Interim Control – How To Reduce The Risk Of A Gout Attack

You still need to reduce the risk of acute gout while you are waiting for your serum urate to be corrected.

The Gout Remedy report (see the link to the review in the sidebar on my blog ==>) shows you how to reduce the risk and even eliminate the condition completely by changing a few of your lifestyle habits, and consuming some healthy gout foods.

If you prefer to take a pharmaceutical gout treatment, there are two drugs which can prevent acute gout, neither of which has any intrinsic effect upon the serum urate concentration. These are colchicine and the group of NSAID drugs. The dose used depends on the purpose for which they are used. When they are used prophylactically (preventatively), a low dose is used each day. When they are used to treat an acute attack, a large dose is used initially, tailing off fairly rapidly as the acute gout subsides.

A prophylactic (preventive) dose of colchicine ranges between 1 and 2 tablets (each of 0.5 mg) a day. This interferes with the response of the polymorph white blood cells to any urate crystals, reducing the potential for an inflammatory response. In acute gout the dose is usually sufficient to induce diarrhea, but the prophylactic dose should not produce any gastrointestinal side-effects such as abdominal discomfort, diarrhea or nausea.

If it does, the dose should be reduced until it produces no side-effects whatsoever. There have been rare cases of muscle pains and weakness in the lower limbs in patients with kidney insufficiency who have been taking prophylactic colchicine long-term. The value of prophylactic colchicine is sufficient to justify my continuing to advise patients to use it, even if they have some renal insufficiency, although they should be advised to stop the colchicine if they develop weakness or pain in the leg muscles.

Many of the non-steroidal anti-inflammatory agents (NSAIDs) are also useful prophylactics against acute attacks of gout. However, their side-effects are potentially more serious than those of colchicine.

Colchicine is therefore the preferred prophylactic agent and it is totally effective in 80 per cent of patients and ineffective in only 5 per cent.

The use of prophylactic colchicine is particularly valuable in: patients with hyperuricemia between attacks before urate-lowering therapy has been begun or during the investigation of the causes of hyperuricemia; during therapy to lower serum urate to within the normal range, a situation in which, as we have seen, there is an increased risk of precipitating acute gout; and in patients whose serum urate has been restored to the normal range either by lifestyle or dietary modification or by the use of drugs.

In this last group of patients, the risk of gout may continue for about a year of normal urate concentrations and can be reduced by continuing prophylactic colchicine. However, after a patient has had a normal serum urate and no acute attacks of gout for 12 months, the prophylactic colchicine can be stopped.

Some patients who regularly take large doses of NSAIDs to prevent frequent recurrences of gout can develop a very severe attack of gout with the formation of large tophi without warning. This is rarely a problem with colchicine prophylaxis (prevention).

Tagged as: colchicine, gout remedies, gout treatment

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What Medication Can Be Used To Treat An Acute Attack Of Gout

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Generally speaking, the best gout treatment is not pharmaceutical based – natural gout remedies and diet changes are the best way to combat gout. However, in many cases when the pain is unbearable (which it usually is), you need some form of drug based gout treatment to ease the pain. Then you can get on with looking into longer term remedies like those cover in the Gout Remedies Report (find the link in the right sidebar of this site for more details on that).

So, what we want to know is:

What medication is available?What are the benefits and side-effects of each?

Only three types of medication are used to treat an acute attack of gout:

colchicinecorticosteroids, either by injection into the affected joint, taken orally, or by intramuscular injection, andnon-steroidal anti-inflammatory drugs (NSAIDs).

These need to be prescribed and may need to be administered by a medical practitioner. The first couple of attacks of gout probably need to be seen by a medical practitioner, at least to establish the diagnosis. However, once the diagnosis is established, self-medication of previously prescribed medication is both necessary and desirable.

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The gout sufferer can usually diagnose the onset of a further acute attack accurately and at an early stage. Because early treatment can limit the duration of the attack, it is important that the person at risk of an attack of gout has access to one form of treatment which can be taken at short notice, at any hour of the day or night.

In choosing between different therapies, a physician has to weigh up both the likely success of the therapy and the risk to the individual patient of any side-effects. In regard to the attack of gout itself, its severity, the frequency of attacks and previous response to therapy will be useful guidelines.

However, the seriousness and risk of side-effects varies from patient to patient, so selection of treatment needs to be individualised and there are no specific criteria which apply to all patients. The possible side-effects will be known for the individual therapies, but in each case the physician will be trying to balance the associated risks with the benefits. Thus, colchicine may be chosen if non-steroidal anti-inflammatory drugs need to be avoided. Alternatively, steroids may be administered by injection into a joint if medication cannot be taken by mouth, for example because the patient has had a recent operation, or if, for some reason, colchicine and non-steroidal anti-inflammatory drugs are not appropriate.

It is important to emphasise once again that it is vital not to do anything which will either elevate or lower the serum urate concentration while there is any persisting gouty inflammation.

Thus, drugs to lower the serum urate should not be taken while there are any symptoms of gout in a joint. Likewise, drugs which are controlling the serum urate should not be stopped because an acute attack of gout has developed. If acute gout develops, it needs to be treated appropriately on its merits and, at that time, nothing should be done either to correct the associated high urate concentration or to stop drug treatment to control this.

(There is only one special case when the medical practitioner may decide not to follow this rule. That is if the first administration of a drug to lower the serum urate concentration induces an acute attack of gout. In such a case, it may be desirable to stop the urate-lowering drug, but this is not a decision to be made by the patient. I accept that this advice can be a little confusing but it is a special case and does not alter the basic advice which is not to alter the serum urate during an acute attack of gout.)

Tagged as: colchicine, corticosteroids, gout remedies, gout treatment, NSAIDs

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