Arthritis Treatment: How Is Gouty Arthritis Treated?

Gout is a common metabolic disease characterized by elevated blood levels of uric acid (UA). This arises as a result of either the inability to excrete (get rid of) UA or overproducing it. In any event, what occurs is that over time, deposits of monosodium urate form inside joints and other organs, particularly the kidneys, which is the major organ responsible for excreting UA.

At a certain critical point in time, if enough UA has built up, an attack of gouty arthritis (GA) will occur.

GA typically affects a joint or joints in the leg, preferentially attacking the foot, ankle, or knee. The attacks tend to occur early in the morning, often awaking a patient from sleep. The pain builds in intensity and is accompanied by swelling, redness, and heat. The discomfort is so severe that the patient may complain that even "the weight of a bedsheet" on the affected area causes unbearable pain.

The treatment of GA is generally divided into treatment for the acute attack and treatment of chronic disease.

This article will focus on the treatment of an acute attack.

There are multiple choices available and the decision regarding which avenue to pursue will depend on a number of factors including, the duration of attack, location of attack, the possibility of another process going on (ie, infection), and the presence of co-morbid conditions- other diseases a patient has that could potentially be affected by treatment intervention.

In addition to the medicines that will be discussed, rest with ice may be beneficial since ice reduces inflammation.

Non-steroidal anti-inflammatory drugs (NSAIDS) are the most commonly used treatment for acute attacks.

NSAIDS should be started as soon as possible and tapered when the attack is controlled.

Unfortunately, these medicines have many potential side effects including stomach ulcers, kidney damage, aggravation of hypertension, and increased risk of heart attack and stroke. They should be avoided in patients taking blood thinners. Their use in older individuals should be monitored carefully and avoided if possible.

Colchicine is a time-honored medication that blocks gout inflammation effectively. Low doses, 0.6 mgs two to three times a day for 1-2 days may be sufficient to break an attack. Colchicine has a number of side effects that limit its use. These include stomach cramps, nausea, vomiting bone marrow suppression, and neurologic as well as muscle damage. It should not be used in patients with liver or kidney disease.

Glucocorticoids ("cortisone") can be given directly into the joint if only one or two joints are affected or be given by mouth or intramuscularly. Glucocorticoids are a good alternative when NSAIDs and colchicine can't be used.

Blocking interleukin -1 using biologic therapy is a new concept in the treatment of acute gout attacks. It is very effective but carries the drawback of being extremely expensive.