Arthritis Treatment: How to Treat Gout

Gout is the most common form of inflammatory arthritis in men past the age of 40. It is also an increasingly common cause of arthritis in women after menopause.

Gout is a metabolic condition due to inability to maintain normal levels of serum uric acid (SUA). The latter occurs as a result of both overproduction of uric acid from purines, a constituent of many foods, as well as the inability of the kidneys to excrete enough uric acid to maintain normal levels in the blood. Over time there is accumulation of this material in the joints and other organs like the kidneys. Deposits collect in the form of monosodium urate.

When a certain critical point is reached, gout attacks occur. The treatment of gout involves both managing acute attacks as well as controlling elevated levels of serum uric acid. A program that reduces SUA helps prevent recurrent attacks and progression of the disease.

The approach to treatment using medication is three-fold.

First, the acute attack must be "broken" using either colchicine, non-steroidal-anti-inflammatory drugs, or glucocorticoids. The latter can be administered either intramuscularly, directly into the affected joint, or given by mouth.

Once the acute attack is taken care of, attention can then be directed towards lowering SUA. The goal is to keep the SUA below a level of 6mg/Dl. Medications can lower SUA through different mechanisms. Some medicines do it by lowering the amount of uric acid produced. Other drugs lower SUA by increasing the urinary output of uric acid.

When this is started, it's important to understand that flare ups of gout can occur as a result of shifts of uric acid. These are termed "mobilization flares." As a result, patients should receive prophylaxis against these flares. Either low-dose colchicine or non-steroidal anti-inflammatory drugs are the preferred agents. Prophylaxis should be continued for six months.

Lifestyle changes should be addressed. Foods and drinks high in purines should be avoided. These include red meat, shellfish, alcohol, and fructose containing soft drinks. It has been shown that diet alone can lower SUA by 1 mg/dL.

One issue that crops up is the high incidence of non-adherence to drug therapy among gout patients. Therefore, patient education is mandatory and scheduling of follow-up visits with close monitoring of SUA is critical to a good outcome. In addition, laboratory monitoring of blood is important from the vantage point of detecting drug toxicity as well.