Gout is caused by a buildup of uric acid in the blood that crystallizes in joints. The severity of symptoms varies over time, from acute gouty attacks, characterized by significant pain, inflammation and fever to intercritcal periods between attacks in which pain and inflammation are absent or minimal. If left untreated, chronic gout may develop, affecting multiple joints and the development of urate deposits known as tophi. Medications are available to treat and/or prevent gout at these various stages. With the exception of some NSAIDs, all of these medicines are available only by prescription.
NSAIDs
High doses of nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen, ibuprofen or indomethacin, are usually the preferred agents for acute gouty attacks. These drugs relieve pain and inflammation if started soon after the onset of symptoms. They should be taken in high dosages for only a few days and used cautiously, if at all, in patients with a history of stomach ulcers or kidney problems.
Colchicine
Colchicine is used both to treat and prevent acute gouty attacks. For treatment, the drug should be started as soon as symptoms develop and taken in frequent small dosages until pain abates, diarrhea occurs or a maximum dose (typically 8mg) is taken. However, according to treatment guidelines published in "Rheumatology" in 2007, colchicine does not work as fast as the NSAIDs for relieving an acute attack. Colchicine may also be used in lower daily doses with other gout medications to prevent acute attacks.
Corticosteroids
Corticosteroids may be taken by mouth or injection to relieve acute attacks if NSAIDs or colchicine are inappropriate. Prednisone is one of many corticosteroids.
Allopurinol and Febuxostat
Allopurinol or febuxostat (Uloric), may be used to lower blood uric acid levels by decreasing its formation. They do not alleviate acute attacks and should be started during the intercritical period. Like other drugs that reduce blood uric acid levels, allopurinol and febuxostat may initially precipitate acute gouty attacks by mobilizing uric acid. Therefore, they may be used with colchicine to avoid acute attacks during the first few months of therapy. According to the "Rheumatology" guidelines, these agents should generally be tried before probenecid or sulfinpyrazone in most patients.
Probenecid and Sulfinpyrazone
Probenecid and sulfinpyrazone both lower blood uric acid levels by increasing its elimination through the kidneys and should be started during intercritical periods. Like allopurinol and febuxostat, probenecid and sulfinpyrazone do not alleviate acute attacks. They may cause uric acid kidney stones when first initiated, which can be prevented by drinking water and starting with a lower dose. Colchicine may be given with these drugs to prevent acute attacks for the first several months.
References
- "Rheumatolgy"; British Society for Rheumatology and British Health Professionals in Rheumatology Guideline for the Management of Gout; Kelsey M. Jordan, J. Stewart Cameron, Michael Snaith, et al.; August 2007
- "Pharmacotherapy: A Pathophysiologic Approach"; J.T. DiPiro, R.L. Talbert, G.C. Yee, et al, editors; 2005
- "AHFS Drug Information"; G.K. McEvoy, editor; 2009
- Uloric Product Information; Takeda Pharmaceuticals America; February 2009
