When Should Hyperuricemia Be Corrected

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Any correction of hyperuricemia must be life-long if it is to be worthwhile. Patients who correct their hyperuricemia for only a period of months will develop further attacks of gout when their hyperuricemia returns, although they will usually have a further period of some months before more acute attacks recur.

You should understand this and must be so motivated that any therapy, changes in lifestyle and gout remedies, once started, will be continued permanently, whether the hyperuricemia is corrected by correcting the cause or by taking medication. Usually the motivation comes from having experienced the attacks. Lifestyle changes and natural remedies are always preferable to continued use of drug treatments.

Each person is different in the severity and extent of gout needed to persuade them that they need continuing treatment to eradicate the gout. Some people make a permanent resolve after a single attack of gout, while others may suffer acute attacks for years before they decide that they need to correct their hyperuricemia and hence their gout. I generally advise patients to prevent further attacks when they have had two attacks or more of acute gout in a 12 month period. Some patients do not seek preventative treatment because they do not know it exists, and others feel that the acute attacks of gout can be managed so effectively with anti-inflammatory treatment that regular treatment to prevent the attacks simply is not worth the trouble.

Other patients may not be persuaded to undertake urate correcting treatment until they have developed complications in the form of hypertension, renal disease or tophi.

Decision-making is rarely simple and it needs to be remembered that there are exceptions to all rules in medicine. One way to get started is read the Gout Remedy report (see the link in the right sidebar of this blog). This contains several tips and remedies which you could start using today.

Sometimes patients, despite the best efforts, still develop a flare-up of acute gout during treatment to lower the serum urate. This complex situation needs close medical supervision and treatment which may involve the use of both colchicine and anti-inflammatory drugs to control any acute flare-up while normalisation of the serum urate concentration proceeds.

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Summary

Treat an acute attack of gout early, making certain of the diagnosis.Do not attempt to modify the serum urate concentration intentionally until the acute attack has settled completely.Use prophylactic colchicine in an attempt to prevent further acute attacks of gout.Investigate the cause of the hyperuricemia while you are without symptoms and while you are receiving prophylactic colchicine. As a result of these investigations, decide on a plan of attack to correct the hyperuricemia. This offers two options: either correct the cause of the hyperuricemia by modifying your lifestyle or take drugs to correct the hyperuricemia.Correct the hyperuricemia steadily but slowly under cover of prophylactic colchicine.Reduce the associated risk factors for vascular disease by correcting smoking, obesity, excess alcohol, diuretic therapy and hypertension.Aim to achieve a serum urate concentration consistently less than 0.36 mmol/L (6 mg per 100 mL). This serum urate needs to be checked each 1-2 months for the first 6 months and, once it has been in this normal range for 6 months, it needs to be checked three-monthly for the next 1-2 years, and intermittently thereafter as indicated by the extent of its fluctuation. If it is consistently less than 0.36 mmol/L, it needs to be checked less frequently than if it is sometimes below and sometimes above this value. A serum urate above this value is inadequate for preventing gout and is a signal to the physician to find out why the medication is ineffective. Sometimes, it is simply that the patient is forgetting to take the tablet. The presence of tophi requires a lower urate concentration to be achieved (preferably less than 0.3 mmol/L (5 mg per 100 mL).Above all, don’t intentionally do anything to modify the serum urate concentration while you are still suffering any residual acute gout. Such modification can be taken when you are completely free from gout and are adequately covered by prophylactic colchicine.Tagged as: diet, gout remedies, lifestyle

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