Gout: Difference between revisions
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[[Allopurinol]] can reduce frequency of attacks. However, when [[allopurinol]] is started, [[colchicine]] 0.6 mg twice daily should also be used. In a [[randomized controlled trial]], co-treatment with colchicine 0.6 mg twice daily while allopurinol was tapered up from 100 mg/day until 3 months after the serum urate concentration < 6.5 mg/dl, reduced flares of gout from 77% in the placebo broup to 33% with colchicine prophylaxis. Most of these patients had tophi.<ref name="pmid15570646">{{cite journal |author=Borstad GC, Bryant LR, Abel MP, Scroggie DA, Harris MD, Alloway JA |title=Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis |journal=J. Rheumatol. |volume=31 |issue=12 |pages=2429–32 |year=2004 |pmid=15570646 |doi=}}</ref> | [[Allopurinol]] can reduce frequency of attacks. However, when [[allopurinol]] is started, [[colchicine]] 0.6 mg twice daily should also be used. In a [[randomized controlled trial]], co-treatment with colchicine 0.6 mg twice daily while allopurinol was tapered up from 100 mg/day until 3 months after the serum urate concentration < 6.5 mg/dl, reduced flares of gout from 77% in the placebo broup to 33% with colchicine prophylaxis. Most of these patients had tophi.<ref name="pmid15570646">{{cite journal |author=Borstad GC, Bryant LR, Abel MP, Scroggie DA, Harris MD, Alloway JA |title=Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis |journal=J. Rheumatol. |volume=31 |issue=12 |pages=2429–32 |year=2004 |pmid=15570646 |doi=}}</ref> | ||
Allopurinol should be increased as possible to achieve a goal serum urate of <u><</u>6 mg/dl (360 micromoles/liter).<ref name="pmid17907217">{{cite journal |author=Perez-Ruiz F, Lioté F |title=Lowering serum uric acid levels: What is the optimal target for improving clinical outcomes in gout? |journal=Arthritis Rheum. |volume=57 |issue=7 |pages=1324–8 |year=2007 |pmid=17907217 |doi=10.1002/art.23007}}</ref> | [[Allopurinol]] should be increased as possible to achieve a goal serum urate of <u><</u>6 mg/dl (360 micromoles/liter).<ref name="pmid17907217">{{cite journal |author=Perez-Ruiz F, Lioté F |title=Lowering serum uric acid levels: What is the optimal target for improving clinical outcomes in gout? |journal=Arthritis Rheum. |volume=57 |issue=7 |pages=1324–8 |year=2007 |pmid=17907217 |doi=10.1002/art.23007}}</ref> | ||
Febuxostat, a non-purine inhibitor, is equally effective as allopurinol when compared in a [[randomized controlled trial]].<ref>Becker MA, Schumacher HR Jr, Wortmann RL, MacDonald PA, Eustace D, Palo WA, Streit J, Joseph-Ridge N.Febuxostat compared with allopurinol in patients with hyperuricemia and gout.N Engl J Med. 2005 Dec 8;353(23):2450-61. PMID 16339094</ref> | [[Febuxostat]], a non-purine inhibitor, is equally effective as allopurinol when compared in a [[randomized controlled trial]].<ref>Becker MA, Schumacher HR Jr, Wortmann RL, MacDonald PA, Eustace D, Palo WA, Streit J, Joseph-Ridge N.Febuxostat compared with allopurinol in patients with hyperuricemia and gout.N Engl J Med. 2005 Dec 8;353(23):2450-61. PMID 16339094</ref> | ||
===Uricosuric agents==== | ===Uricosuric agents==== | ||
Revision as of 15:29, 24 June 2008
Treatment
Randomized controlled trials find similar benefit from nonsteroidal anti-inflammatory drugs and oral glucocorticoids. In the first trial, less adverse drug reactions occurred in the glucocorticoids group.[1] In the nonsteroidal anti-inflammatory drugs group, each patient initially received diclofenac (75 mg) intramuscularly, indomethacin 50 mg orally, and acetaminophen 1 g orally. The patient was received a 5-days of indomethacin (50 mg orally every 8 hours for 2 days, followed by indomethacin 25 mg every 8 hours for 3 days), and acetaminophen 1 g every 6 hours as needed. The glucocorticoids patients received prednisolone 30 mg orally, and acetaminophen 1 g orally. The patient was then given prednisolone 30 mg orally once per day for five days.
In the second randomized controlled trial equal effect resulted from prednisolone 35 mg orally per day or naproxen 500 mg orally per day.[2]
A randomized controlled trial found that patients who used ice packs had better relief of pain with no negative side effects.[3]
Prevention
Diet
Avoiding products with high fructose such as sugary soft drinks (sweetened with high fructose corn syrup), and other high-fructose products, such as fruit juice, apples, and oranges may help.[4]
Medications
Xanthine oxidase inhibitors
Allopurinol can reduce frequency of attacks. However, when allopurinol is started, colchicine 0.6 mg twice daily should also be used. In a randomized controlled trial, co-treatment with colchicine 0.6 mg twice daily while allopurinol was tapered up from 100 mg/day until 3 months after the serum urate concentration < 6.5 mg/dl, reduced flares of gout from 77% in the placebo broup to 33% with colchicine prophylaxis. Most of these patients had tophi.[5]
Allopurinol should be increased as possible to achieve a goal serum urate of <6 mg/dl (360 micromoles/liter).[6]
Febuxostat, a non-purine inhibitor, is equally effective as allopurinol when compared in a randomized controlled trial.[7]
Uricosuric agents=
References
- ↑ Man CY, Cheung IT, Cameron PA, Rainer TH (2007). "Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute goutlike arthritis: a double-blind, randomized, controlled trial". Annals of emergency medicine 49 (5): 670–7. DOI:10.1016/j.annemergmed.2006.11.014. PMID 17276548. Research Blogging.
- ↑ Janssens et al. Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial. Lancet. 2008 May 31;371(9627):1854-60. PMID: 18514729
- ↑ Schlesinger N, Detry MA, Holland BK, et al (2002). "Local ice therapy during bouts of acute gouty arthritis". J. Rheumatol. 29 (2): 331–4. PMID 11838852. [e]
- ↑ Hyon K Choi and Gary Curhan, “Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study,” BMJ (January 31, 2008): bmj.39449.819271.BE.
- ↑ Borstad GC, Bryant LR, Abel MP, Scroggie DA, Harris MD, Alloway JA (2004). "Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis". J. Rheumatol. 31 (12): 2429–32. PMID 15570646. [e]
- ↑ Perez-Ruiz F, Lioté F (2007). "Lowering serum uric acid levels: What is the optimal target for improving clinical outcomes in gout?". Arthritis Rheum. 57 (7): 1324–8. DOI:10.1002/art.23007. PMID 17907217. Research Blogging.
- ↑ Becker MA, Schumacher HR Jr, Wortmann RL, MacDonald PA, Eustace D, Palo WA, Streit J, Joseph-Ridge N.Febuxostat compared with allopurinol in patients with hyperuricemia and gout.N Engl J Med. 2005 Dec 8;353(23):2450-61. PMID 16339094