Gout Causes And Treatments

Content

• Arthritis
• Who Is At Risk Of Gout?
• How Is Gout Diagnosed?
• What Is The Latest Research On Gout?
• What Are Future Possible Treatments Of Gout?

As an “induction therapy,” uricase ultimately could be replaced by less intensive maintenance oral SUA-lowering therapy with other agents, once resolution of clinically detectable tophi and gross synovitis is achieved. Pegloticase is awaiting FDA approval, and although there may be long-term safety issues, its potential for rapidly eliminating the tophus burden and reducing morbidity is indisputable. Most rheumatologists prescribe about 40 mg/d of prednisone with a slow taper to avoid rebound attacks after corticosteroid withdrawal.

“If they have a history of gout in the past and they have been treated with a certain type of treatment, I usually ask what their response was,” said Seoyoung C. Kim, MD, a rheumatologist at Brigham and Women's Hospital in Boston. Acute attacks usually are managed with nonsteroidal anti-inflammatory drugs , colchicine or steroids , depending on the patient's comorbidities and potential medication interactions, he said. Infection is a major concern in the differential of acute gout. “If somebody comes in with a red hot joint, exquisitely painful, and they don't want to move it, the number one thing on your list of concerns should always be septic joint,” Dr. O’Dell said.

Arthritis

When uric acid levels in your blood stay too high, more and more crystals form around your joints. It can turn into a long-term condition, leading to painful and damaged joints. Gout occurs more often in men, primarily because women tend to have lower uric acid levels.

Who Is At Risk Of Gout?

Acutely, gout can be managed with non-steroidal anti-inflammatory drugs (e.g. naproxen), colchicine, prednisolone, or newer cytokine blocking agents (e.g. IL-1 blockers such as anakinra or canakinumab) if refractory disease 12. In the long-term, xanthine oxidase inhibitors (e.g. allopurinol or feboxustat), uricosuric drugs (e.g. probenecid), or uricase agents (e.g. pegloticase) may be used to reduce urate levels and prevent further acute flares 12. Tophaceous gout can also be managed with surgical excision of symptomatic lesions 12. If a patient has normal kidney function, no biliary disease, and no potential drug interactions, some clinicians use a short course of colchicine, beginning with 1.2 mg and adding 0.6 mg an hour later. In the results of the AGREE trial, published April 2010 in Arthritis & Rheumatism, this regimen provided significant pain relief over 24 hours to patients taking the medication very soon after the onset of gout pain.

What beans to avoid with gout?

However, there are some beans that are particularly high in purines, so people with severe gout may want to avoid them. Purine-rich vegetables: Asparagus, dried beans (especially fava and garbanzo), mushrooms, peas, spinach.

After menopause, however, women's uric acid levels approach those of men. Men are also more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause. Certain diseases and conditions increase your risk of gout. These include untreated high blood pressure and chronic conditions such as diabetes, obesity, metabolic syndrome, and heart and kidney diseases. Some people with severe chronic gout have only short breaks in between attacks and feel symptoms of gout most of the time.

A small ulcerated tophus is also visible on the fingertip of the thumb. Voluminous, erupted and ulcerated nodule on the first metatarsophalangeal joint of the left foot containing chalky material . Secondary end points were assessed at baseline, at the week-13 and week-19 visits, and at the week-25 final visit. A tophus complete response was defined as 100% reduction in the measured area of at least 1 tophus (of baseline diameter ≥5 mm) without growth of any baseline tophus or appearance of any new tophus.

Located throughout the body, these thin, slippery sacs with just a slight amount of fluid in them act as cushions between bones and soft tissues. The bursae most commonly inflamed from gout are the boney tip of the elbow and the front of the kneecap . However, it can affect small joints like those in the finger, as well as large joints, such as the knee and hip. A doctor may recommend surgical removal if the tophi are large and painful or risk causing complications.

The lump is called a tophus, from Latin, meaning a type of stone. Tophi can develop after a person has had gout for many years. Acute gout is a painful condition that often affects only one joint. Chronic gout is the repeated episodes of pain and inflammation.

What is the first line drug of choice for treating gout?

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.

Synovial fluid or tophus aspiration permits diagnosis through demonstration of negatively birefringent monosodium urate crystals . But the most important fork in the road for gout sufferers is whether to start taking a drug that will lower their uric acid levels. Once people start taking these drugs, they usually must take them for the rest of their lives. Going on and off a uric acid–lowering medication can provoke gout attacks.

What Is The Latest Research On Gout?

Chronic gout may need different medication than that used for less severe cases. We here present the case of an elderly lady with severe polyarticular, tophaceous gout, coexistent renal insufficiency, and allopurinol hypersensitivity. Under therapy with the novel xanthin oxidase inhibitor febuxostat, serum uric acid levels decreased to normal values.

Self-management is what you do day to day to manage your condition and stay healthy, like making healthy lifestyle choices. The self-management strategies described below are proven to reduce pain and disability, so you can pursue the activities important to you. Making changes to your diet and lifestyle, such as losing weight, limiting alcohol, eating less purine-rich food , may help prevent future attacks. Changing or stopping medications associated with hyperuricemia may also help.

Although colchicine has been used for gout management since the 6th century ad,19 only 1 year has passed since its FDA approval for acute and chronic gout. As a result, dosing guidelines and the evidence basis for colchicine in acute gout management have advanced. To maximize response time while minimizing adverse effects, some clinicians managing acute gout add an intermediate dosing regimen of colchicine (0.6 mg every 6 to 8 hours) to their patients' NSAID regimens.