bone, joint, and muscle disorders
Gout
Treatment of Gout
Medications to relieve pain and swelling resulting from inflammation Rest, immobilization of a painful joint with a splint, and ice Dietary changes and weight loss to lower the uric acid levels and help prevent further flare-ups Medications to prevent flares by preventing inflammation caused by crystals Medications to lower uric acid levels and dissolve the crystals (most effective way to cure gout and end flares, but it takes time to dissolve all of the deposits) Gout treatment has three goals: Relieve the pain of acute flares Prevent further flares Control gout long term to prevent deposits of uric acid in the tissues and eliminate the body's excess uric acid stores by lowering blood levels of uric acid Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Treatment with NSAIDs should be continued for several days after the pain and inflammation have resolved to prevent them from appearing again (a condition called relapse). Concerns with these medications relate to irritation of the stomach, interactions with blood thinners, and temporary decrease in kidney function. Colchicineis the traditional, but no longer the most common, first-step treatment of a flare. In some people, joint pain begins to subside after 12 to 24 hours of treatment withcolchicineand is sometimes gone within 3 to 7 days.Colchicineis taken usually as 2 pills as soon as possible after symptoms of a flare begin. A third pill is taken 1 hour later. This therapy is continued the next day by taking 1 pill once or twice a day for 7 to 10 days.Colchicinecan cause diarrhea and rarely lower blood counts. Corticosteroids,such asprednisone, are sometimes used to reduce joint inflammation (including the swelling) in people who cannot tolerate the other medications. If only one or two joints are affected, a corticosteroid such asprednisolonetebutate along with an anesthetic can be injected into an inflamed joint. As with NSAID andcolchicinetherapy, corticosteroids that are taken by mouth should be continued for a few days after the flare fully resolves to prevent relapse. Sometimes combinations of these medications are given. If people cannot tolerate corticosteroids,colchicine, or NSAIDs, particular drugs that suppress the immune system and inflammatory system (such asanakinradaily injections) can be used. If there are underlying problems, such as Chronic Kidney Disease or In addition to medications, rest, immobilization with a splint, and ice can be used to reduce pain. Preventive daily drug treatment may be needed for people who experience repeated, severe flares.Colchicinemay be taken daily to prevent flares or to greatly reduce their frequency. NSAIDs taken daily can also prevent flares. These medications help prevent crystals from causing the inflammation that results in flares. However,colchicineand NSAIDs may cause some side effects and do not prevent excess deposits of uric acid in and around joints. Although medication is almost always required, the following can help prevent further gout flare-ups: Avoiding alcoholic beverages (such as beer and liquor) and nonalcoholic beer Eating smaller amounts of purine-rich foods Substituting low-fat dairy products for other foods Losing weight Changing medications that cause elevated blood levels of uric acid Most people who have primary gout have overweight. As they gradually lose weight, their blood levels of uric acid often decrease but usually not enough to dissolve the uric acid deposits. People with gout who take a diuretic to Treatment may have fewer flares if they take A high level of uric acid in the blood causes problems for people with gout and may increase the risk of kidney disease in people without gout. Lowering the level of uric acid in the blood helps dissolve deposits of uric acid in the tissues and over time prevent flares. People with gout who especially need their blood level of uric acid lowered include those who have the following: Frequent or severe flares (more than 2 per year) or continuing need forcolchicine, an NSAID, or both to prevent flares Tophi that are found on examination Uric acid kidney stones Conditions that make NSAIDs or corticosteroids more complicated to take (such as Peptic Ulcer Disease , People taking medications to lower the blood level of uric acid should know their level, just as people with high blood pressure should know their blood pressure. The goal of drug therapy is to decrease the level to less than 6 milligrams per deciliter (0.4 millimoles per litre). If the blood level is maintained below 6 [0.4], uric acid will stop being deposited in the joints and in soft tissues, and the existing deposits will eventually dissolve, although this may take several years. Most tophi on the ears, hands, or feet shrink slowly when the uric acid level is maintained at less than 6 milligrams per deciliter (0.4 millimoles per litre). Medications can lower blood levels of uric acid by decreasing the body’s production of uric acid or increasing the excretion of uric acid in the urine. The lower the blood uric acid level, the faster the deposits will dissolve. As the deposits start to dissolve (mobilize), crystals can be released and cause mobilization flares. These flares are a sign that the drugs are working and therefore should not be stopped. These drugs may be used long-term or for a person's lifetime. can upset the stomach and can sometimes cause a rash, decrease the number of white blood cells, or cause liver damage or inflammation of vessels ( Overview of Vasculitis ). Febuxostatis another medication that lowers blood levels of uric acid. It is especially useful in patients who cannot take or have not been helped byallopurinol. As withallopurinol, flares can occur as the uric acid level in the blood first decreases. Pegloticaseis a specialized medication that is used to lower blood levels of uric acid dramatically in people with severe gout. It is given by intravenous infusion every 2 weeks and is used primarily in people who have long-standing gout that has not been successfully treated with other therapies.Pegloticaseis not used with other drugs that lower blood levels of uric acid. If people respond topegloticase, deposits, including tophi, may begin to dissolve quickly and become less visible over months. However, many people develop antibodies that prevent this medication from continuing to work. Doctors may give immunosuppressive medications to prevent this from happening. Uricosuric drugs(drugs that increase excretion of uric acid in the urine) also can be used to lower the levels of uric acid in the blood in people who have normal kidney function.Probenecidis a uricosuric drug, usually taken twice a day and may be combined with eitherallopurinolorfebuxostat. , but low doses that protect the heart (81 milligrams daily) should be continued, because Overview of Coronary Artery Disease (CAD) is a considerable risk in people with gout. Low doses of The blood pressure–lowering druglosartanand the triglyceride-lowering drugfenofibrateboth cause uric acid to be excreted in the urine. These medications can decrease uric acid slightly in people who are taking them for other reasons. Any treatment that decreases levels of uric acid in the blood can trigger an acute flare (mobilization flare). Mobilization flares are particularly likely soon after a medication that lowers the blood level of uric acid is started. A mobilization flare may be a sign that a medication is working well to decrease uric acid levels. During a mobilization flare, people should not stop taking the medications that decrease the uric acid level. Low-dosecolchicineor an NSAID can be given for a few months after starting the medication to lower the uric acid level to help prevent mobilization flares. 