Are you tired of the crippling pain of gout that seems to strike out of nowhere? Are you looking for reliable and effective treatments for gout Stay tuned to find out how, In today,’s video, I will focus on the treatment of gout and how to manage this painful condition. I will discuss everything from common medications like Allopurinol Febuxostat, Colchicine, Pegloticase Methotrexate.
I will also explore the crucial role of lifestyle changes and help you understand when treatment should be initiated based on the latest Gout Guidelines.
So let’s dive right in Hi I am Dr Diana Girnita, The founder of Rheumatologist OnCall, Now To truly comprehend the treatment options.
It’s essential to understand WHAT IS GOUT and how it affects your body.
Gout is a type of arthritis affecting about 9 2 million people only in the US Gout is characterized by sudden severe attacks of pain, swelling redness and tenderness in the joints, often at the base of the big toe, but many other joints can be affected.
It is caused by a build up of uric acid crystals in the joints leading to inflammation and intense pain.
If you want to learn more about gout, you can watch this video on my channel, where I discuss the most common five signs of gout.
Although the treatment for gout has been available for many years and is not expensive at all, many people are still not sure When they should start treatment.
What is the most appropriate treatment? How long should they be on treatment? What are the long term consequences, However? Leaving gout untreated for many years can cause many complications from joints being affected even destroyed by multiple gout attacks to deposits in the skin, like tophi to kidney stones or even kidney disease.
Today We will discuss all of these aspects. Should you treat only the gout flare up or long term to decrease the uric acid level? If you have only 1 2 flare of gout year, then your doctor may decide to treat only that flare and just monitor you Here is the time that you should look over your diet and make some important changes.
If you want to learn what are the best and the worst foods that may trigger a gout attack, watch this video in my channel and learn how food can help you prevent a gout attack.
If you have 2 flares year, then it is the time to start long term therapy that we call URATE LOWERING THERAPY This type of therapy aimed to decrease the amount of uric acid produced in your body.
There are also a few other indications for starting urate lowering therapy, and these are 1 or more subcutaneous.
Tophi Xrays changes due to gout.
If you have the first flare and if you have chronic kidney disease stage 3, if you have kidney stones or if you have a level of uric acid 9 mg dl, you should discuss with your doctor.
If the therapy is beneficial or not to you.
If your uric acid level, 6 8 mg dl, you never experienced gout flares you don’t have tophi.
There is no need to be on long term therapy, Gout flare treatment.
A gout attack can cause debilitating pain To treat a gout flare up. I use a few medications Colchicine.
This is a medication that can reduce inflammation and alleviates the pain.
However, colchicine should be started in the first 24 hours of a gout attack to be effective.
So if you dont, have it handy, usually by the time that patients get to their doctor, they pass this 24 hour window and is not effective anymore.
If colchicine is innefective, then I use NSAIDs like Indometacin Ibuprofen Naproxen Celebrex.
But If you suffer from kidney disease, then you should definitely avoid NSAIDs and start on.
Prednisone Prednisone is a steroid medication and is a very powerful anti inflammatory medication that usually makes wonders as it can decrease the swelling and pain in hours or a few days In some of my patients, I can give them an injection with steroids that can help the Patient faster COMMON MEDICATIONS FOR GOUT, Let’s move on to the medications that are commonly used in the long term.
Treatment of gout Allopurinol Febuxostat are medications that help lower the level of uric acid in your body, preventing the formation of crystals in your joints.
Both of these medications decrease the production of uric acid in your body by inhibiting a specific enzyme called xantine.
Oxidase Allopurinol is usually the first line. Medication preferred even in patients with Chronic kidney disease.
Many patients tolerate this medication.
Well, although some can develop side effects, If you are of Asian background, you should pay attention, as there is a higher risk of developing side effects.
Febuxostat can be used to replace Allopurinol, but it should be avoided.
If you had a history of heart attacks, There were some reports of increased risk of Cardiovascular events with this medication, so disclose to your doctor.
If you, have any heart problems The goal of this therapy is to decrease and maintain the uric acid level to less than 6 mg dl NEWER, TREATMENTS FOR GOUT When patients failed, therapy.
With allopurinol or febuxostat, when they continue to have multiple flare ups and multiple tophi.
At that point, I recommend the newest treatment called PEGLOTICASE.
Pegloticase is a recombinant uricase, created by a genetically altered variant of Escherichia coli that exerts its mechanism of action by catalyzing uric acid.
To the water soluble purine metabolite allantoin, Once the uric acid is oxidized to allantoin, it is readily excreted by the kidneys for elimination, making it a helpful agent in treating chronic gout. This is not a pill.
It is an infusion given to patient through IV therapy.
Every 2 weeks This is a powerful medication, but you should also know that can cause also allergic reactions and many patients develop antibodies against this drug that can decrease the efficacy of the medication.
That is why a relatively new study published in 2022 showed that associating a low dose of methotrexate to pegloticase about 15 mg week.
It might improve the success of this drug and can decrease the number of people that develop antibodies to this drug.
However, this was a small study in only 14 people and we need further study to see if this effect will be sustained in larger studies.
Lifestyle CHANGES.
What I tell patients in my practice, RheumatologistOncall, is that medication is not the only way to manage gout Lifestyle changes play a crucial role in preventing gout attacks.
This includes maintaining a Healthy weight Exercise regularly Avoid foods high in purines Avoid alcohol such as red meat and seafood, and alcohol, especially beer Drinking plenty of water and eating a diet rich in fruits and vegetables can also help manage your uric acid levels and decrease the Frequency of gout attacks – If you want to leran more about foods that you need to eat, check this video in my channel.
So there you have it In this video. I covered the common and newer medications for gout the importance of lifestyle changes and the current guidelines for when to start treatment.
Remember the key to managing gout is a combination of effective medication, lifestyle modifications and regular consultation.
With your physician.
It is very important to have access to a physician when you need it the most, and that is the role of my practice, Rheumatologist OnCall, to be there for patients breaking geographical barriers and offering care in the most difficult moments.
Thank you for watching.
If you found this information helpful, please give this video a thumbs up and subscribe to my channel, And if you have any questions, please leave them in the comments below Stay healthy and I’ll see you in the next video .
