What to do with gout attacks?

What to do with gout attacks, this article describes how to treat gout and how to prevent gout attacks.

Previously, people often thought that gout was related to the lifestyle. Many people liked to eat fish or seafood , almost everyday. High-purine foods and alcohol were the most likely to cause high uric acid, which in turn could cause gout. Cosimodi Giovannide’Medici was the richest man in the world during the Renaissance. He died of gout.

What to do with gout attacks?

But many people are full of doubts, how to treat this gout so badly? I heard that gout comes from eating, so what should we pay attention to?

1. Gout treatment

In fact, the treatment of gout should be strictly divided into two stages. Many people always complain that the medicine prescribed by the doctor is not effective. In fact, this is related to the insufficient grasp of the indications for the treatment of the disease. This issue is often overlooked.

1) Treatment of acute attacks of gout

The treatment of gout attacks has only one purpose, that is, rapid pain relief. Drug therapy is the most effective method and should be treated as early as possible (symptomatic treatment within 24 hours).

There are three main drugs to choose from:

non-steroidal anti-inflammatory drugs NSAIDs,
colchicine
glucocorticoids.

The first two are first-line drugs and should be preferred.

Colchicine:

It is a special medicine for the treatment of gout. The earlier it is used, the better the effect, but after 36 hours, the effect decreases. Specific use: Start taking 2 tablets (0.5mg/tablet), 1 tablet after 1 hour, 1 tablet after 12 hours, and 1 tablet each time, 2-3 times a day.

For patients whose NSAIDs are contraindicated, low-dose colchicine alone is recommended. The adverse reactions of colchicine increase with the increase of the dose. There are often gastrointestinal reactions such as nausea, vomiting, diarrhea, abdominal pain, etc. The drug should be stopped immediately when symptoms appear.

Long-term application can cause elevated transaminase, leukopenia, and renal function damage. So don’t take acute medicine for a long time to control uric acid.

NSAID:

It is the antipyretic and analgesic we often say. This type of medicine has a large family member. Commonly used are Voltaren, ibuprofen, acetaminophen, etc., as well as new analgesics (selective COX-2 inhibitors) iricoxib, meloxicam, celecoxib, etc., the latter has gastrointestinal adverse reactions Less, recommended.

NSAIDs advocate early and adequate doses, that is, give the maximum dose 2 days before the onset of symptoms, and quickly reduce to the regular dose after the symptoms are relieved. The common side effects of this drug are gastrointestinal symptoms, such as gastrointestinal ulcers, gastrointestinal perforation, upper gastrointestinal bleeding, etc. In addition, long-term use can also cause kidney damage. The drugs must be taken strictly in accordance with the drug instructions, and the simultaneous use of two drugs is prohibited.

Hormone:

It is the hormone we often say. It is not the first choice to use. It can only be used when the two types of drugs mentioned above are ineffective or when the kidney function is not good. Apply intermediate-acting hormones such as prednisone (prednisone) or methylprednisolone, time: 0.5mg/kg/day, equivalent to 6-7 tablets of prednisone or methylprednisolone per day, once in the morning, medication 2 -Taking off gradually after 5 days for a total of 7-10 days of treatment.

The long-term use of hormones has many side effects, such as central obesity, infection, diabetes, gastric ulcer, etc. There is no problem with short-term use, mainly to prevent gastrointestinal reactions, such as gastric and duodenal ulcers, gastrointestinal bleeding, etc.

For patients with severe gout and severe pain, it can be used in combination: such as colchicine + glucocorticoid, or colchicine + non-steroidal anti-inflammatory drugs. The combination of non-steroidal anti-inflammatory drugs and glucocorticoids is not recommended, because both of them have obvious damage to the gastrointestinal mucosa and easily cause gastrointestinal bleeding.

According to the Chinese Guidelines for Clinical Diagnosis and Treatment of Gout, it is recommended to first use non-steroidal anti-inflammatory drugs to relieve symptoms during the acute attack of gout. For patients with contraindications to non-steroidal anti-inflammatory drugs, it is recommended to use low-dose colchicine alone. Patients without contraindications can use the combination of the above two drugs to quickly relieve pain. The efficacy and safety of short-term single-use glucocorticoids are similar to those of non-steroidal anti-inflammatory drugs, but they cannot be used for a long time.

During an acute gout attack, the patient should be instructed to reduce activity, rest in bed, raise the affected limb, and apply local ice (or magnesium sulfate wet compress) to lower body temperature and reduce pain and redness. Remember, massage and hot compresses are not allowed at this time. Hot compresses will dilate blood vessels and increase local swelling and pain.

When arthritis has an acute attack, the patient’s blood uric acid concentration should be kept relatively stable as far as possible. It is not recommended to add uric acid lowering drugs during the acute attack of arthritis, and uric acid lowering drugs should be added after the joint pain is completely relieved for 1-2 weeks. It must be noted that starting from a small dose, slowly increasing, so that the blood uric acid gradually decreases gradually, to avoid obvious fluctuations.

However, if the patient has an acute attack while taking the uric acid-lowering drug, it is not necessary to stop taking the uric acid-lowering drug. The purpose is to keep the blood uric acid concentration relatively stable.

2) Uric acid lowering treatment after acute phase.

In addition to the treatment of acute attacks, the treatment of gout is mainly to control uric acid. Only when uric acid is reduced, the various uric acid crystals deposited in the body can be dissolved and discharged. To achieve this, uric acid must be reduced to below 320μmol/L (the upper limit of normal is 420μmol/L), that is, to insist on taking uric acid lowering drugs for a long time.

In short, if acute gouty arthritis attacks more than twice a year, and is accompanied by chronic gouty arthritis, or is diagnosed with tophi, uric acid-lowering treatment is required.

Adjust the water level in the water tank, on the one hand, close the water inlet valve, on the other hand, accelerate the drainage and control uric acid. When using uric acid-lowering therapy, we can inhibit the production of uric acid on the one hand. Allopurinol or febuxostat is recommended for these drugs; on the other hand, it can promote the excretion of uric acid, and benzbromarone is recommended.

Allopurinol: The initial dose for adults is 50-100 mg/day, and the maximum dose is 600 mg/day. Patients with renal failure should reduce the dose. When the dose is 50-100mg/d, the glomerular filtration rate is ≤60ml/min, and it should be disabled when the glomerular filtration rate is ≤30ml/min. Allopurinol can cause skin allergies and liver and kidney damage, and can cause exfoliative dermatitis in severe cases.

Febuta: The initial dose per day is 20-40 mg, and the maximum dose is 80 mg/day. Kidney safety, mild to moderate renal insufficiency does not need to be reduced, and severe renal insufficiency is used with caution (glomerular filtration rate ≤ 30ml/min). Side effects include liver damage, nausea, rash, etc. This is a new uric acid control drug, which is relatively safe, but the disadvantage is one word, expensive!

The starting dose for adults is 25-50mg/day, and the highest dose is 100mg/day, taken after breakfast. It is safe for the kidneys. When the glomerular filtration rate is 20-60ml/min, it is recommended to use 50mg per day; when the glomerular filtration rate is 20ml/min, or patients with uric acid nephrolithiasis are contraindicated. Side effects include gastrointestinal discomfort, diarrhea, skin rash, and liver damage.

Uric acid lowering drugs have certain liver and kidney toxicity, and liver and kidney function should be closely monitored during uric acid lowering treatment.

Because taking uric acid lowering drugs can cause blood uric acid to rise, a small dose of colchicine (0.5-1mg/d) is needed in the early stage of treatment to prevent acute gout attacks.

Patients who cannot tolerate colchicine can consider using low-dose NSAIDs or COX-2 inhibitors instead.

2. Prevention of gout attacks.

In addition to drug treatment, good living habits are the only way to treat gout and hyperuricemia. Because gout is “disease comes from the mouth”, what should we pay attention to?

Low-purine diet.

When it comes to the gout diet, many people immediately blurt out: Eat less meat and drink more water! Yes, but that is only part of the reason. There is also knowledge about how to eat it.

Strict restrictions on high-purine foods such as animal offal, aquatic products, and meat. It is a general principle to encourage eating more fresh vegetables, and moderate consumption of beans and soybean products. Some patients believe that animal foods contain high purines, so they include animal foods such as fish and eggs and milk in their diets.

Animal offal, broth, all kinds of meat and most fish contain a lot of purines. However, milk and eggs are low-purine foods, rich in high-quality protein and essential amino acids, and can be completely consumed by gout patients. Although soybeans are high-purine foods, their purine content is greatly reduced after being made into soy products, and patients with gout can also consume them in moderation.

Patients with gout should follow the principle of a low-purine diet, but milk and eggs can be eaten completely, and patients with hypercholesterolemia should pay attention to not excessive egg yolk.

Because purine is easy to dissolve in the soup, the content of purine in various broths is extremely high, even the milder gout patients cannot drink the broth, but after the lean meat is boiled, the soup can be discarded and restricted.

(source:chinanet, reference only)

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