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- Rich food and alcohol are often a part of celebrations.
Unfortunately, after all the enjoyment,
an unfortunate thing can occur for people at risk,
a bad gout attack.
Certain foods and alcohol drinks
contain high levels of purines,
which then produces high levels of uric acid
when broken down in the body.
The uric acid crystallizes and forms around the joint,
causing a very very painful joint.
So how do we treat this problem
and ensure that it does not keep occurring?
The treatment of gout requires two approaches.
First, we must treat the acute attack of swelling and pain.
Meaning the immediate swelling and pain
caused by the excess food and drink,
which raised your uric acid level.
Second, we then treat the actual cause of the gout attack,
the principle problem of the high levels of uric acid.
We do this by lowering these levels down through medication.
In this video we'll be talking solely
about treating the acute gout attack
or immediate swelling and pain of the affected joint.
Pharmacologic treatment is crucial in gout attacks.
And anti-inflammatory medications should be given
within 24 hours of onset to be most effective.
The goal of these medications is
to decrease pain and swelling of the joints affected.
The choice of which agent you would be prescribed
depends on the severity of the symptoms,
the number of joints involved,
and the other medical issues the patient has.
Your physician will be able to talk to you
about your treatment options.
Let's get started learning about the medications
you may be prescribed for treating your acute gout attack.
Nonsteroidal anti-inflammatory drugs, also known as NSAIDs,
are frequently used to quickly relieve the pain
and swelling of an acute gout episode.
Especially if taken at the full dose in the first 24 hours.
Commonly used NSAIDs are ibuprofen, indomethacin,
naproxen, COX-2 inhibitors such as celecoxib,
can be used in patients with
gastrointestinal contraindications or intolerance to NSAIDs.
Side effects can include stomach pain and heartburn,
stomach ulcers, high blood pressure,
liver and kidney problems, and a tendency to bleed.
Treatment should be continued
until the acute gout attack completely resolves.
Colchicine is another prescription
and anti-inflammatory medication,
which can be given as several doses in succession initially,
followed by a daily dose until the attack is resolved.
Colchicine's most common side effects
are diarrhea, nausea, and abdominal cramps.
But more severe side effects can occur at high doses.
To avoid side effects, lower doses are much better received
and may be used in combination with NSAIDs.
In patients with contraindication to these other agents,
corticosteroids or steroids are the next choice.
It can be administered as an injection
into the affected joint, called intra-articular,
steroids are given systemically such as orally,
with things such as prednisone or Medrol.
Intra-articular steroids are useful
if only one or two joints are affected.
This modality could be used in combination
with oral steroids, NSAIDs, or colchicine.
Some side effect of systemic steroids
include difficulty sleeping, elevated blood sugar,
high blood pressure and weight gain.
These types of agents are used not only
to resolve an attack of acute inflammation, but also
to prevent it from ever occurring, called prophylaxis.
Although these are the types of agents
people often consider as gout treatment,
one must remember that they only work
to resolve the effects of inflammation from gout,
and not treat the actual reason for gout,
which is the high levels of uric acid.
We will talk about these agents in the next section.
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