Therapeutic Approaches In The Treatment Of Gout

Content

• What Does Arthritis Pain Feel Like?
• Clinical Presentation
• Managing An Acute Flare
• Gout Diagnosis And Management: Updated Treatment Guidelines
• Is It Possible To Prevent Gout?

Your doctor will also want to know if you have any family history of gout. Your doctor may recommend colchicine , an anti-inflammatory drug that effectively reduces gout pain. The drug's effectiveness may be offset, however, by side effects such as nausea, vomiting and diarrhea. Data collection forms will be designed by the project team in Distiller SR, piloted by the reviewers, further modified, and then the final forms piloted with a random selection of included studies to ensure agreement of interpretation. Studies based on large prospective cohorts will be identified in their Distiller records to allow comparison to ensure data are not duplicated.

Lose weight.For people who are overweight or obese, losing weight reduces pressure on joints, particularly weight bearing joints like the hips and knees. Reaching or maintaining a healthy weight can relieve pain, improve function, and slow the progression of arthritis. Learn more about the CDC-recommended self-management education programs. The new guidelines also give a nod to the fact that gout is not simply the result of overindulging or eating the “wrong” foods.

What Does Arthritis Pain Feel Like?

This results in secretion of cytokines including interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) leading to endothelial activation and attraction of neutrophils to the site of inflammation. Neutrophils secrete inflammatory mediators that create an acidic environment, which further causes precipitation of urate crystals . The prevalence of use of prescription gout medications is illustrated in Table 2. Allopurinol had the highest utilization, with nearly 80% of members taking this medication, while colchicine was taken over by 30% of members. Since the introduction of branded colchicine , as well as the removal of generic versions, the use of colchicine has declined over 5 points.

NSAIDs include over-the-counter options such as ibuprofen and naproxen sodium , as well as more-powerful prescription NSAIDs such as indomethacin or celecoxib . Which type of medication is right for you depends on the frequency and severity of your symptoms, along with any other health problems you may have. For studies of efficacy and effectiveness, we will limit the inclusion to randomized controlled trials. Observational studies will be included for the assessment of rare adverse events. If the situation arises where there are no randomized controlled trials for an intervention of interest, we may consider observational studies of efficacy or effectiveness if their study is sufficiently strong to support a causal inference.

Clinical Presentation

First, the design of the study was cross-sectional in nature with reliance on medical records for data extraction. Therefore, we cannot infer causality between explanatory covariates and gout. Second, although joint aspiration for monosodium urate crystals remains the gold standard for diagnosis in clinical practice, our study relied on a clinical diagnosis from medical records based on physician-diagnosis and/or use of ULT. Inclusion of ULT medications ensured greater capture of clinical gout that may not have been recorded on the patient’s medical record.

Given the elevated risk of severe cutaneous reactions to allopurinol in patients with heart disease, it is important to ensure that hyperuricemia is not related to heart disease medication before starting allopurinol. Rather than allopurinol, the patient may simply need modification of the cardiac regimen . Talk to your doctor.You can play an active role in controlling your arthritis by attending regular appointments with your health care provider and following your recommended treatment plan. This is especially important if you also have other chronic conditions, like diabetes or heart disease. Updated gout treatment guidelines from the American College of Rheumatology emphasize the importance of a “treat-to-target” approach, which in this case means treating a gout patient as aggressively as needed to keep their urate levels below 6 mg/dL.

In addition to following your doctor's treatment plan, there are choices you can make to prevent gout attacks and future joint damage. Reducing inflammation during an acute gout attack will provide pain relief. Most people with hyperuricemia never develop gout, and people with gout may have varying levels of uric acid in their blood. High uric acid levels may cause kidney stones and, sometimes, damage the kidneys. Although nondrug therapy certainly plays an important role in gout management, pharmacologic therapy remains the mainstay. Making one or more of these lifestyle and dietary changes can reduce your risk of another gout attack and the joint damage it can cause.

What type of doctor specializes in gout treatment?

Rheumatologist. A rheumatologist is a physician with special training in treating diseases of the joints and connective tissues. A rheumatologist can provide more specialized care if your gout is especially severe or involves joint damage.

If you think your condition is getting worse, talk to your doctor. They will give you medicine to keep your uric acid levels low and to try to prevent future attacks and complications. Uricase is an enzyme that converts poorly soluable urate to the more soluable allantoin . Uricase is present in most mammals, and these mammals with uricase do not develop gout. However, humans and some primates lack uricase and lack the ability to make uric acid more soluable and hence, have gout. Pegloticase is a porcine uricase which was approved by the FDA in September 2010 for the treatment of gout in patients who have failed conventional therapy.

These medications include such agents as naproxen (Naprosyn®), ibuprofen (Motrin®), celecoxib (Celebrex®), indomethacin (Indocin®) and many others. These agents reliably decrease the inflammation and pain of gout. However, patients with ulcers, hypertension, coronary disease, and fluid retention must be careful with these agents, even for the short courses (usually 3-7 days) needed to resolve a gout attack.

Serum albumin is a negative acute phase reactant, and thus low serum albumin levels may also reflect ongoing systemic inflammation associated with gout. Recent studies have identified strong relationships between gout and CKD, which are not surprising given that hyperuricaemia, the principal driver of gout, is an inevitable consequence of worsening kidney function . However, only few have quantified the burden of gout and corresponding rates of ULT treatment among patients with pre-existing CKD.