Infusion Therapy For Chronic Gout

Content

• Johns Hopkins Rheumatology
• Treating Gout And Tophi With Surgery
• Lifestyle Interventions For Chronic Gout
• Diagnosis, Treatment, And Prevention Of Gout
• Prognosis Of Gout
• Managing An Acute Flare

It is unclear whether dietary supplements have an effect in people with gout. The 4 main phases of gout are asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout, and chronic tophaceous gout. The last is characterized by hyperuricemia (serum uric acid level above 7 mg/dL) and large accumulations of monosodium urate crystals in joints, bones, and soft tissues. After many untreated attacks of gout, MSU crystals form tophi that can cause erosion and resorption of bone.

Research is being done on using medications that block a chemical signal known as interleukin-1 to treat gout flares in patients who do not respond to other therapies. Anakinra and canakinumab are two medications that block interleukin-1. They are currently used for other conditions and are under investigation for use in gout flare-ups. Some of the risk factors for gout are genetic, and those are not preventable. However, many of the risk factors for gout, such as obesity and diet, are controllable. Maintaining a healthy weight and a diet low in refined carbohydrates and low in saturated fat and red meat may prevent gout.

Johns Hopkins Rheumatology

Uric acid crystals in the joints cause gouty arthritis which can only be managed through a medically directed treatment plan. The most reliable method to diagnose gout is to have fluid removed from an inflamed joint and examined under a microscope for urate crystals. In addition to weight loss, diet, and physical exercise, talk to your doctor about any other home remedies for gout — but you’ll almost always need meds as well. For example, “cherry juice may slightly lower urate level but in general is not advised , since if someone is having trouble with gout they should be on a medication such as allopurinol, which is much more potent,” Dr. Fields says. In addition, the disease overall may progress with “recurrent or more frequent gout attacks with longer duration, the involvement of more joints, and the presence of tophi,” Dr. Meysami says. During this stage, progressive joint damage develops, so patients with gout should be treated before this starts happening.

Treating Gout And Tophi With Surgery

Together, these diagnostic tools can be used to rule out other medical conditions and provide an accurate diagnosis. Corticosteroids, such as prednisone and methylprednisolone (Medrol®), are anti-inflammatory agents that are quite effective against 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.

Lowering the amount of uric acid in the blood is key to reducing the risk of a flare. This may be accomplished by addressing modifiable risk factors, such as diet. Foods such as red meat and shellfish have been shown to cause increases in uric acid levels, while low-fat dairy products have been shown to reduce uric acid levels.

One principle is that treatment for an attack of gout should be instituted quickly, since quick treatment can often be rewarded with a quick improvement. Special effort should be made to distinguish gout from the other crystal-induced types of arthritis. For example, pseudogout, caused by a different type of crystal , causes the same type of hot, red joint, and the same rapid acceleration of pain as does gout. Pseudogout can be distinguished by seeing calcium deposits within the joints on X-ray, which deposits in a different way than it does in gout.

The joint at the base of the big toe is affected in about half of cases. It may also result in tophi, kidney stones, or kidney damage. Chronic tophaceous gout is the most debilitating type of gout. Permanent damage may have occurred in the joints and the kidneys. The patient can suffer from chronic arthritis and develop tophi, big lumps of urate crystals, in cooler areas of the body such as the joints of the fingers.

Lifestyle Interventions For Chronic Gout

During this test, synovial fluid is drawn from your inflamed joint. When you have gout, there is more fluid in the joint and the fluid contains white blood cells. It will also contain uric acid crystals that can be seen with a special microscope. About two-thirds of people with elevated uric acid levels never have gout attacks. It is not known why some people do not react to abnormally high levels of uric acid. Joint aspiration subjected to polarized light microscopy is especially critical when differentiating gout from CPPD .

Development of potential new therapies has capitalized on evolving understanding of the pathophysiology of the inflammatory response in acute gout. Although increased purine intake and increased production can contribute to hyperuricemia, the most common cause of gout is decreased urate excretion secondary to kidney disorders or hereditary variations. and the triglyceride-lowering drug fenofibrate both have uricosuric effects and can be used to decrease uric acid in patients who have other reasons for taking these drugs. Low doses of salicylates may worsen hyperuricemia, but only trivially, and should not be avoided if otherwise indicated as in secondary prevention of cardiovascular disease. Complications of gout include renal obstruction and infection, with secondary tubulointerstitial disease.

This analysis—which includes culture, crystal analysis and cell count—determines whether the patient has gout, septic arthritis, pseudogout , a combination of those or other conditions, thus enabling prompt treatment. Canakinumab for the treatment of acute flares in difficult-to-treat gouty arthritis. Febuxostat is a potent, nonpurine, selective inhibitor of xanthine oxidase.32 More significantly, it is primarily metabolized by the liver.

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.

Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. At this point, that sudden, unexpected nighttime attack of gout symptoms might occur. Taxonomic variations in the gut microbiome of gout patients with and without tophi might have a functional impact on urate metabolism. Gout is rare in most other animals due to their ability to produce uricase, which breaks down uric acid. Humans and other great apes do not have this ability; thus, gout is common.