Sunday, April 27, 2014

Treatment for Gout - Things You May Need To Know

gouty tophi on elbow of middle aged male nurse
gouty tophi on elbow of middle aged male nurse (Photo credit: Wikipedia)
Many patients with gout come to their doctor with an acute pain attack. This kind of extremely painful flares usually punctuated after some silent period in a chronic gout. In half of the cases, the very first acute attack involves the first joint of the big toe which famously known as podagra. Untreated or undertreated chronic gout will progress with more frequent attacks, and there will be formation of urate crystal deposits called tophi. The tophi will eventually lead to deformation of the joints.

Normal value for serum urate level is 6.8 mg/dL. Hyperuricemia occurs when the normal level is exceeded. Hyperuricemia does not necessarily mean a gout attack. It is merely a risk factor for developing gout in a long run.

There are certain conditions which co-exist more frequently in patients with gout. Obesity, high cholesterol, diabetes, hypertension, coronary heart disease, stroke, peripheral artery disease, congestive heart failure, and chronic kidney disease are more frequently found in patients with history of gout. It is very important to be aware of these comorbidities, as these conditions are potentially life threatening if left unmanaged.

Gout can be prevented by controlling the modifiable risk factors. There are risk factors that we can not change such as age, gender (male), and race, but serum uric acid level (diet), obesity, moderate to heavy alcohol intake, and hypertension are some of risk factors that ought to be controlable.

The extremely painful attacks of gout can be treated with proper analgetics and/or steroids. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids are the main agents used to control pain in a gout flare. A thorough communication with a doctor is essential when using these medications.

After the pain is relieved, it is very important to proceed with urate-lowering treatment. This is necessary to protect against future attack of gout and its potentially destructive complications. The urate-lowering treatment is indicated if you have frequent or disabling gout flares, gout with tophi, gout with impairment of renal function, gout with urolithiasis, uric acid overproduction, or if you are under radiation or chemotherapy for lymphoma or leukemia.

Some urate-lowering agents that you may need to know: Allopurinol (the most common and time-tested urate-lowering agents to date), Probenecid (old one, most potent, used primarily when Allopurinol is contra-indicated), and Febuxostat (new agent). There are a few others that mostly experimental.
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