A gout attack that comes on suddenly and abruptly needs to be seen by a physician in the first 24 hours of its onset. Your doctor will immediately prescribe you medications that alleviate your acute gout attack or the immediate swelling and pain caused by the sharp increase in your uric acid levels.
But that’s not where the treatment phase ends. We need to also treat the actual cause of the gout attack, the high levels of uric acid in the blood, to prevent the chronic effects of gout.
Remember uric acid is the compound in the body responsible for the development of gout and is a natural product of the breakdown of many foods,and even cells in our body.
This article will cover the medications that can be prescribed to you to keep your uric acid level down and maintain it there. In someone that has large deposits of gout in the body called tophi, has at least two attacks of gout per year, and has chronic kidney disease or a history of kidney stones composed of uric acid, we must start them on the uric acid lowering therapy.
The goal is to lower down the uric acid level to at least less than six and maintain it there. This is what decreases the existing burden of uric acid and prevents more uric acid from building up in the joints and damaging them.
The following are options for urate-lowering therapy. It is important to know that all of these agents can put you at risk for a gout flare, particularly when they are first started due to shifts in the uric acid level.
Allopurinol is a well-established and commonly used drug, and it’s one of the first line treatments for gout.
It is under the class of xanthine oxidase inhibitors. These work by decreasing uric acid production and is widely available, efficacious and affordable.
Side effects include gastrointestinal distress, rashes, and a rare but severe type of allergic reaction called stevens-Johnson syndrome, and allopurinol hypersensitivity syndrome.
The latter has been implicated in patients with renal impairment and concurrent use of diuretics such as thiazides, and is more common in people of certain ethnic backgrounds.
Febuxostat is from the same class of drug as allopurinol and is a xanthine oxidase inhibitor as well.
It is well-tolerated,comparable in efficacy to allopurinol and safe inpatients with renal impairment. Side effects include diarrhea, nausea, and elevation of liver enzymes.
Increased gout flares have been reported with high doses, and is usually expected in the first month of treatment.
Probenecid is a uricosuric agent. Uricosurics are the second class of uric acid lowering treatment. They lower uric acid levels through increased excretion in the kidneys.
These agents increase the risk of uric acid stones, and is contraindicated in those with a history of kidney stones.
It can be used alone or as an adjunct to xanthine oxidase inhibitors. Allergic reactions can occur with probenecid and should be used with caution in patients with G6PD deficiency and peptic ulcer disease.
Several drug interactions also exist, whereby concurrent use of probenecid may increase blood levels of drugs or diminish their efficacy. Lesinurad is a recently-approved uricosuric which increases uric acid excretion by working on the uric acid transporters in the kidneys.
It is approved for use in combination with a xanthine oxidase inhibitor such as allopurinol for hyperuricemia. It is shown to decrease tophus formation and lower the likelihood of gout flares associated with sustained decrease in serum uric acid.
Most common adverse effects include headache, influenza, and reflux disease. It can also increase creatinine levels, renal stones, and other renal related adverse events have occurred. Duzallo.
This is the newest gout treatment that has become available in the market, and it combines both allopurinol and lesinurad in one pill. This is indicated in patients who have not achieved the goal level of uric acid from allopurinol alone.
The most common adverse effects were headaches, influenza, and increased creatinine levels, as well as reflux.
Similar to side effects from the individual components of allopurinol and lesinurad. Pegloticase is a recombinant enzyme that breaks down uric acid in the body into a form that is easily excretable in the urine.
This medication is given as an infusion every two weeks, and is approved by the FDA for gout that is refractory to conventional treatment, including with deforming tophaceous gout.
This medication can lead to a rapid reduction in uric acid burden in the body and faster dissolution of tophi, and can be used in patients with renal and liver impairment. However, infusion reactions and the development of antibodies against the medication leading to a loss of efficacy can occur.
Patients should not be on another urate-lowering agent at the time of infusions, and close monitoring of the serum uric acid levels should be done prior to each infusion.
If a uric acid of greater than six is seen twice before subsequent infusions, it is recommended that the infusions be stopped so as to prevent side effects.
Can you see how treating the acute gout attack is equally as important as lowering theuric acid level in your body?
There are many different types of medications out there for treating both, but your doctor will find the perfect solution based on your medical analysis. Gout is a disease that is treatable but requires good compliance and a motivated patient.