Gout.
Last updated Wednesday, December 22, 2004
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Management and treatment
Treatment
Treatment for gout mainly consists of taking medication(s) and watching your diet.
The goals of treatment are to relieve pain, shorten the duration of
inflammation during an acute attack, prevent future attacks, and
prevent joint damage.
Diet
There are many myths about diet and gout. Here are the facts:
- Obesity can be linked to high uric acid levels in the
blood. If you are overweight, work with your doctor to develop a
weight-loss program. Don't fast or try to diet too severely because
that can raise your uric acid level and make the gout worse. If you are
not overweight, watch your diet carefully so you don't become
overweight.
- Usually you can eat what you like within
limits. If you have kidney stones due to uric acid, you may need to
avoid or limit foods that raise your uric acid level, such as those
listed below. Talk to your doctor about what foods you may have to
avoid.
You may need to completely avoid these foods which may raise uric acid levels:
- Brains
- Kidney
- Broths, gravies
- Sardines, anchovies
- Liver
- Sweetbreads
You can drink coffee and tea. However, talk to your doctor about
drinking alcohol. Too much alcohol may raise your uric acid level and
bring on a gout episode. Drink at least 10-12 eight-ounce glasses of
non-alcoholic fluids daily, especially if you have had kidney stones.
This will help flush the uric acid crystals out of your body.
Medications
Using medications
for gout can be complicated. The treatment needs to be tailored for
each person and may have to be changed from time to time. People who
have hyperuricemia but no other problems usually do not require
medications.
Medications are used to:
- Relieve the pain and swelling of an acute attack--these medications include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, corticosteroid drugs, and/or adrenocorticotropic hormone (ACTH).
- Prevent future episodes--these medications include colchicine, probenecid, sulfinpyrazone, and allopurinol.
- Prevent or treat tophi--these medications include probenecid, sulfinpyrazone, and allopurinol.
- Prevent uric acid kidney stones (with allopurinol).
All of these drugs are powerful, so you need to understand
why you are taking them, what side effects may occur, and what to do if
you have any problems.
Medications to treat acute attacks
Colchicine has been used to treat gout for over 2,400 years.
It relieves the pain and swelling of acute attacks. It usually is taken
by mouth in several small doses every day. It works best if taken
during the first two days of an attack. When taken by mouth, colchicine
can cause diarrhea, nausea, and abdominal cramps. If side effects
occur, stop taking the drug and notify your doctor. To prevent future
episodes, you may have to continue taking a small dose of colchicine
after the attack has cleared.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
are sometimes used to relieve the pain and swelling of an acute attack.
They usually begin working within 24 hours after you start taking them.
These medications are as effective as colchicine but may have less
frequent side effects. However, side effects from NSAIDs may include
stomach upset, headache, skin rashes, and sometimes ulcers.
Doctors teach many people with gout how to begin treatment on
their own. When a gout episode begins, call your doctor and begin
taking your medication. Your doctor may suggest that you keep a supply
of medication on hand to take at the first sign of trouble.
Medications that control uric acid levels
The medications listed below are used to treat or prevent
tophi and to prevent future gout episodes. (In addition, allopurinol is
used to prevent kidney stone formation.) However, these medications do
not relieve the pain and inflammation of an acute attack. These
medicines start working slowly over many months. They may cause you to
have more gout episodes when you first start taking them, so you may
have to take colchicine or an NSAID
at the same time for the first three to six months to prevent such
attacks. Many people with gout do not require these medicines. If you
must take them, however, you'll probably have to do so for the rest of
your life in order to prevent future problems.
Allopurinol (Lopurin, Zurinol, Zyloprim) reduces the amount
of uric acid in your blood and urine by slowing the rate at which the
body makes uric acid. It is the best medicine for people who have
kidney problems or kidney stones caused by uric acid.
Occasional side effects include skin rash and stomach upset.
Stomach problems usually go away as your body adjusts to the drug. In
rare cases, this drug can cause a severe allergic reaction. If you have
a skin rash along with hives, itching, fever, nausea, or muscle pain,
contact your doctor right away. This drug also may make some people
drowsy or less alert. Make sure you know how you react to this medicine
before you drive or operate machinery.
Some drugs lower the uric acid level in your blood by
increasing the amount of uric acid passed in your urine. They help
dissolve tophi and prevent uric acid deposits in joints. The drugs
commonly used to lower uric acid levels in gout are probenecid
(Benemid, Parbenem, Probalan) and sulfinpyrazone (Anturane). They
usually are taken by mouth on a daily basis. Your doctor will adjust
the amount of medication you take based on your blood uric acid level.
When a normal level of uric acid is reached, no more crystals will be
deposited in your joint(s). Those already present will start
dissolving.
Common side effects include nausea, skin rash, stomach upset, or headaches.
While the skin rash sometimes can be serious, other side
effects usually are not serious and may go away as your body gets used
to the medicine. If any side effects continue to bother you, contact
your doctor.
Take these medications with plenty of liquids. Do not take
aspirin with these drugs because it blocks their effects on the
kidneys. Read the labels of any prescription or over-the-counter
medicines you take to be sure they don't contain aspirin.
Tips for taking Probenecid, Sulfinpyrazone, or Allopurinol
At first, probenecid or sulfinpyrazone may increase your risk
for kidney stones by increasing the uric acid content of the urine. To
prevent this problem, keep your urine diluted by drinking 10-12 eight
ounce glasses of fluid every day.
Probenecid, sulfinpyrazone, and allopurinol also may cause
you to have more frequent gout episodes at first. During this time you
may have to take colchicine or an NSAID for the first three to six
months to prevent an episode.
Take your medicine exactly as your doctor instructs. In order
to be effective, these medicines must be taken continuously. This will
help your body get rid of excess uric acid and will keep the uric acid
level from rising again.
Do not take double doses of your medicine. If you forget to
take a dose, take it as soon as possible. However, if it is almost time
for your next dose, skip the dose you missed.
Talk with your doctor about all the drugs you're taking. This
includes over-the-counter drugs such as aspirin or diuretics. Some of
the gout medications will not work properly if you are taking other
drugs at the same time. Don't start any new drugs without being sure
they will work properly with the ones you're already taking. The amount
of medications you take will depend upon your symptoms and laboratory
test results. You may only need to take one drug. On the other hand, it
may be necessary to take a combination of the drugs listed here. Not
all people with gout require these drugs. Whether you take these drugs
depends on your doctor's judgment and your willingness to make a
lifelong commitment to taking daily medications.
Surgery
Surgery
is rarely used to treat gout. If you have large tophi that are
draining, infected, or are interfering with the movement of your
joints, you and your doctor may decide to have them surgically removed.
There are several kinds of operations that can be done to relieve pain
and improve the function of the affected joints.
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