Gout - Arthritis : Treatment

by Food and Drug Administration (FDA)

(Page 2 of 2)

As with most illnesses, effective treatment of gout depends on a correct diagnosis. Gout can be unequivocally diagnosed by telltale uric acid crystals in joint fluid. But appropriate treatment is often started after a "clinical" diagnosis based on painfully obvious signs and symptoms and other relevant factors, such as the patient's uric acid level, age, weight, gender, diet, and alcohol use. If this picture adds up to a strong suspicion of gout, treatment can be started with the immediate goal of arresting the acute attack.

Acute gout is treated with drugs that block the inflammatory reaction. One of the oldest agents known to be effective against acute gout is colchicine, which comes from a common European plant, the autumn crocus, and is marketed in this country primarily as a generic drug. An English clergyman, Sidney Smith, said a century and a half ago that he had only to go into his garden and hold out his gouty toe to the plant to obtain a prompt cure. This may have been an exaggeration, but a rapid response to colchicine suggests that the patient does indeed have gout.

This old, powerful remedy is now used less often than it once was because it can be quite toxic, causing nausea, vomiting, diarrhea, and stomach cramps when taken by mouth and severe (even fatal) blood disorders when taken intravenously. Moreover, modern agents, specifically nonsteroidal anti-inflammatory drugs (NSAIDs) are highly effective against acute gout and less toxic than colchicine. To treat an acute case of gout, the first choice of many physicians is the NSAID Indocin (and other brands of indomethacin). Naprosyn (naproxen) is another NSAID commonly used in acute gout.

Steroid drugs, such as Deltasone (and other brands of prednisone) and Acthar (and other brands of adrenocorticotropic hormone), may be used if NSAIDs fail to control an acute attack. Steroids may be taken by mouth or by injection into the bloodstream or muscle.

Drug treatment usually relieves the symptoms of acute gout within 48 hours. Subsequent treatment, which may well be lifelong, is aimed at preventing further attacks by controlling uric acid in the blood — keeping it below concentrations at which crystals can form. Two main treatment approaches are used, in some cases simultaneously.

One approach is to slow the rate at which the body produces uric acid. Zyloprim (allopurinol) has been approved for the treatment of gout and is frequently prescribed for gout patients who have uric acid kidney stones or other kidney problems. Side effects include skin rash and upset stomach, both of which usually subside as the body becomes used to the drug. Zyloprim makes some patients drowsy, so they need to be cautious about driving or using machinery.

The other approach to controlling gout following an initial acute attack is to increase the amount of uric acid excreted in urine. Two so-called uricosuric drugs commonly used for this are Benemid (probenecid) and Anturane (sulfinpyrazone), both approved by FDA for gout treatment. In addition to lowering blood uric acid levels, these drugs help dissolve deposits of uric acid crystals around joints and in other tissue. Zyloprim is also used to dissolve tophaceous gout in uric acid over-producers. Uricosurics can cause nausea, stomach upset, headache, and a potentially serious skin rash.

Drugs to control uric acid levels may, paradoxically, prolong an acute attack. For this reason, Benemid, Anturane and Zyloprim are not used during the acute stage of gout. They may, in fact, induce gout flare-ups during the early part of long-term use. Accordingly, colchicine in a dose low enough to avoid toxic side effects is sometimes prescribed to prevent acute attacks during this phase of treatment.

Common-Sense Measures

Better understanding of what gout is, what causes it, and how to treat it has perhaps dispelled some of the traditional myths about what has been erroneously called "the disease of kings." Then, too, folk wisdom about gout, coupled with good science and medicine, points to measures that prudent people can take to prevent or at least lessen the severity of the condition.

Many authorities and the Arthritis Foundation, which supports research and public service programs relating to gout, advocate weight control as a logical aid to gout prevention. They point out, however, that people who are overweight should get professional guidance in planning a weight-reduction program, because fasting or severe dieting can actually increase uric acid levels.

Experts generally agree that people with gout can eat pretty much what they want, within limits. People who have kidney stones caused by uric acid may need to avoid purine-rich foods. But this problem can usually be handled effectively with drug treatment.

Curbing alcohol use and avoiding "binge" drinking can reduce the likelihood of acute attacks. So can drinking six or eight glasses of water a day, which dilutes uric acid and aids its removal by the kidneys. Some medicines — in particular the thiazide diuretics ("water pills") used to control high blood pressure — tend to increase uric acid levels. A gout patient taking one of these drugs may have to switch to another type of diuretic or blood pressure medicine.

Finally, although uncommon, it might be helpful to find out if an environmental or occupational exposure to lead is playing a role in a patient's problem with gout.

While a cure for gout — a treatment that gets rid of the condition once and for all — isn't on the horizon, reliable and effective ways of diagnosing gout and keeping it under control constitute one of the more impressive success stories of modern medical science.

There may be no sure-fire way to keep a person from having that first agonizing attack, but prompt treatment can minimize the risk of further attacks and virtually rule out the damaging and crippling effects of chronic gouty arthritis.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.