The Role Of Medication In Prevention Of Gout
Table 3: Medications to pevent attacks of gout
Standard medications in preventing gout attacks
i. Colchicine : using the matches analogy discussed above1, using colchicine can be seen as dampening the uric acid matches. Colchicine does not lower the bodys store of uric acid, but it decreases the intensity of the bodys inflammatory reaction to these crystals. Recent studies have shown that at least one mechanism of colchicines action is by acting to prevent a cascade of reactions that lead to the production of interleukin 1-beta, which is an inflammatory protein , which is important in gouty inflammation.8
ii. Allopurinol: This agent is presently the most commonly used drug for the prevention of gout. Allopurinol blocks the enzyme xanthine oxidase, which blocks the breakdown of purines, thus decreasing the bodys total amount of uric acid. Allopurinol is effective in preventing gout no matter what the mechanism of the elevated uric acid was. Whether a person is making too much uric acid, or has difficulty excreting it via the kidney, allopurinols decrease in uric acid production leads to the same goal: a decreased total body uric acid.
Table 4: Reasons to use medication to lower uric acid
When Is Surgery Considered For Gout
The question of surgery for gout most commonly comes up when a patient has a large clump of urate crystals , which is causing problems. This may be if the tophus is on the bottom of the foot, and the person has difficulty walking on it, or on the side of the foot making it hard to wear shoes. An especially difficult problem is when the urate crystals inside the tophus break out to the skin surface. This then can allow bacteria a point of entry, which can lead to infection, which could even track back to the bone. Whenever possible, however, we try to avoid surgery to remove tophi. The problem is that the crystals are often extensive, and track back to the bone, so there is not a good healing surface once the tophus is removed. In some rare cases, such as when a tophus is infected or when its location is causing major disability, surgical removal may be considered.
Since it is hard to heal the skin after a tophus is removed, a skin graft may be needed. For this reason, we often try hard to manage the tophus medically. If we give high doses of medication to lower the urate level, such as allopurinol, over time the tophus will gradually reabsorb. In severe cases, we may consider using the intravenous medication pegloticase , since it lowers the urate level the most dramatically, and can lead to the fastest shrinkage of the tophus.
How Should I Use Allopurinol
Take allopurinol exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.
Take allopurinol oral with a full glass of water. To reduce your risk of kidney stones forming, drink 8 to 10 full glasses of fluid every day, unless your doctor tells you otherwise.
If this medicine upsets your stomach, take allopurinol oral after a meal.
Allopurinol injection is given as an infusion into a vein if you are unable to take the medicine by mouth. A healthcare provider will give your first dose and may teach you how to properly use the medication by yourself.
You may need to mix the injection with a liquid in an IV bag. When using injections by yourself, be sure you understand how to properly mix and store the medicine. Ask your doctor or pharmacist if you don’t understand all instructions.
Prepare an injection only when you are ready to give it. Do not use if the medicine has changed colors or has particles in it. Call your pharmacist for new medicine.
You may need frequent medical tests. Even if you have no symptoms, tests can help your doctor determine if allopurinol is effective.
You may have gout attacks more often when you first start taking this medicine oral. Your doctor may recommend other gout medication to take with allopurinol. Keep taking the medicine as directed.
Store at room temperature away from moisture and heat.
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Fish Oil Supplements For Gout
Fish oil derived from fish contains omega-3 fatty acids. Your body has to rely on omega-3 fatty acids for proper functioning-
- Alpha-linoleic acid
- Docosahexaenoic acid
- Eicosapentaenoic acid
The best fish oil has DHA and EPA. Fatty acids are essential to maintain the function of your brain and immune system.
Most importantly, there must be a proper ratio of omega-6 and omega-3 fatty acids. Unsaturated fat has the potential to prevent inflammation problems in your body. However, do not take a high amount of fatty acids. Consumption of fish oil helps in fighting against inflammation. That is why you can decrease the swelling, pain, redness, and potential joint damage caused by gout.
The meat of the fish contains purines. However, the molecularly distilled fish oil does not have a high amount of purines. You can safely purchase pharmaceutical-grade fish oil supplements. Make sure that the supplement is molecularly distilled. But, it may not be safe for those having bleeding disorders.
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Topical Cold Or Hot Application
Applying cold or hot water to inflamed joints may also be effective.
Studies and opinions on this are mixed. Soaking in cold water is most often recommended and considered most effective. Ice packs may also work.
Soaking in hot water is typically only recommended when inflammation isnt as intense.
Alternating hot and cold applications may also be helpful.
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What Can Increase Your Risk
A high level of uric acid in the blood is the main factor that increases your risk of developing gout. However, it’s still uncertain why some people with a high level of uric acid in the blood develop gout, while others with an equally high level don’t.
Other factors that may increase your risk of developing gout are outlined below.
Gout Remedies That Work
Gout is something that plagues more and more people every day, and its caused from uric acid buildup in the body. I want to go over my top six home gout remedies all-natural ways to beat gout symptoms but right before that, go over the diet that is crucial to get rid of gout, along with the worst food offenders.
So if you have gout, the first thing you have to do is eliminate the excess sugar and grains in your diet, as well as processed meat. That means you need to kick that sugar addiction, as sugar feeds yeast in the body and conventional grains turn into sugar. Meanwhile, those meats are full of unhealthy hormones and antibiotics, and theyre so acidic to your system. In terms of beverages, its important to stay away from alcohol. Diet- and drink-wise, those are the best things you can do right now to eliminate gout symptoms.
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Warning Signs Of A Gout Flare
Some people with gout, also known as gouty arthritis, say an attack begins with a burning, itching, or tingling feeling in a joint maybe an hour or two before the flare-up starts. The joint may feel a little stiff or a bit sore. Not long after, the telltale signs of gout begin. If you get repeated attacks, you’ll learn your body’s signals that one is about to begin.
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.
When the flare starts, most people have redness, swelling, and severe pain, usually in one joint. The most common place for gout is the base of the big toe, but it can happen in other joints such as the elbow, knee, wrist, ankle, and instep.
What Are The Symptoms Of Gout
If you think you are suffering from gout, how can you be sure? One of the tell-tale signs of gout is excruciating swelling and pain in the big toe, usually resultant of an injury. Gout may affect other joints intermittently, though, most often it affects the joints in the foot and knee. If left untreated, gout can become a chronic condition.
If you do not treat gout symptoms, your body may produce something called tophi which are little crystals that form disfiguring lumps near your joints and can also produce painful kidney stones.
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How To Handle Your First Gout Attack
After a first attack of gout, its OK to try to stave off another one with dietary changes alone. But if you have another attack, its important to start taking preventive gout medications on a regular basis. Long-term medications for gout include allopurinol and febuxostat, both of which limit uric acid production.
Some patients, says Dr. Fields, treat each attack as a separate event and dont talk to their doctors about doing a preventive approach. He uses the analogy of lighting a book of matches. If you have one match lit, its easy to put out, but if you have the whole book lit, its a lot harder.
Medicines For Gout Prevention And Complications
Your doctor can prescribe medicines that can help keep a healthy level of uric acid in your body, which can prevent future gout attacks and the complications from gout. When you have gout, your body either makes too much uric acid, or cannot get rid of enough of it, which causes it to build up. Some medicines are safe to take when you have kidney disease, but some are not. Talk to your doctor about which medicines are safe for you.
Allopurinol is a medicine for people who make too much uric acid. It is the most common medicine used to treat chronic gout. Your doctor can tell you if allopurinol is safe for you to take if you have kidney disease.
Probenecid is a medicine that works for people who cannot get rid of enough uric acid. It works to remove extra uric acid through your urine. Probenecid can increase your risk of kidney stones. Probenecid is not safe to take for many people with kidney disease, so talk to your doctor for more information about probenecid.
Pegloticase is an infusion medicine given by injection into your vein at your doctors office, usually every two weeks. It is used for severe chronic gout when other medicines do not work. Pegloticase can quickly bring your uric acid level down to a lower level than most medicines can. Talk to your doctor about whether pegloticase is safe for you.
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Lowering Uric Acid Levels
Standard urate-lowering medicines are:
- Allopurinol This is an oral prescription that helps lower serum uric acid levels. This medicine is also known by brand names Lopurin® and Zyloprim®. When started on this drug, your doctor will likely gradually increase the dosage to a standard prescription dose.
- This is another urate-lowering therapy that can be prescribed under the brand name Uloric®. This medication is taken orally and decreases the bodys production of uric acid. It can be taken by people with mild to moderate kidney or liver disease.
Some general potential side effects of allopurinol are: changes in taste, diarrhea, indigestion and stomach pain or cramps. For febuxostat, some minor side effects are: changes in appetite, constipation or diarrhea, nausea, hot flush to face or skin, stomach upset or pain. Its important that if they persist or there are questions, call a doctor.
Though only 1 in 1,000 patient cases, there is a more severe hypersensitivity reaction to allopurinol, with fever or rash that can cover the body and deterioration of liver and kidney function. At-risk patient populations can be screened for a genetic marker that can predict this reaction. To alleviate this hypersensitivity, doctors will start a patient on a low dose with a step-up plan to the optimal medication dose.
Naturasil Gout Pain Relief
- Cost: $29.95
Naturasil for Gout is a product offered by Nature’s Innovation, an Atlanta-based biotech company that manufactures natural products and homeopathic medicines. Applied topically wherever your joints are painful, this gout relief product can be used 3-4 times per day and massaged in.
The ingredients in Naturasil for Gout are 100% essential oils:
- Capsicum Annuum
- Peppermint Oil
- Sesame Seed Oil
Visit the product page to see how each of those components work together to relieve pain, aid in joint movement, and improve circulation, among other benefits. Keep in mind that some people may be sensitive to essential oils, so you may want to test a small area of your skin before going full speed ahead with a large-scale application.
Middle of the pack pricing
One 15mL bottle should last around 30 days, depending on how often you use it for gout relief. At a price of $29.95, that’s right in the middle compared with similar products. Shipping fees are calculated at checkout you can expect to pay a little over $5 for a single bottle via USPS First Class.
90 day guarantee
This product is backed by a 90-day money-back guarantee. The company asks that you use Gout Pain Relief as directed for at least 30 days before requesting a refund, which will have any shipping costs deducted from the total amount.
Lack of customer reviews
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What Else Should I Ask My Healthcare Provider About Gout
Consider asking your healthcare provider:
- What is causing the gout?
- Do I have any joint damage?
- What can I do to prevent future attacks?
- Can any gout medications help me?
- How long will I need to take gout medications?
A note from Cleveland Clinic
Gout is a painful form of arthritis. Extra uric acid in your body creates sharp crystals in the joints, leading to swelling and extreme tenderness. Gout usually starts in the big toe but can affect other joints. Gout is a treatable condition, and the uric acid level can be decreased by medication and lifestyle changes. Talk to your healthcare provider about medications that can reduce uric acid levels. They can also discuss changes you can make to your diet and lifestyle to prevent and reduce gout attacks.
Last reviewed by a Cleveland Clinic medical professional on 11/15/2020.
Effects On Other Treatments
Some drugs interact with allopurinol, so you should discuss any new medication with your doctor before starting it. You should also tell anyone else treating you that youre taking allopurinol.
Do not use complementary treatments, such as herbal remedies, without discussing this first with your doctor or pharmacist. Some of them could react with allopurinol.
You should avoid taking aspirin while youre being treated for gout. If youre in pain, you can take paracetamol and NSAIDs. But remember you should only take one NSAID at a time so do not take another if you have already been prescribed one to reduce the effects of gout attacks.
Allopurinol can also react with drugs that are often prescribed for high blood pressure, such as bendroflumethiazide, indapamide, lisinopril, ramipril.
It can also reduce the breakdown of the leukaemia drug mercaptopurine, so the dose of mercaptopurine will need to be reduced if you take this drug.
Allopurinol may also increase the risk of developing a rash if you take them with the antibiotics ampicillin or amoxicillin.
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Oral Gout Medicines Dont:
- CONVERT URIC ACID: KRYSTEXXA is the only gout treatment that controls by changing uric acid into a water-soluble substance called allantoin that your body easily gets rid of through urine.
- SIGNIFICANTLY LOWER YOUR URIC ACID LEVEL IN 24 HOURS: After just one IV treatment, KRYSTEXXA starts to lower your uric acid level enough to begin dissolving years of uric acid crystal buildup and .
- DISSOLVE YEARS OF GOUT BUILDUP IN JUST MONTHS: It can take more than two years for oral gout medicines to dissolve even a small amount of uric acid crystal buildup. KRYSTEXXA can dissolve most of it in about 6 months.
What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture .
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
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