Treatment of Gout.

Gout is an acute disease which usually attacks a single joint (the joint at the base of the big toe being the most commonly affected). It can be a very painful condition and treatment of gout primarily aims to relieve these symptoms of gout.

The second aim of treating gout is to prevent further attacks and preventing the gout from going chronic. The reason for this is that ignoring gout can cause certain long  term complications, which have to be avoided.

Gout Remedies.

Before starting on gout cures, it is necessary to know and follow the following. They are discussed separately, but a short mention is required here.

• Follow healthy lifestyle habits: Drink plenty of water, avoid alcohol and avoid being over weight.
• Stick to a diet that is not rich in purines. The details are given in diet for gout. It is the purine in our body cells that is converted into uric acid when it gets broken down.
• Know the causes of gout and if any are applicable in your case, have them corrected.

Medication for Gout.

It can be quite testing for your doctor to treat gout, because medicines for gout need variation in the drug itself and also in the dosage from individual to iundividual. Choice of drugs and  their dosages vary from person to person. Gout cure, therefore requires  regular follow ups to your physician till he is satisfied that the right gout medicine and dosage has been established.

Curing Gout can be divided into two parts:

1)      Treating Gout Symptoms.

2)      Preventing further gout attacks.

 

Treatment of Gout symptoms.

1) Self care.

• Give as much rest to the affected joint as possible.
• Keep the limb elevated above chest level when sleeping or sitting, to reduce swelling.
• Take care to avoid trauma to the joint.
• Keep ice packs on the affected joints for not more than 15 minutes at a time. The ice should be covered in an ice pack bag or a towel. Do not keep the ice directly on the joint. Do it 2 to 3 times a day. This will help to relieve symptoms.
• During the day, you could wrap a cotton bandage around the swollen limb.

2) Medication for Gout Symptoms.

One aim of gout cure, as mentioned above involves use of medicines that will give relief from symptoms which are pain, swelling and tenderness. Fever may also be present.

(a) NSAIDs. First drugs of choice here are called non steroidal anti inflammatory drugs (NSAIDs), which give relief from pain and swelling. They are to be taken as prescribed during the gout attack and are to continued for 48 hours even after the attack has subsided. The list of these drugs is long , but to mention a few:

• Aspirin is to be avoided in gout because it causes abrupt changes in uric acid levels and can worsen the symptoms.
• Ibuprofen (Motrin),
• Diclofenac (Voltaren),
• Naproxen (Naprocen),
• Indomethacin (Indocin).

How they Act.

NSAIDs block the action of certain enzymes which are responsible for formation of certain chemicals in the body called prostaglandins. Prostaglandins promote pain, inflammation and fever. Blocking the action of the enzymes prevent the formation of prostaglandins, thereby giving relief from inflammation, pain and swelling.

Caution when using NSAIDs.

These drugs are to be avoided in patients having kidney diseases, bleeding disorders, indigestion and stomach ulcers.

(b) Colchicine is used when NSAIDs are contraindicated for some reason. It is very effective for relieving gout pain especially when taken immediately at the onset of gout pain. They give relief within 12 to 24 hours. Colchicine also helps to prevent further attacks when continued in low doses. It is also used when necessary with other medicines for gout such as probenecid and allopurinol.

How colchicine acts.

It does not lower the uric acid levels but interferes with formation of uric acid crystals, thereby reducing inflammation.

Side effects of Colchicine.

Side effects include nausea, vomiting, diarrhea and abdominal pain. More serious side effects include inflammation of muscles and bone marrow disorders. High doses of this drug are to be avoided.

( c ) Corticosteroids.

Corticostroids such as dexamethasone or prednisolone or its derivatives are used when NSAIDs or colchicines fail to yield results or are contraindicated in patients who have kidneys diseases or  peptic ulcer or bleeding disorders. They may be given as oral pills or by injection, either intra muscular or intra venous depending on the severity of the gout attack. Corticosteroids are also injected directly into the affected joint. This is done when only one joint is involved and indicated when the inflammation is very severe. Steroids are given over a short period of time of 3 to 4 days and then taken off in tapering doses.

How corticosteroids act.

They are useful in stubborn gout cases and give rapid relief by reducing the inflammation and thereby the pain.

Caution while taking corticosteroids.

In patients of high blood pressure, monitoring of blood pressure when on corticosteroids is important. Similarly patients of diabetes too require monitoring of their blood sugar levels. More importantly corticosteroids are not to be given when bacterial infection is present because they can flare up the infection.

Side effects of corticosteroids.

Though corticosteroids give rapid relief, they are to be used for a short period only. Their long term use can cause the following side effects.

• Fluid retention,
• Weight gain,
• Osteoporosis,
• Weakness of muscles,
• High blood Pressure,
• Diabetes,
• Glaucoma,
• Ulcer,
• Increase risk of getting infection.

3) Gout medicines to prevent recurrence of attacks.

(d) Uricosuric Agents.

Probenecid and sulfinpyrazone. These medicines which are used for gout cure help to prevent further attacks of gout. Probenecid and sulfinpyrazone belong to this category of gout drugs.

Indications. These drugs are not given during an acute gout attack but are primarily used to prevent recurrence after the acute attack of gouty arthritis has subsided. They are however continued even during an acute attack if the patient is already taking them. These drugs help to prevent gout attacks but do not cure the gout attack. Required results are obtained in only 75% of the cases.

How they act.

These drugs lower serum uric acid levels by increasing the excretion of uric acid through the urine. They thus prevent the formation of uric acid crystals in the joints.

Contraindications.

These gout medicines are contraindicated in patients who are

• having kidney disease or stones in the genito urinary tract,
• in cancer patients who are on radiotherapy and/or chemotherapy,
• on maintenance doses of aspirin.

Side effects of uricosuric agents.

Skin rash, headache, formation of kidney stones and gastrointestinal upsets. Rarely bone marrow disorders may be caused.

Note. It is important that a patient who is on these drugs should form a habit of drinking plenty of water spaced out during the day. Read benefits of drinking water.

e) Allopurinol

How it acts.

While uricosuric agents lower uric acid levels by increasing their excretion through the kidneys, Allopurinol lowers uric acid levels by blocking its formation. It does this by blocking the release of xanthine oxidase which is responsible for formation of uric acid in the body. It also helps to lower tophi, which are uric acid nodules formed under the skin.

Indications.

Allopurinol is indicated after the acute gout has subsided. However if acute gout develops when you are already on allopurinol, allopurinol therapy is continued.

Contraindications.

Allopurinol is contraindicated in people who develop sensitivity to it and in people who have high levels of iron in blood.

Side effects.

Skin rash is common and is treated with anti allergic medicines. Other rare side effects include hepatitis, anemia and vasculitis (inflammation of blood vessels).

 

 

Related posts:

1. Causes of Gout.
2. Gout.
3. Gout Symptoms.
4. Complications of Gout.
5. Diagnosis of Gout.
6. Diets for Gout.