Gout is the most common type of inflammatory arthritis in men over 40 years old. Gout is also a more common form of arthritis in women who have gone through menopause. Gout is a metabolic condition that results in the inability to maintain normal levels (SUA) of serum uric acid. This is due to both excess uric acids from purines (a component of many foods) and inability to excrete enough uric Acid to maintain normal blood levels. This material builds up in the joints and other organs, such as the kidneys. Monosodium urate is the most common form of deposits.
Gout Attacks
Gout attacks can occur when a certain point is reached. Gout treatment involves managing acute attacks and controlling high levels of serum uric acids. Recurrent attacks and progression can be prevented by a program that lowers SUA. Three steps are required to treat the disease with medication. The first step is to “break” the acute attack using colchicine, nonsteroidal-anti-inflammatory drugs or glucocorticoids. These drugs can be administered intramuscularly, directly into affected joints, or by mouth.
After the acute attack has been treated, you can focus your attention on lowering SUA. The goal is to keep SUA below 6 mg/Dl. Different medications can lower SUA. Some medications lower the amount of uric acids produced. Other drugs reduce SUA by increasing the amount of uric acid excreted. It is important to know that flare-ups of gout can result from shifts in uric acid when this is initiated.
Mobilization Flares
These are called “mobilization flares.” These flares are preventable. The preferred agents are either low-dose colchicine, or non-steroidal antiinflammatory drugs. For six months, prophylaxis should continue. Lifestyle changes should be made. Avoid foods and drinks high levels of purines. These include red meat, shellfish and alcohol.
Studies have shown that diet alone can reduce SUA by 1 mg/dL. Gout patients are more likely to not adhere to their drug treatment. This is a problem. To ensure a positive outcome, education and follow-up visits are essential. Laboratory monitoring of blood is also important for detecting drug toxicity.