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Controlling chronic gout

After a first attack, doctors usually wait to see if gout flares up again before recommending medications that lower uric acid levels. "Because of potential side effects, we don't want to start patients on long-term drug therapy until we know they have chronic gout," said rheumatologist Tuhina Neogi, MD, an associate professor of medicine at Boston University School of Medicine.

However, doctors may recommend medication immediately in patients who have lumps of uric acid crystal deposits forming under their skin, called tophi. Tophi, which are a sign of chronic gout, can occur anywhere. But they are most likely to form on the ear cartilage or helix, elbows, the Achilles tendon, or around affected joints. Other complications related to chronic gout include the formation of kidney stones and kidney disease.

To diagnose gout, doctors typically measure uric acid levels in the bloodstream. Uric acid levels of 6.8 mg/dL or higher can lead to the formation of uric acid crystals. However, uric acid levels are not a good measure of the severity of gout, Baraf told WebMD. Some people have significantly elevated uric acid levels and no symptoms of gout. Others may have severe gout and only slightly elevated uric acid levels. If levels reach as high as 11 mg/dL, doctors usually recommend lowering uric acid with medication even if there are no gout symptoms.

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.

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