Which Medications Should Be Avoided In Gout
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. Low-dose aspirin is also uricosuric. 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.
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
Gout Myths And Misconceptions And The Facts
Gout was once called the disease of kings, because of its propensity to affect overweight, rich men throughout history. Famous gout sufferers have included Alexander the Great, Charlemagne, Henry VIII of England, and Benjamin Franklin.
While gout is no longer thought to be a disease of the wealthy, it is more common in men and people with weight-related health problems including high blood pressure and type 2 diabetes.
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Why Treating Gout Takes A 2
Gout treatment takes a two-pronged approach:
Important Information About Gout Medication
If you are taking medication to lower uric acid, you need to take it every day, whether you are having an attack or not.
Treatment is important to reduce gout attacks and avoid permanent joint damage. However, as all medicines have side effects, discuss medication choices with your doctor by asking:
- what are the benefits of gout medication?
- what are the risks of this medication?
- what are the side effects?
Always let your doctor or pharmacist know what medicines you are taking to avoid interactions. It is also a good idea to discuss if you want to stop or change the dose of your medications.
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Other Symptoms Of Acute Gout Or A Gout Attack
- Sudden crushing or throbbing pain in one or a few joints that may last for a few days
- Sometimes an acute gouty arthritis attack has a sudden onset at nighttime. The big toe joint pain may be so severe that even the weight of bedsheets causes discomfort.
- Joints that appear swollen and inflamed, with reddish-purple skin that may feel warm
How Is Gout Treated
Gout can be effectively treated and managed with medical treatment and self-management strategies. Your health care provider may recommend a medical treatment plan to
- Manage the pain of a flare. Treatment for flares consists of nonsteroidal anti-inflammatory drugs like ibuprofen, steroids, and the anti-inflammatory drug colchicine.
- Prevent future flares. Making changes to your diet and lifestyle, such as losing weight, limiting alcohol, eating less purine-rich food , may help prevent future attacks. Changing or stopping medications associated with hyperuricemia may also help.
- Prevent tophi and kidney stones from forming as a result of chronic high levels of uric acid. Tophi are hard, uric acid deposits under the skin. For people with frequent acute flares or chronic gout, doctors may recommend preventive therapy to lower uric acid levels in the blood using drugs like allopurinol, febuxostat, and pegloticase.
In addition to medical treatment, you can manage your gout with self-management strategies. Self-management is what you do day to day to manage your condition and stay healthy, like making healthy lifestyle choices. The self-management strategies described below are proven to reduce pain and disability, so you can pursue the activities important to you.
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Alternative And Complementary Therapies
Many complementary and alternative medicine approaches for managing gout focus on diet, weight loss, and exercise.
Your risk of gout goes up when your diet is high in naturally occurring compounds called purines. When purines break down in the body, they cause uric acid to form. In most cases, people who have gout will still need medication even when they follow a diet for gout. That said, tweaking your diet can be a powerful way to help manage gout and gout symptoms. Some research suggests that food changes alone can lower your uric acid levels by up to 15 percent, according to the Institute for Quality and Efficiency in Health Care.
The main principles of a gout diet are basically the same as those of any healthy diet: Reduce calorie consumption if you are overweight opt for unrefined carbohydrates like fruits, vegetables, and whole grains limit your intake of sugar, organ meats , and saturated fats.
How To Use Colchicine Oral
Read the Medication Guide provided by your pharmacist before you start taking colchicine and each time you get a refill. If you have any questions regarding the information, ask your doctor or pharmacist.
Take this medication by mouth with or without food, exactly as directed by your doctor. Dosing recommendations vary widely and may be different from the following recommendations. Taking more than the recommended dose may not increase this drug’s effectiveness and may increase your risk for side effects. Ask your doctor or pharmacist for more details.
If you are taking this medication to treat a gout attack, carefully follow the directions given by your doctor. This medication works best if you take it at the first sign of an attack. The recommended dose is 1.2 milligrams at the first sign of an attack, followed by 0.6 milligrams one hour later. The maximum recommended dose is 1.8 milligrams taken over a 1-hour period. Ask your doctor ahead of time about how soon you can repeat treatment with this medication if you have another gout attack.
If you are taking this medication to prevent gout attacks or for pericarditis, ask your doctor about the dose and schedule you should follow. Carefully follow your doctor’s directions.
If your doctor directs you to take colchicine regularly, use it regularly to get the most benefit from it. To help you remember, take it at the same time each day.
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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.
Related Conditions And Causes Of Gout
Other conditions that are sometimes confused with gout include:
- Reactive arthritis
- Infectious arthritis
- Psoriatic arthritis
- Rheumatoid arthritis , which occurs when the body releases too many inflammatory chemicals . Gout is caused by too much uric acid.
- Osteoarthritis , known as wear-and-tear arthritis.
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What Are The Signs And Symptoms Of Gout
Gout flares start suddenly and can last days or weeks. These flares are followed by long periods of remissionweeks, months, or yearswithout symptoms before another flare begins. Gout usually occurs in only one joint at a time. It is often found in the big toe. Along with the big toe, joints that are commonly affected are the lesser toe joints, the ankle, and the knee.
Symptoms in the affected joint may include:
- Pain, usually intense
What Gout Treatment Options Are Available To Me Best Gout Medications
Before you choose the right treatment for you, its important to understand what options are available.
A talk with your doctor may leave out some important options, so its important to be informed going into your visit. This article aims to explain every option you have, with some commentary on the pros and cons of each one for further discussion. Towards the end, we explore the newer, lifestyle based alternatives.
Uric acid production inhibitors
Scientifically known as xanthine oxidase inhibitors, these medications limit the amount of uric acid produced by the body. They help to reduce blood uric acid concentrations and reduce the overall risk of gout.
Like all drugs, unintended side effects are a part of use. This particular class of drugs can produce side effects including rash, low blood volume, nausea, and reduced liver function. Best Gout Medications
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What Are Future Possible Treatments Of Gout
Fortunately, present medications are successful in the vast majority of gout patients. But some patients cannot tolerate our present arsenal of gout medications. For others, these agents are not sufficiently effective. Therefore, new treatments are continually being sought. Some of the more promising include anakinra, rilonacept, canakinumab, BCX4208 and arhalofenate.
Southern Cross Medical Library
The purpose of the Southern Cross Medical Library is to provide information of a general nature to help you better understand certain medical conditions. Always seek specific medical advice for treatment appropriate to you. This information is not intended to relate specifically to insurance or healthcare services provided by Southern Cross. For more articles go to the Medical Library index page.
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What Is The Safest Gout Medication
This cannot be inferred without the necessary information such as your health condition, medications you are currently on and your current lifestyle. Your doctor will be able to prescribe the safest medication for you, provided you advise them accordingly.
References:
Gøtzsche PC . Non-steroidal anti-inflammatory drugs, search date December 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
Teichman JMH . Acute renal colic from ureteral calculus. New England Journal of Medicine, 350: 684â693.
Wise C . Crystal-induced joint disease. In DC Dale, DD Federman, eds., ACP Medicine, section 15, chap. 9. New York: WebMD.
Learn About Gout
Additional Tips For Treating Gout Naturally
Studies show that many of the dietary items we consume lead to gout as well as other health problems. Changing your diet and lifestyle may be the easy solution to beating gout. One of the first things to do is eliminate certain foods and beverages from your diet to beat gout.
1. Eliminate or reduce sugar intake
As many studies are now illustrating, gout is common in people with excessive sugar intake, especially high fructose corn syrup Its wise to read the labels of all your food and drinks. If you find HFCS then eliminate that from your diet. In addition, look for sugar added under the guise of other common names for sugar look for cose at the end of words and these are probably types of sugar you dont want to be consuming.
2. Eliminate grains
Grains in the body are converted to sugars so again you want to limit or avoid grains altogether. They are also very inflammatory to your body.
3. Limit alcohol consumption
Again, alcohol becomes sugar once ingested so eliminate this completely unless you have a healthy body already. Any substance that will be converted to one or another type of sugar by the body should be avoided at all costs. In order to get your uric acid levels down you must consistently avoid sugar in your diet.
4. Eliminate soda and diet soda
5. Consume cherries and strawberries daily
6. Exercise
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What Does A Gout Attack Look And Feel Like What Would A Foot Or Toe With Gout Look Like
When gout occurs, the joint tends to be extremely painful and is warm, red and swollen . The inflammation that is part of a gout attack is systemic, so that fever and chills, fatigue and malaise are not uncommonly part of the picture of a gout attack.
Figure 6: Toe with Acute Attack of Gout
Gout attacks can occur in joints that look normal, or in joints that have easily visible deposits of uric acid. These deposits are called tophi and can be in numerous locations, but especially on the feet and elbows. In Figure 9, the little finger of the right hand is bandaged since fluid was just removed from it, which demonstrated innumerable uric acid crystals.
Figure 7a: Tophi on Foot
Figure 7b: Tophus Over Achilles’ Tendon
Figure 8: Tophus on Elbow
Figure 9: Tophi on Hands
Figure 10: Large Tophus of Finger
While some gout attacks will solve quickly by themselves, the majority will go on for a week, several weeks, or even longer if not treated. Since gout attacks are usually quite painful and often make walking difficult, most gout sufferers will request specific treatment for their painful condition.
Managing A Gout Flare
Gout flares are unexpected and painful heres how to get a handle on them.
Few things in life are more painful than a gout flare, so if youre awakened in the wee hours by a joint that is tender, swollen, red and radiating heat, youll want to act fast. Heres what you can do when a gout flare starts to ease the pain and reduce the risk of others.
Take Medicine You Have on Hand. Start treatment immediately with over-the-counter ibuprofen or naproxen , but never take aspirin, which can worsen a flare. If you have had a flare before and your doctor has prescribed an anti-inflammatory medication to take in the event of another, take your prescribed medication as your doctor directed. If you are already taking a uric acid-lowering drug to reduce the risk of flares, continue to take that drug.
Ice Down. Applying an ice pack to the painful joint may help ease pain and inflammation. Wrap a pack in a dish cloth and apply to the area for 20- to 30-minutes at a stretch several times a day.
Let your doctor know what is going on right away. She may prescribe a new medication, or have you come to the office for a joint fluid test or an injection of a corticosteroid to start relieving inflammation quickly. Getting treatment within the first 24 hours of the start of a flare can lessen its length and severity.
Get a Cane. Walking with a cane during an acute gou flare can help keep pressure off your painful joint.
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Can You Drop 8 Pounds Weight Loss Helps Prevent Gout
If youre overweight, you are likely to have higher-than-normal uric acid levels, a primary risk factor for developing gout. Thats why weight loss is an important part of a gout diet.
Losing weight may help lower uric acid levels and reduce the risk that you will experience future gout attacks. In fact, a weight loss of about eight pounds or more led to long-term reductions in uric acid levels and gout attacks in overweight or obese people, according to a review of studies published in 2017 in the Annals of the Rheumatic Diseases.
While some people with gout benefit from cutting back on foods that are high in purine, a chemical that contributes to uric acid formation, it is not clear how much purine intake makes a difference. You dont have to avoid all high-purine foods. Moderate changes to your eating style may help you feel better and reduce gout risks, and research suggests that purine-rich vegetables dont trigger gout. High-purine foods such as lentils and beans can be a smart source of lean protein.
Tophus Formation/ Ongoing Gout
Painful flares can, and often do, prevaileven when patients are taking medications as prescribed and are following a healthy diet and exercise regimen.
During this stage, also known as intercritical gout, a patient is between gout flares. There is symptom-free time, when joints are functioning normally. Howevereven when the patient is not experiencing symptomsongoing deposits of uric acid crystals will continue to accumulate, silently. This tophus formation often leads to more painful flares, unless urate levels are lowered to 6.0 mg/dL or below.
Where the first or early gout flares lasted for three to seven days once or twice a year, this next phase of gout is marked by flares every four to six months and lasting one to two weeks. This, indeed, is a frustrating time for patientsparticularly, if they are adhering to prescription guidelines.
If traditional gout therapy is not working, physicians may increase medication dosage, add another medication to the traditional therapy or change the medication. All of this is done with the goal of bringing urate levels under control.
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