Gout treatment
Treatment of acute attacks of gout
Acute gout or gouty arthritis crises are treated with nonsteroidal anti-inflammatory drugs (NSAIDs), and high doses are often necessary. Although all NSAIDs are probably effective in the treatment of acute gout, indomethacin is usually used.
Acute gout can also be treated with colchicine if the stomach tolerates it.
Drop
Hypouricemic drugs, that is, lowers uric acid, such as allopurinol or probenecid, worsen episodes of acute gout and should never be administered during an acute attack. It is usually treated with colchicine, anti-inflammatories or both at the same time. Colchicine has the disadvantage of producing diarrhea and the anti-inflammatory discomfort of the stomach.
Maintenance treatment
Once the acute arthritis has been controlled, it is necessary to consider whether or not to decrease the uric acid values with medication. In this section we will only review the medications.
There are two classes of useful medications:
Those that prevent the formation of uric acid: Allopurinol.
Those that favor its elimination by the kidney: Probenecid, sulfinpyrazone.
When starting treatment with any of these drugs can cause the onset of a gout attack, so it is usually associated at the beginning the treatment that decrease uric acid with colchicine at low doses to prevent these attacks of arthritis.
The doses that are used in each patient will be variable, but always look for the minimum dose necessary to maintain uric acid in normal figures. This forces us to perform analyzes at the beginning of the treatment with relative frequency, first to adjust the dose to the minimum required and then to verify that there are no undesirable effects due to the medication.
The treatment of gout is very long and generally for life, which should be understood by patients, but in some cases by correcting factors that contribute to hyperuricemia such as obesity and eliminating alcohol and following a strict diet, Patients can minimize medications.
People with asymptomatic hyperuricemia should not be treated unless the uric acid levels are well above normal values or their removal by the kidney is very important, since in these cases the chances of developing arthritis attacks or nephritic colic They are very high. In the rest of the patients, as the risk of developing the disease is not very great they will not be treated.
The choice of treatment depends on the characteristics of each patient. Allopurinol is indicated in patients with nephrolithiasis (kidney stones), gouty tophi (nodules in the joints) or gouty nephropathy, as well as those with a congenital hyperproduction of uric acid.
Just as it is known that the diet is not very useful, adequate hydration is important in the treatment of gout.
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