If you have chronic gout – persistently high levels of uric acid and gout attacks – the most important part of your care is keeping uric acid levels low (below 6.0 mg of uric acid to l dl of blood) in order to stave off future attacks.
Uric acid is formed from purines, substances in animal and plants that the body converts to uric acid during digestion. Some people’s systems produce too much acid; others can’t excrete what it produced. When excess acid remains in the system, it can form crystals that lodge in the joints, causing the pain and inflammation that characterize a gout attack. If gout is left untreated, tophi – deposits of uric acid crystals – can form under the skin around joints and other soft tissues.
Your doctor will likely prescribe long-term medications to keep uric acid levels steady. Because these drugs cause acid level to shift, you won’t start taking them until your acute attack is under control. (To learn how to manage an acute gout attack, click here).
Some patients only experience one gout attack, so physicians may not start long-term drugs until after a second episode occurs.
It can take time for long-term gout medications. You may even have a flare after you start the medication. So, in the meantime, keep taking the medications your doctor prescribes to treat the acute attack as well.
Below are the medication options for chronic gout.
Allopurinol (Lopurin, Zyloprim), the most traditional and widely used medication for lowering uric acid levels, slows the production of uric acid and may dissolve the uric acid crystals in tophi. However, the drug can take three to six months to dissolve the crystals, and during that time, a gout attack may occur. Doctors typically start patients on a low oral dose, increasing it every two to four weeks, as needed to establish safe uric acid levels. It’s a good choice for patients who overproduce uric acid as opposed to those who under-excrete it (the difference is determined by blood or urine tests). Side effects may include skin rash, sleepiness and stomach upset; the latter usually diminishes as your body adapts to the drug.
Rarely, the drug causes a severe allergic reaction, particularly if you already have congestive heart disease, high blood pressure, diabetes, kidney disease, stomach ulcers or other digestive difficulties, or cancer being treated by radiation or chemotherapy. If you experience itching, a skin rash with hives, fever, nausea or muscle pain, call your doctor immediately. Up to 5 percent of patients can’t tolerate the drug.
Febuxostat (Uloric) was approved by the U.S. Food and Drug Administration (FDA) in 2009. It helps prevent uric acid production by blocking an enzyme that breaks down purines into uric acid. Taken orally once daily, febuxostat is safe for people with mild to moderate kidney or liver disease. Side effects can include liver irritation, nausea, joint pain, and rash. Febuxostat has a higher risk of blood clots than allopurinol.
Probenecid (Benemid, Probalan),taken orally, lowers uric acid in the body by increasing the amount excreted in urine. It’s most likely to be used by people who have trouble excreting uric acid, as opposed to those who overproduce it. Some rheumatologists prefer probenecid to allopurinol because it has less dangerous side effects. However, it isn’t recommended for people with kidney disease. Possible side effects include kidney stones, nausea, skin rash, stomach upset and headaches. Patients taking probenecid need to drink at least eight cups of water or other fluid a day to reduce their risk of kidney stones.
What Doctors Choose:
Allopurinol: For patients who overproduce uric acid; have kidney failure, kidney stones or tophi; use aspirin; or who don’t respond to probenecid.
Febuxostat: For patients with mild to moderate kidney or liver disease. Has an effectiveness and side effects similar to allopurinol.
Probenecid: For patients who cannot tolerate allopurinol. NOT for elderly patients; those with kidney failure or kidney stones; those who take aspirin (it blocks the effect of probenecid); those who overproduce uric acid
drug Niaspan is taken with DiovanHCT which
contains a diuretic to control HBP. I believe
it triggered my attack. Also, is the Niacin
in a multi-vitamin safe. Lastly, what is the
drug LOVAZA's relationship to gout attacks.
If I recall it stated that if the alluprinaol dosage was increased every four weeks it would actually remove all crystals and after a year or 2 would completely cure the gout. I was hoping to pinch the article but someone else nicked the magazine before I had a chance.
Could yu kindly confirm the article as I would like to take it to my GP for further advice?
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