Arthritis Treatment: The Four Critical Keys To Optimal Gouty Arthritis Treatment

Gouty arthritis (GA) is an inborn error of metabolism. This means that the normal conversion of purines (an ingredient found in many foods) to uric acid (UA) works abnormally. The end result is an abnormal accumulation of UA in the blood and other body tissues because either UA is overproduced or it is under-excreted (not being rid from the body).

The buildup of UA in joints leads to a painful form of arthritis which can cause crippling and disability. Also, gout can cause the kidneys to become damaged.

There are three stages of gout:

* Asymptomatic elevated UA in the blood
* Acute attacks of GA
* Chronic GA

So what is the treatment?

1. The treatment of the acute attack is aimed at reducing symptoms as quickly as possible. This involves using one of three options: colchicine, non-steroidal anti-inflammatory drugs, or steroids, given either by mouth or by injection.

However, that is only part of the optimal treatment because it is critical to understand that once gout causes symptoms, this means that UA has accumulated over a long period of time and it is going to be necessary to place a patient on long term UA lowering medicines.

2. Diet is probably the first issue to bring up since many foods are high in purines and need to be avoided. These include red meat (beef, pork, etc), beer, hard liquor, shellfish, soft drinks (which contain corn syrup), and canned fish such as tuna and sardines. Eating foods high in purines is sure to trigger an attack of GA in a susceptible patient.

3. Uric acid lowering drugs also need to be instituted. The decision as to when and what kind need to be individualized. It's important to understand that during the first six months of therapy, a patient needs to be on prophylactic colchicine or anti-inflammatory medicines in order to prevent a flare up of gout. It is felt that the rapid fluctuations in blood uric acid are responsible for these paradoxical attacks.

The aim is to lower the blood UA level to less than 6.0 mg/dl.

Once that target level has been achieved, most patients will become symptom free.

4. The three main types of uric acid lowering drugs are probenecid, allopurinol, and Uloric. There are other drugs in development for GA. Some are aimed at treating acute attacks that don't respond to conventional medicines. Others are designed to help patients who have difficulty with chronic disease and lack of response to conventional medicines.