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.

Further treatment

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.