Beware when getting can gout be treated and do your research first. Allopurinol. Allopurinol, a xanthine oxidase inhibitor, is a first-line agent to prevent recurrent gout.9 In patients with gout and chronic kidney disease or congestive heart failure, allopurinol has the added benefit of preventing chronic disease progression. Dosing is guided by the target serum uric acid level.9,22 In patients with chronic kidney disease, low initial doses are recommended with slow titration to achieve target uric acid levels.9 Certain ethnic groups have a higher risk of a severe hypersensitivity skin reaction when starting allopurinol therapy. regardless of kidney function, or in Koreans with chronic kidney disease stage 3 or greater.34
Febuxostat. it is not more effective at reducing the frequency of gout flares.35,36 Febuxostat is considered a first-line agent to prevent recurrent gout,9 but it is considerably more expensive than allopurinol.
Probenecid. Probenecid increases urinary excretion of uric acid and is typically used as a second-line treatment because of numerous drug interactions. Of particular concern, probenecid increases blood levels of methotrexate and ketorolac, which may result in severe toxicity. Probenecid may be used in combination with allopurinol or febuxostat when one drug does not independently lower serum uric acid to target levels. Nephrolithiasis is a common adverse effect that may be avoided by high fluid intake and urine alkalization with potassium citrate.9
Pegloticase. The mechanism of action involves metabolism of uric acid to allantoin. It is a third-line agent and is indicated for treatment of refractory gout.28
the Cochrane database, Essential Evidence Plus, and the National Guideline Clearinghouse. The search included expert consensus statements, clinical reviews, and clinical trials. Search terms included gout, gouty arthritis, gout prevention, and gout therapy.
Gout is a painful and potentially disabling form of arthritis that has been around since ancient times. It is sometimes referred to as the “disease of kings,” because people long have incorrectly linked it to the kind of overindulgence in food and wine only the rich and powerful could afford. In fact, gout can affect anyone, and its risk factors vary.
The first symptoms usually are intense episodes of painful swelling in single joints, most often in the feet, especially the big toe. The swollen site may be red and warm. Fifty percent of first episodes occur in the big toe, but any joint can be involved. Fortunately, it is possible to treat gout and reduce its very painful attacks by avoiding food and medication triggers and by taking medicines that can help. However, diagnosing gout can be hard, and treatment plans often must be tailored for each person.
Gout occurs when excess uric acid (a normal waste product) collects in the body, and needle‐like urate crystals deposit in the joints. This may happen because either uric acid production increases or, more often, the kidneys cannot remove uric acid from the body well enough. Certain foods and drugs may raise uric acid levels and lead to gout attacks. These include: