GOUT – MANAGEMENT
The management of gout is dependent on the phase of gout attack- Acute, Intermittent or Chronic.
Treatment of acute attacks is focused on reducing pain:
- Bed rest for initial 24 hours provides great relief.
- Hot fomentation also reduces pain.
- NSAIDs are drugs of choice for pain relief in acute attacks. Though Indomethacin is the most frequently used drug, patients at high risk of side-effects may be recommended newer drug COX-2 inhibitors (nimesulide, celecoxib, rofecoxib).
- Colchicine is also very effective but not used frequently as it has known to cause high incidences of side-effects. Common side-effects include nausea, vomiting, abdominal pain and loose motions.
- Steroid injections may be administered in the affected joint if the use of NSAIDs is contraindicated.
The goal is to:
- Lower the frequency of attacks
- Minimise the deposition of uric acid in the body.
This can be done by changing the lifestyle, diet modification and use of drugs. Guidelines include the following:
- Take low purine diet.
- Avoid alcohol consumption.
- Take adequate amount of fluid as it promotes excretion of uric acid in urine.
- Avoid drugs that increase the blood uric acid levels; e.g. low dose aspirin, certain diuretics.
- Maintain ideal weight.
- Colchicine may be used to prevent further attacks or precipitation of acute gout when uric acid lowering agents are initiated. Colchicine is avoided in presence of renal disease.
- Uric acid level in body can be reduced either by increasing its excretion in the urine (uricosuric drugs) or by decreasing its production :
- Uricosuric drugs probenecid and sulphinpyrazone inhibits the reabsorption of uric acid in kidneys and promotes urinary loss. They should be avoided by peptic ulcer patients. Dyspepsia is a common side-effect of these drugs. Liberal fluid intake (urine output 2 liters) is necessary to avoid precipitation of uric acid in the urinary tract. Low dose aspirin antagonises the action of these drugs and should be avoided.
- Allopurinol inhibits the enzyme xanthine oxidase responsible for formation of uric acid thereby reducing the uric acid level. Common side-effects include precipitation of acute gout, headache and dyspepsia. Ampicillin should be avoided while taking allopurinol.