Treatment of Gout

ID-10063055The initial aim of treatment of gout is to reduce and control symptoms of acute attack (flare-up). There are various medications available for treating acute attack such as NSAIDs (non-steroidal anti-inflammatory drugs), corticosteroids, colchicine, pegloticase (approved by USFDA in 2010) etc. Next aim is to prevent recurrent attacks or flare-ups and prevent complications, which can be achieved by use of various medications to lower serum uric acid level, by reducing uric acid production (such as allopurinol, febuxostat) and by increasing uric acid excretion by uricosuric drugs (such as probenecid and sulfinpyrazone).

Treatment of acute attacks (flare-ups) of gout:

NSAIDs in treatment of gout:

NSAIDs are the first line drugs for treatment of acute attacks of gout. Commonly used NSAIDs include piroxicam, indomethacin, ibuprofen, diclofenac etc. These drugs should be given along with acid lowering agents (proton pump inhibitors) such as omeprazole, pantoprazole, rabeprazole etc. to prevent/reduce GIT side effects of NSAIDs.

Corticosteroids in treatment of gout:

Corticosteroids are as effective as NSAIDs, in treating acute attacks of gout and they can be used if NSAIDs cannot be used for any reason. Side effects of corticosteroids shold be kept in mind while using them.

Colchicine in treatment of Gout:

This is not an anti-inflammatory drug, but it specifically subside gouty inflammation and useful only for management of gout. Gastrointestinal side effects are common with colchicine, which limits its use in gout.

Pegloticase in treatment of gout:

Pegloticase is used for treatment of gout, when other commonly used drugs can not be used for some reason in approximately 3% individuals with gout. It is given as intravenous infusion once in two weeks. It can reduce uric acid level too.

Treatment or prophylaxis of chronic gout:

Chronic gout is treated by uric acid lowering agents (allopurinol and febuxostat) and/or by uricosuric agents (probenecid and sulfinpyrazone).

Commonly, uric acid lowering agents or xanthine oxidase inhibitors (allopurinol and febuxostat) are used for treatment of chronic gout. They are more efficacious and have lesser side effects. Both the drugs inhibit enzyme xanthine oxidase, which is responsible for synthesis of uric acid from purine. Both drugs (allopurinol and febuxostat) are effective in loweing serum uric acid level. Recent studies suggest that febuxostat may have slight advantage over allopurinol, because it is more selective in inhibiting xanthine oxidase enzyme and have lesser side effects. It may also be little more efficacious (in reducing serum uric acid level) than allopurinol. Hence, its use is gaining popularity over allopurinol.

Uricosuric agents (probenecid and sulfinpyrazone) are less commonly used than xanthine oxidase inhibitors for treatment of chronic gout. These agents should ideally be used among under-excretors, but under-excretors are equally efficacious in under-excretors also. Hence, they are used less commonly. Uricosuric agents should not be used in individuals with history of kidney stone formation.

 

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4 Comments

  • Peter September 10, 2013 08.16 am

    Well, I just hope there’s a permanent cure for gout. I am so over trying to lessen my intake of almonds. They’re my favorite!

    Reply 
    • admin September 11, 2013 12.15 am

      Permanent cure for gout is not possible in near future

      Reply 
    • Mattie February 09, 2017 01.38 am

      Thanks for writing such an ease-to-undyrstand article on this topic.

      Reply 
    • http://www.hackandcheatscentral.us/ May 08, 2017 03.43 pm

      hej igen.har lige fået mail fra magasin og det viser sig at de har lavet totalt rod i min bestilling så lightscapade er ikke udsolgt endnu, som de skrev til mig i går, så nu burde der være en på vej til mig, endelig :0)

      Reply 

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