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Gouty Arthritis MedicationsGouty arthritis (gout) is a common, painful form of arthritis, involving uric acid deposits in the joints. It results from an elevated blood level of uric acid which can be caused by an overproduction of uric acid or a reduced ability of the kidney to eliminate uric acid. The disorder causes joint inflammation and pain, especially in the joints of the feet and legs. Gout most often affects the base of the big toe (podagra). It also commonly affects other joints: the ankle, knee, wrist and elbow. Urate crystals may form in these joints because the joints are cooler than the central part of the body. The uric acid level in the blood becomes abnormally high when the kidneys cannot eliminate enough uric acid in the urine. Too mach uric acid in the blood can result in urate crystals being formed and deposited in joints. Combining a high-purine diet with alcohol can worsen matters, because alcohol both increases the production of uric acid and interferes with its elimination by the kidneys. Gouty arthritis is more common in males, postmenopausal women, and people with high blood pressure. Heavy alcohol use, diabetes, obesity, sickle cell anemia, and kidney disease also increases the risk. The condition may also develop in people who take drugs which interfere with uric acid excretion. Gout medicines are used to relieve acute pain and inflammation and reduce uric acid in the blood, preventing recurrence of attacks. NSAIDs, corticosteroids and an anti-inflammatory medication colchicine are often prescribed to quickly reduce pain and inflammation during gout attacks, but for long-term treatment, the most useful drugs are those that target the build-up of uric acid and prevent deposits of crystals in the joints. Colchicine is the traditional first-step treatment, approved by the FDA in 1939. It is an alkaloid derived from the dried seeds of Colchicum autumnale (known as autumn crocus or meadow saffron). Colchicine is used to treat the acute flares of gouty arthritis or to prevent recurring attacks. This medicine is effective in reducing the pain, swelling, and inflammation associated with acute gout attacks1. Usually, joint pain begins to subside after 12 hours of treatment and is gone within 36 to 48 hours. Colchicine does not cure gout or take the place of the medicines that lower the amount of uric acid in the body. It prevents or relieves gout symptoms by reducing inflammation. Drugs that cause excretion of uric acid in the urine (uricosuric drugs) can be used to lower the uric acid level in the blood (in people who have normal kidney function) by increasing the kidney's excretion of uric acid. Allopurinol (Zyloprim) blocks the production of uric acid in the body and is especially helpful for people who have high blood uric level and urate stones or kidney damage. This medicine is used to prevent gout attacks, not to treat once the attack occurs. Patients should drink plenty of water or other fluids to reduce the risk of kidney complications. Allopurinol can cause a gout attack when it is first taken. Low-dose colchicine or an NSAID is usually given at the same time, for a few months, to decrease this risk. Probenecid (Benemid, Probalan) is used to reduce uric acid levels and decrease the frequency and severity of gout attacks. It is recommended to drink at least 2 liters of fluid a day while taking this medication to prevent uric acid kidney stones from forming. Probenecid is not appropriate for the treatment of an acute attack, and can make an attack worse. Probenecid and colchicine (ColBenemid, Col-Probenecid, Proben-C) is a gout medication that contains uricosuric and anti-inflammatory agents. References
Last updated: June, 2010 |
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