New treatment options for gout
A variety of medications are now available to control chronic gout and prevent permanent damage to bone and cartilage, including:
- Allopurinol (Lopurin, Zyloprim), which decreases the formation of uric acid by the body, has long been used to control chronic gout.
- Probenecid (Benemid) can also reduce elevated uric acid levels by increasing the amount eliminated by the kidneys.
- Febuxostat (Uloric) is another drug that lowers uric acid levels in the blood.
- Pegloticase (Krystexxa), the newest drug to be approved by the FDA, is used for severe cases of gout. Given intravenously, pegloticase converts uric acid into a substance that can be eliminated by the body.
The goal of treatment is to bring uric acid levels in the bloodstream down to at least 6 mg/dL, or even lower if you have tophi. When uric acid levels dip low enough, accumulations of uric acid crystals begin to dissolve.
Oddly enough, uric acid-lowering drugs can actually trigger an acute flare-up of gout, especially within the first two weeks of treatment. "When drugs begin to break up deposits and the uric acid crystals come up into joint fluid, you can get a sudden inflammatory response," says Baraf. To prevent flare-ups, doctors prescribe anti-inflammatory medications along with uric acid-lowering medication. Most experts recommend continuing anti-inflammatory drugs for 6 months or until uric acid deposits have been completely eliminated.
Treatment of gout can become complicated in patients with other serious illnesses, such as kidney disease. However, with effective treatment, experts say, many patients don't have to suffer repeated attacks of gout or the damage to joints that can result from them. Even for patients suffering advanced gout, the effects of treatment can be dramatic.
"We've had patients who were in almost constant pain from gout and really disfigured by the disease," Neogi told WebMD, "and we've seen their tophi melt away with treatment. That's why treating gout can be very rewarding. You really can change people's lives."