Gout

Gout (also called gouty arthritis, Greek name: podagra, from pod - foot and agra - trap) is a form of arthritis caused by the accumulation of uric acid crystals in joints. It is an intensely painful disease, which in most cases affects only one joint (monoarthritis), most commonly the big toe.

Treatment

Attacks

Acutely, first line treatment should be pain relief. Once the diagnosis has been confirmed, the drugs of choice are indomethacin, other nonsteroidal anti-inflammatory drugs (NSAIDs), or intraarticular glucocorticoids, administered via a joint injection.

Related Topics:
Indomethacin - Nonsteroidal anti-inflammatory drugs - Glucocorticoids - Joint injection

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Colchicine was previously the drug of choice in acute attacks of gout. It impairs the motility of granulocytes and can prevent the inflammatory phenomena that initiate an attack of gout. Colchicine should be taken within the first 12 hours of the attack and usually relieves the pain within 48 hours. Its main side-effects (gastrointestinal upset) can complicate its use. NSAIDs are the preferred form of analgesia for patients with gout.

Related Topics:
Colchicine - Granulocyte

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Before medical help is available, some over the counter medication can provide temporary relief to the pain and swelling. NSAIDs such as ibuprofen can reduce the pain and inflammation slightly. Preparation H hemorrhoidal ointment can be applied to the swollen skin to reduce the swelling temporarily. Professional medical care is needed for long term management of gout.

Related Topics:
Ibuprofen - Preparation H - Hemorrhoidal - Ointment

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Prevention

Long term treatment (in frequent attacks) is antihyperuricemic therapy. Dietary change can make a small contribution to lowering the plasma urate level if a diet low in purines is maintained, because the body metabolizes purines into uric acid. The mainstay of this approach, however, is the drug allopurinol, a xanthine oxidase inhibitor, which directly reduces the production of uric acid. However, allopurinol treatment should not be initiated during an attack of gout, as it can then worsen the attack. If a patient is on allopurinol during an attack, it should be continued.

Related Topics:
Allopurinol - Xanthine oxidase

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The decision to use allopurinol is often a lifelong one. Patients have been known to relapse into acute arthritic gout when they stop taking their allopurinol, as the changing of their serum urate levels alone seems to cause crystal precipitation.

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Probenecid, a uricosuric drug that promotes the excretion of uric acid in urine, is also commonly prescribed - often in conjunction with colchicine. Interestingly, the drug fenofibrate (which is used in treating hyperlipidemia) also exerts beneficial uricosuric effect (Bardin 2003).

Related Topics:
Probenecid - Colchicine - Fenofibrate - Hyperlipidemia

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Allopurinol and ucosoric agents are contraindicated in patients with kidney stones and other renal conditions.

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As arterial hypertension quite often coexists with gout treating it with losartan, an AT receptor antagonist, might have an additional beneficial effect on uric acid plasma levels. This way losartan can for instance offset the negative side-effect of thiazides (a group of diuretics used for high blood pressure) on uric acid metabolism in patients with gout.

Related Topics:
Losartan - AT - Thiazide - Diuretic - High blood pressure

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Surgery

For extreme cases of gout, surgery may be necessary to remove large tophi and correct joint deformity.

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