Acute Gout Flares: What Else You Can Do
While your prescription gout medication should quickly treat your joint pain, swelling and redness, there are things you can do on your own in addition to taking your medicine:
Ice it. Treat your swollen joint with topical ice for a short period of time if you need a little extra relief. Ice can ease pain and swelling. Wrap ice or an ice pack in a soft towel or cloth before placing it on your skin. Dont place ice directly onto your joint, even if its inside a plastic bag.
Elevate it. If your big toe or foot is affected, prop it up on pillows while you rest on the sofa. Keep your joint elevated above the level of your heart for the best effect.
Give it a rest. Its OK to take it easy for a day or two while your symptoms are at their worst. Rest if you can. Try not to use your affected joint until your medications can reduce the inflammation. Gout flares often get worse if you try to ignore them and stress your affected joint.
Avoid Changing Hypouricaemic Therapy
During the treatment of acute gout any sudden change in the concentration of serum uric acid will exacerbate the attack. Patients taking regular hypouricaemic therapy should therefore not stop their treatment. Likewise, hypouricaemic therapy should not commence until after the attack has settled. The use of concurrent low-dose colchicine during the introductory phase of hypouricaemic therapy reduces the frequency of attacks during that relatively high-risk period.
Second Stage Or Acute Gout
Hyperuricemia in the bloodstream can progress to forming urate crystals in the joints of the foot, ankle or knee once these crystals appear, they cause swelling and moderate-to-intense pain, in what is now acute gout. This can make the joints hypersensitive to touch, even from something as innocuous as ones own sheets, to the point of excruciating pain. The redness and swelling associated with acute gout makes the feet feel warm to the touch.
Acute gout attacks usually continue appearing over a period of months or years, manifesting very suddenly and lasting several days to weeks, if left untreated and can get more frequent and worse, causing joint damage as well as tendon and other tissue damage.
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Monosodium Urate Solubility Results
Franz-Cell Solubility Experiments
The saturated solubility of MSU was measured in the PBS media in the receptor cells of Franz cells. Pigs skin was used as the membrane between the donor and receptor cells. The 10 products and control were added to the donor cells ensuring complete coverage of the exposed membrane. Samples were taken after 72 hours. Results are given as percentages with respect to the control for each experiment and are shown in Figure 3.
Figure 3 Solubility of monosodium urate in phosphate buffered saline in the receptor cell of a Franz cell after application of the product onto the pigs skin membrane.
The seven commercial products all showed MSU solubilities in a similar range to the control, between 99% and 103%. VO diclofenac gel 2% and IB ibuprofen gel 5% gave the highest solubilities and NU ibuprofen gel 10% gave the lowest solubility .
The three GB products all gave significant increase in the solubility of MSU, ranging from 120% to 126% . The GB no drug gel product showed an increase in solubility to 122%.
Vial-Based Solubility Experiments
The saturated solubility of MSU in PBS was determined in vials with the direct addition of some extra materials . All percentage values are relative to the control PBS solubility at that temperature.
Table 1 Saturated Solubility of Monosodium Urate in PBS in Vials After 24 Hours
What Are The Symptoms Of Gout
The symptoms of gout include severe pain in one or more joints. In most cases, gout affects one joint at a time.
- The joint most commonly affected is the large toe. Other sites include your forefoot, instep, heel, ankle and knee. Gout is uncommon in the upper body, but it can affect your fingers, wrists and elbows.
- Gout attacks are very painful. A gout attack usually begins suddenly, often at night. Within hours, the joint becomes red, swollen, hot and painful. This is due to uric acid crystals in the joint causing sudden inflammation.
- The pain and tenderness can be so severe that even gentle pressure from bedding is a problem. Even though only one small joint is affected, the inflammation can be intense enough to cause fever, muscle aches and other flu-like symptoms.
- An attack usually lasts for 5 to 10 days but in rare cases, it can continue for weeks.
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Before Using Diclofenac Gel
To make sure this is the right treatment for you, before you start using diclofenac gel it is important that your doctor knows:
- If you are pregnant or breastfeeding.
- If you have asthma or any other allergic disorder.
- If you have any other skin condition – eczema, for example.
- If you have ever had an allergic reaction to a non-steroidal painkiller or to any other medicine.
Gout Is Caused By A Buildup Of Uric Acid In Your Body
- Uric acid mostly comes from the breakdown of cells in your body. The remainder comes from chemicals called purines that are in your food.
- Normally, your kidneys filter uric acid from your blood and flush it out of your body in urine .
- When uric acid levels in your blood are high, uric acid crystals form in your joints. These crystals cause pain, inflammation and lumps .
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Know What Else You Can Do
- Take control by knowing your uric acid level.
- Work with your healthcare team and be an important part of it.
- Know about your treatment options, ie, physical therapies, preventive medicines, prescription and non-prescription medications.
- Find new ways to stay active.
- Learn techniques to help manage your pain.
- Acknowledge your feelings and seek support.
- Make food choices that count milk, low-fat dairy products, coffee and vitamin C appear to reduce the risk of developing gout.
- People with gout often have higher risk for diabetes, high blood pressure, heart disease and kidney problems. Ask your doctor/nurse for a heart & diabetes check.
- Create your own care plan and ask any health provider you see to fill it in.
Attending a self-management course is a great way to find out what you can do to help yourself, meet new friends, support each other and make some healthier choices for yourself and your family. Ask your doctor for groups in your area.
Leni Doesn’t Have Gout Attacks Anymore
Look at Lenis story and what he has learnt about managing his gout and bringing his uric acid down so he doesnt have painful gout attacks anymore.Click on the control bar below the flipbook to open to full screen, flip automatically or stop at specific pages.
Jackson G1, Dalbeth N, Te Karu L, Winnard D, Gow P, Gerard C, Minko N. Variation in gout care in Aotearoa New Zealand a national analysis of quality markers NZ Med J. 2014 Oct 17 127:37-47.van Durme CM, Wechalekar MD, et al. Non-steroidal anti-inflammatory drugs for acute gout Cochrane Database Syst Rev. 2014 Sep 16 9:CD010120. doi: 10.1002/14651858.CD010120.pub2. Kydd ASR, Seth R, Buchbinder R, Edwards CJ, Bombardier C. Uricosuric medications for chronic gout Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD010457. DOI: 10.1002/14651858.CD010457.pub2.
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Fourth Stage Chronic Tophaceous Gout
Finally, chronic tophaceous gout, or fourth-stage gout, occurs when gout is left untreated for too long. Most people do not get this far with proper medication and treatment. Often taking several years or more than a decade to develop fully, chronic tophaceous gout entails hard nodules called tophi developing in the joints and tissues surrounding the joints.
Over time, tophi can do permanent damage to the joints and is the most debilitating, causing skin ulcers to appear. This is extremely rare and only if left untreated for decades. Tophi also often appear in other parts of the body, such as the fingers and ears. Permanent kidney damage at this point is also a possibility.
Adverse Effects In Observational Studies
A total of seven observational studies reported AEs of topical NSAIDs. Conventional meta-analysis showed that topical NSAID users did not exhibit a significantly higher rate of AEs than non-users . Three case-control studies examined serious systemic AEs such as GI bleeding, perforation, symptomatic peptic ulcers and acute renal failure associated with the use of topical NSAIDs. The risks of GI bleeding , acute renal failure and symptomatic peptic ulcers were not significant. In addition, two case-control studies examined the photosensitivity associated with topical NSAIDs. One showed that the reporting OR for topical ketoprofen was 3.9 and the proportional reporting ratio was 3.4 , versus other topical NSAIDs. The other reported that the overall population attributable risk for severe photosensitivity reactions linked to topical ketoprofen was 11.92% and the PAR for other topical NSAIDs was 2.47% . Another case-control study showed that topical NSAIDs might decrease the risk of squamous cell carcinoma : 0.85, 0.76 to 0.94) and malignant melanoma . Finally, no AEs associated with topical NSAIDs were reported in the cross-sectional study.
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Voltaren Gel For Gout
Voltaren is one of the brand names of diclofenac that is part of the NSAID or Non-Steroidal Anti-inflammatory Drugs category of medications. As the category implies, it is beneficial in getting rid of inflammation and pain, which are very similar as the colchicine. However, Voltarens mechanism is quite contradictory.
Moreover, diclofenac gets rid of the inflammation and pain through the removal of the sufferers capacity to feel them.
When experiencing gout, the inflammation and pain are the bodys reaction or alarm systems. In addition, the inflammation and the pain occurs only to say that theres something on that particular part of the body that must not be in there. This is a part of the survival mechanism of the body.
To be able to initiate the repulsion of the foreign object, which comes together with the inflammation and pain, the broken cells discharge arachidonic acid, which will then be changed by cyclooxygenase enzymes, to some other substances that will send different signals like reducing the pain, inflammation, and body temperature thats rising.
Voltaren is typically taken orally. However, there is also Voltaren in the form of gel as a topical medication. If you want to use it in relieving the gout pain and inflammation, you just need to apply it on the skin of the affected area and it will do its magic on its own.
How Should I Use Diclofenac Gel
Over-the-counter topical diclofenac comes as a 1% gel to apply on up to two joint areas, four times daily.2 These areas can include the foot, ankle, knee, hand, wrist or elbow. It’s recommended to apply your OTC diclofenac gel around the same time every day. Some basic tips for application for Voltaren Arthritis Pain diclofenac gel:2,3
- Apply diclofenac gel on clean, dry skin.
- Apply the gel to two joints only. For example, a hand and an elbow, a knee and an ankle or two knees. Use your hands to gently rub the gel into your skin.
- For each upper body area , squeeze out 2.25 inches and apply. For each lower body area , squeeze out 4.5 inches and apply.
- Wash your hands thoroughly after applying the gel unless you are using the medication for your hands. If so, do not wash your hands for an hour after application.
- Do not apply gel to skin that is broken, infected, cut or covered in a rash
- Diclofenac topical gel is only for external use on the skin. Be careful not to get diclofenac gel in your eyes, nose or mouth.
Diclofenac sodium gel may cause a severe allergic reaction, especially in people allergic to aspirin. Symptoms include:3
Make sure to keep your diclofenac sodium topical gel in the container it came in and out of reach of children or pets. It’s important to keep it out of sight and high enough that children can’t reach it or see it.
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Who Can And Cannot Take Diclofenac
Most adults can take diclofenac.
Children may be prescribed diclofenac to treat joint problems. Diclofenac tablets, capsules and suppositories are suitable for children aged 6 months and above.
Diclofenac gel is suitable for children aged 14 and above. Diclofenac plasters and patches are suitable for young people aged 16 and above.
Diclofenac is not suitable for some people. To make sure it’s safe for you, tell your doctor or pharmacist if you:
- have ever had an allergic reaction to diclofenac or any other medicines
- have a blood clotting disorder
- are pregnant, planning to get pregnant, or breastfeeding
Adverse Effects Of Diclofenac
NSAIDs have a distinct mechanism of action which makes them highly effective therapeutically but also causes side effects that are particularly common after oral administration. It is estimated that approximately 2125% of known cases of adverse drug reactions are caused by NSAIDs. The most frequent side effects associated with NSAID treatment, especially when used on a long-term basis, are functional disorders of the gastrointestinal tract, kidneys, cardiovascular and central nervous systems. Nonsteroidal anti-inflammatory drugs have been shown to vary considerably in terms of adverse effects, contraindications and use restrictions .
The toxicity of NSAIDs in the upper gastrointestinal tract is currently well documented. They may also cause injury to the small and large intestines, and other digestive organs. NSAIDs induce perforations, ulcerations and strictures of the small intestine requiring operative treatment, and may cause enteropathy, i.e. inflammation accompanied by blood and protein loss from the intestine. In addition, drugs from this class may exacerbate the underlying large-bowel disease, lead to reactivation of previously inactive disease or induce the primary episode of inflammatory bowel diseases.
However, a review of results obtained in 3,789 studies found by searching the Medline and Embase databases, published before June 2016, demonstrated an elevated risk of acute nephritis in the elderly and patients with chronic kidney diseases .
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How Should Voltaren Gel Be Taken
The proper amount of Voltaren® Gel should be measuredusing the dosing card supplied in the drug product carton. The dosing card ismade of clear polypropylene. The dosing card should be used for eachapplication of drug product. The gel should be applied within the rectangulararea of the dosing card up to the 2 gram or 4 gram line . The 2 g line is 2.25inches long. The 4 g line is 4.5 inches long. The dosing card containingVoltaren® Gel can be used to apply the gel. The hands should then be used togently rub the gel into the skin. After using the dosing card, hold withfingertips, rinse, and dry. If treatment site is the hands, patients shouldwait at least one hour to wash their hands.
Lower Extremities, Including The Feet, Ankles, Or Knees
Apply the gel to the affected foot, ankle, or knee4 times daily. Voltaren® Gel should be gently massaged into the skin ensuringapplication to the entire affected foot, or knee or ankle. The entire footincludes the sole, top of the foot and the toes. Do not apply more than 16 gdaily to any single joint of the lower extremities.
Upper Extremities Including The Hands, Wrists, Or Elbows
Apply the gel to the affected hand, wrist, or elbow4 times daily. Voltaren® Gel should be gently massaged into the skin ensuringapplication to the entire affected hand, wrist, or elbow. The entire handincludes the palm, back of the hands, and the fingers. Do not apply more than 8g daily to any single joint of the upper extremities.
Before Taking This Medicine
Diclofenac topical can increase your risk of fatal heart attack or stroke, even if you dont have any risk factors. Do not use diclofenac topical just before or after heart bypass surgery .
Diclofenac topical may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using diclofenac topical, especially in older adults.
Diclofenac topical is not approved for use by anyone younger than 18 years old.
Tell your doctor if you have ever had:
Diclofenac can affect ovulation and it may be harder to get pregnant while you are using this medicine.
If you are pregnant, you should not take diclofenac topical unless your doctor tells you to. Taking an NSAID during the last 20 weeks of pregnancy can cause serious heart or kidney problems in the unborn baby and possible complications with your pregnancy.
It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.
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Renal Toxicity And Hyperkalemia
Long-term administration of NSAIDs has resulted in renal papillary necrosis and other renal injury.
Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion. In these patients, administration of an NSAID may cause a dose-dependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation. Patients at greatest risk of this reaction are those with impaired renal function, dehydration, hypovolemia, heart failure, liver dysfunction, those taking diuretics and ACE-inhibitors or ARBs, and the elderly. Discontinuation of NSAID therapy is usually followed by recovery to the pretreatment state.
No information is available from controlled clinical studies regarding the use of diclofenac sodium topical gel in patients with advanced renal disease. The renal effects of diclofenac sodium topical gel may hasten the progression of renal dysfunction in patients with preexisting renal disease.
Hyperkalemia Increases in serum potassium concentration, including hyperkalemia, have been reported with use of NSAIDs, even in some patients without renal impairment. In patients with normal renal function, these effects have been attributed to a hyporeninemic-hypoaldosteronism state.