in combination with hydrochlorothiazide. Fixed-dosed combination indicated for treatment of hyperuricemia associated with gout in patients for whom target serum uric acid levels have not been achieved with allopurinol alone.

Prevention Tips

Along with the big toe, joints that are commonly affected are the lesser toe joints, the ankle, and the knee. All patients should be encouraged to modify their lifestyle including limiting alcohol intake, encouraging weight loss where appropriate and decreasing food rich in purines. Co-morbid medical conditions should also be controlled including hypertension, diabetes and hyperlipidemia. Non-medication treatments for gout are important, such as staying off the foot when it is inflamed and attending to diet both to reduce purine intake and to lose weight when indicated. As with Rilonacept above, this agent may have a future role in the acute treatment and relatively short-term prevention of gout, and may have a longer-term role in selected patients with problems with multiple other options.

The drug is administered every two weeks by intravenous infusion. With chronic gout, hard swellings known as tophi can form on the joints. These tophi are made of uric acid and can grow very large, even to the point of breaking through the skin. Colchicine can prevent attacks of gout and control FMF only as long as you take the medication.

Pegloticase is a pegylated uric acid–specific enzyme that is a polyethylene glycol conjugate of recombinant uricase. It achieves its therapeutic effect by catalyzing oxidation of uric acid to allantoin, thereby lowering serum uric acid levels. Pegloticase is indicated for gout in adults refractory to conventional therapy . Probenecid lowers tissue stores of uric acid by increasing net renal excretion of uric acid through inhibition of tubular reabsorption. Some authorities recommend alkalizing the urine when starting probenecid to reduce the risk for renal stone formation. Probenecid is indicated for long-term management of hyperuricemia associated with gout.

The patient may have a headache or fever, and often cannot walk because of the pain. Tophus — A chalky deposit of a uric acid compound found in gout. Tophi occur most frequently around joints and in the external ear. Hyperuricemia — High levels of a waste product called uric acid in the blood. Colchicine is a natural drug that is isolated from Colchicum autumnale . For almost 250 years, it was used as an anti-inflammatory agent .

While indometacin has historically been the most commonly used NSAID, an alternative, such as ibuprofen, may be preferred due to its better side effect profile in the absence of superior effectiveness. For those at risk of gastric side effects from NSAIDs, an additional proton pump inhibitor may be given. There is some evidence that COX-2 inhibitors may work as well as nonselective NSAIDs for acute gout attack with fewer side effects.

Interestingly, the uric acid is typically lowered during a flare of inflammatory gouty arthritis. Therefore, the optimal time to measure the uric acid is after a flare has resolved when acute inflammation is not present. Gouty arthritis is a common cause of a sudden onset of a painful, hot, red, swollen joint, particularly in the foot at the big toe. Gouty arthritis is reportedly the most common cause of inflammatory arthritis in men over the age of 40. It is definitively diagnosed by detecting uric acid crystals in an aspirated sample of the joint fluid.

Hyperuricemia

An untreated attack peaks 24 to 48 hours after symptoms first appear and goes away after 5 to 7 days. Some attacks last only hours, while others go on for as long as several weeks. Though symptoms can subside, the crystals are still present and future attacks are likely to occur. Other medications are aimed at preventing future attacks by lowering uric acid in the body. The rate of disease recurrence was nearly twice as high in the placebo group as in the colchicine group (42.5 percent compared to 21.6 percent). Zyloprim is an oral xanthine oxidase inhibitor which reduces the body’s production of uric acid.

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