Gout Treatment Success Doubled By Combining Two Drugs, Study Finds

Content

• Colchicine
• Dietary Changes
• Medications For Gout
• When Gout Strikes
• Take Caution With Supplements For Gout
• Treatment Of Gout
• Diagnosis, Treatment, And Prevention Of Gout

Gout usually affects the large joint of the big toe, but symptoms can occur in your feet, ankles, knees, hands, and wrists. Although nondrug therapy certainly plays an important role in gout management, pharmacologic therapy remains the mainstay. 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. Gout affects around 1–2% of the Western population at some point in their lifetimes and is becoming more common. Rates of gout approximately doubled between 1990 and 2010. This rise is believed to be due to increasing life expectancy, changes in diet and an increase in diseases associated with gout, such as metabolic syndrome and high blood pressure.

If the rash was relatively mild, one option is an oral desensitization regimen for that agent. Treatments used for prevention, such as allopurinol can actually make things worse if given during an attack, and so need to be held back until the attack has resolved for several weeks. Collections of uric acid need to be searched for, and they can be in numerous locations (see Figures 7-10). Gout frequently affects the large joint of the big toe, but can also affect the forefoot, ankles, knees, elbows, wrists, and fingers. If a person’s flare-ups do not start to improve after 48 hours, they should call their doctor to determine if they need further medical treatments.

Colchicine

During a gout attack, the affected joint becomes swollen, warm to the touch, and appears very red. Even the slightest pressure on the joint can be very painful. The attacks more often occur in the middle of the night; about 50 percent start in the big toe, according to the Alliance for Gout Awareness. During a gout attack, you may experience pain in one or a few joints.

Febuxostat is only recommended in those who cannot tolerate allopurinol. There are concerns about more deaths with febuxostat compared to allopurinol. Febuxostat may also increase the rate of gout flares during early treatment.

Dietary Changes

Urate-lowering drugs should not be started until after the acute attack has completely resolved. Hypertension reduces renal excretion of urate4,30 leading to hyperuricemia. Low-dose aspirin (up to 1-2 g/day) decreases renal urate excretion, especially in the setting of low albumin. Paradoxically, high-dose aspirin actually has a uricosuric effect, leading to an increase in urate excretion.

When your body doesn’t have enough water, your uric acid levels rise even higher. Sometimes, people with gout have no early signs that a flare is about to start. They may just wake up in the middle of the night with a very painful joint.

Non-steroidal anti-inflammatory agents and COX-2 inhibitors are the mainstay of therapy of acute attacks of gout in patients who have no contra-indication to them. 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. The doses of non-steroidal anti-inflammatory agents needed to resolve a gout attack are on the higher side, since full anti-inflammatory effect is needed.

Avoiding the use of medications that elevate uric acid in patients with gout is prudent. Thus, in patients with hypertension, other agents are preferable to a thiazide diuretic, provided that blood pressure can be managed easily with a single drug. The angiotensin-receptor blocker losartan should be considered, because it is uricosuric at 50 mg/day. However, medications that elevate uric acid can still be used, if required, by making appropriate adjustments of allopurinol or probenecid doses.

While it is reasonable to decrease or avoid these foods, it has been found that a high purine-rich diet does not increase the risk of gout, or aggrevate symptoms in research studies. This stage occurs when the urate crystals that have been deposited suddenly cause acute inflammation and intense pain. This sudden attack is referred to as a “flare” and will normally subside within 3 to 10 days. Flares can sometimes be triggered by stressful events, alcohol and drugs, as well as cold weather. Commonly used medications include nonsteroidal anti-inflammatory drugs , colchicine, or corticosteroids. These reduce inflammation and pain in the areas affected by gout and are usually taken orally.

Specifically, you could have an infection at the injection site where the IV needle is inserted. In addition, the IV could become dislodged from the vein — causing the fluids to enter the tissues surrounding the vein. A simple solution for this latter complication involves a healthcare professional reinserting the IV correctly and providing you with a warm compress to prevent or reduce swelling. At Infusion Therapy, you will always have a nurse monitoring your treatment to ensure that everything goes smoothly. When you show up for your appointment for infusion therapy, one of our healthcare providers will discuss all potential side effects, as well as answer all of your questions.

Is gout a serious problem?

Gout is more than just painful flares. If not managed properly, over time gout can cause permanent joint destruction, bone erosion and kidney damage. With advances in treatments and understanding of the disease, gout is a manageable condition and flares can be controlled with the appropriate long-term management.