The treatment of gout depends on the stage of disease. For an acute attack, the crucial step is to provide pain relief and shorten the duration of inflammation. The goal in the management of gout is to prevent recurrent or future gouty attacks with the ultimate objective of preventing joint damage.
Treatment is tailored for each person and medications are used to:
Non-steroidal anti-inflammatory drugs (NSAIDS) for example, Naproxen, Mefenamic acid, Indomethacin, or Diclofenac are commonly used to relieve pain and swelling during an acute gout episode. NSAIDS usually begin to work within 24 hours. Their side-effects include stomach upset, skin rashes, fluid retention or kidney problems and stomach ulcers. They should be used cautiously in patients with kidney impairment and stomach ulcers. Newer drugs called COX-2 inhibitors may be safer for the stomach.
Corticosteroids work quickly as well and can be taken by mouth or injected directly into an inflamed joint to relieve the pain and swelling of an acute episode of gout.
Colchicine gives prompt relief when taken at the first sign of an attack. Common side effects include abdominal cramps or diarrhea. Lower doses of colchicine can be taken daily to prevent future attacks.
Long term management of patients with gouty arthritis is to reduce blood uric acid levels so that future episodes of gouty attacks can be prevented. This is achieved by - medications such as Allopurinol or uricosuric agents (i.e. medications that result in increased urate excretion from the kidneys). These medications do not relieve the pain and inflammation of an acute episode and are usually started after the acute episode of gout is treated. They may occasionally cause you to have more gout episodes when first started, hence you may be prescribed colchicine or NSAIDS to be taken at the same time.
Allopurinol decreases the blood uric acid level and has to be taken daily. It can also reduce tophi size and prevent formation of crystal deposits in joints and other tissues. The most common side effect is skin rash and has to be discontinued if you develop any rashes or itch. Allopurinol is usually taken daily and for years. It should not be stopped during an acute episode of gout.
Uricosuric drugs such as probenecid lower the blood level of uric acid by increasing its excretion in the urine. They are not as effective as allopurinol and do not work as well in people with renal impairment. Patient should drink plenty of water as the excretion of uric acid in the urine may lead to formation of stones in the kidney.
Ultimately, your doctor will advise you regarding the types of medication(s) you need and monitor their side-effects.
Gout may be associated with high blood pressure, diabetes, kidney diseases and obesity. It may be important to screen for these diseases. Uric acid crystals can form deposits in the kidneys or the ureter leading to renal or ureteric stones. This can lead to renal impairment.
Diet plays an important role in the management of gout. Patients with gout should avoid food with high purine content. It is also important to drink lots of water (at least 2 litres per day) unless instructed by a doctor not to do so. Patient should also reduce the consumption of alcoholic beverages and reduce weight. However, crash dieting is not advised.
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