Understanding Gout -- Diagnosis & Treatment
What Are the Treatments for Gout? continued...
Once you've had an attack of gout, it's important to take steps toward preventing another attack.
Your doctor will probably advise you to cut out certain protein-rich foods, especially those high in purines, which will break down into uric acid. These foods include red meats, organ meats, anchovies, shellfish, fatty fish, asparagus, spinach, and most dried beans. You should drink plenty of liquids but avoid alcohol, especially beer, which contains high amounts of purines. Obese patients will be advised to lose weight.
After the pain of a gout attack begins to resolve, the next step is to lower the level of uric acid in the blood. The goal of lowering blood uric acid is to slowly dissolve deposits of uric acid in the joint. Lowering the body's level of uric acid can be done through the diet but usually requires drugs.
The most common drug used to prevent gout attacks is allopurinol. It decreases the production of uric acid in the body. Side effects of allopurinol include rashes, drowsiness, and disorientation, and it can have adverse reactions with other medications, particularly blood thinners and diuretics. Allopurinol should not be taken by patients with poor kidney or liver function.
Another drug called febuxostat (Uloric) is approved for chronic management of hyperuricemia (elevated levels of uric acid) in gout patients. It helps prevent uric acid production and lowers elevated uric acid levels. The most commonly reported adverse events in Uloric's clinical trials were liver function abnormalities, nausea, rash, and joint pain.
Some people with gout have high uric acid levels in their blood because their kidneys are not able to get rid of uric acid quickly enough. Drugs like probenecid and sulfinpyrazone increase the excretion of uric acid in the urine, thus lowering the level in the blood. But like other medications used to combat gout, probenecid and sulfinpyrazone may cause adverse interactions with other drugs or complications with existing ailments such as blood disorders, ulcers, and kidney problems.
The drug Krystexxa (pegloticase) can effectively treat 40% of adults with long-standing chronic gout who do not improve with or cannot tolerate other treatments. It is given intravenously and changes uric acid into another form that can be cleared from the body by the kidneys. Krystexxa does have some side effects. A quarter of the patients who participated in the clinical trials experienced a severe allergic reaction to the drug. Health care providers pretreat patients with an antihistamine, acetaminophen, and a corticosteroid to reduce the risk of an allergic reaction.
In many cases, prompt treatment with appropriate drugs solves the problem of gout permanently. People with recurring gout attacks may have to remain on drugs to prevent further attacks, sometimes for life.