Modern Treatments for Gout
I'm medical and also have suffered from gout. Gout is caused when uric acid, always present in the blood, reaches too high a concentration and precipitates out of solution in crystal form and accumulates in the joints. Like little grains of sand. Ouch!
The old treatment was a combination of indomethacin and cholchicine. Indomethacin is a powerful non-steroidal anti-inflammatory, in the same class as ibuprofen (Advil). Colchicine is derived from the autumn-blooming crocus and has been known as a treatment for gout for two thousand years. Colchicine inhibits uric acid (urate) crystal deposition, which is enhanced by a low pH in the tissues, probably by inhibiting oxidation of glucose and subsequent lactic acid production in white blood cells. The inhibition of uric acid crystal formation is a vital aspect on the mechanism of gout treatment. However, colchicine is mildly toxic, and that is why doctors typically recommend that patients take indomethacin to relieve the inflammation (for most people it takes the "edge" off) while the colchicine works to prevent the deposition of more uric acid crystals. Also, doctors typically will tell the patient to take the colchicine until one of two things happens: the gout subsides, or, the patient is stricken with diarrhea.
Some physicians will prescribe indomethacin alone, and this works (at least it did for me) to stop acute attacks.
One approach -- very painful, but briefly so -- is the direct injection of a steroid by needle -- into the affected joint. This works very quickly -- in a few minutes -- to totally relieve pain, but be sure to ask the doctor for a soft cast .45 Colt 255 grain bullet to bite on before he sticks you. You will be glad you did, and the doctor won't be so likely to hear the string of cuss words that will try to come out of your mouth when he jabs you.
The problem with these treatment approaches is that they are reactive, and that patients almost always suffer recurrences.
The better approach is to prevent the attack in the first place.
The drug most commonly prescribed to prevent gout is allopurinal, which acts by inhibiting the production of uric acid, but there are others, including probenecid, which acts by preventing the reabsorption of uric acid in the body and causing its greater excretion, and hence leads to a lowering of uric acid levels in the blood.
Under development and now in Phase III clinical trials (final pre-marketing phase) is a drug called pegloticase, which will dissolve uric acid crystals safely.
Diet makes a difference since uric acid production is related to the level of purines in the blood, and protein, fat, and alcohol all contribute to elevated purine levels. However, I have never heard of anyone whose gout was controlled by diet alone.
Personally, I have found that 800 mg. of Advil (4 gel caps) taken every day, seems to prevent attacks. I take this dose (which is the dose they will give you in the hospital and can be repeated every 8 hours; the over the counter stuff is only 200 mg. per capsule) every day to control my mild osteoarthritis, and it seems to have the effect of preventing further bouts with the gout. However, this is non-scientific evidence, some people cannot tolerate this dose, and I am not recommending it to anyone. Your treatment should be decided in consultation with your physician, not some guy on the internet.
By the way, do not -- never -- take aspirin for pain control with gout. It will increase acidity and make the condition worse. if you have trouble with indomethacin or ibuprofen, talk with your doctor. There are other non-steroidal anti-inflammatories available, and one of those may be right for you.
I hope this helps.
Bullseye
