Gout is a disease characterized by acute pain and the swelling and redness of the affected articulations. This paper aims to describe the key points of gout treatment. For this purpose, it will give an overview of the disease, discuss treatment principles, and consider pharmacological treatment of gout, and monitoring patients’ adherence to it. Finally, important details as to patient variables and education will be described.
A gout is a form of inflammatory arthritis caused by a high concentration of uric acid in the blood. Urate crystals accumulate in and around joints, leading to hyperuricemia (Perez-Ruiz, Dalbeth, & Bardin, 2015). In 90% of cases, gout is caused by impaired functioning of kidneys when they fail to excrete uric acid (Engel, Just, Bleckwenn, & Weckbecker, 2017). In 10% of cases, overproduction of uric acid leads to this illness (Engel et al., 2017, p. 216). There are four phases of gout: asymptomatic deposits in tissues, acute gout, intercritical periods, and chronic gout (Engel et al., 2017). As the disease progresses, the intervals between flares shorten until the pain becomes chronic.
Gout is the form of arthritis that answers to medical treatment. Standardized guidelines prescribe not to treat asymptomatic hyperuricemia (Wüthrich, Alromaih, & So, 2016). The treatment should start in cases of established gout involving joint erosions and tophi (Wüthrich et al., 2016). The cure follows two stages: first, the urate crystals are dissolved; second, the formation of new crystals is prevented (Perez-Ruiz et al., 2015). The evidence-based recommendation includes treat-to-target, which implies setting a therapeutic goal and regularly testing the progress (Golenbiewski & Keenan, 2019). If there is no advance, the treatment should be changed. Furthermore, the cure should consist of non-pharmacological and pharmacological therapy (Engel et al., 2017). Non-pharmacological treatment includes patient education, changes to diet, and resting the joint (Engel et al., 2017). These measures are essential for the effectiveness of the prescribed medicine.
Pharmacological treatment aims at releasing the pain, reducing inflammation, and lowering the uric acid concentration. First-line medications for treating gout are “nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and colchicine” (Engel et al., 2017, p. 218-219). The most common NSAIDs used for gout treatment are naproxen (Naprosyn), indomethacin (Indocid, Indocin), tenoxicam (Mobiflex) celecoxib (Celebrex, Onsenal), etoricoxib (Arcoxia), and etodolac (Lodine SR, Eccoxolac) (Wüthrich et al., 2016). Colchicine is sold under the trade name Colcrys and is more effective when taken at the beginning of a flare (Golenbiewski & Keenan, 2019). Glucocorticoids are used when colchicine and NSAIDs are contraindicated (Wüthrich et al., 2016). The most common of them are methylprednisolone (Medrol) and triamcinolone (Kenalog) (Wüthrich et al., 2016). As mentioned above, asymptomatic hyperuricemia does not require pharmacological treatment. At the stage of acute gout, therapy should begin as soon as possible; otherwise, the flare may last between 3 days and 2 weeks (Engel et al., 2017). Xanthine oxidase inhibitors are used for treating chronic gout since they lower uric acid levels (Golenbiewski & Keenan, 2019). Thus, the medications differ depending on the stage of the disease.
Since gout treatment is long-lasting and has side effects, patients may fail to adhere to the prescriptions. Therefore, patients prescribed NSAIDs, colchicine, or xanthine oxidase inhibitors should be monitored by checking serum uric acid levels, liver, and kidney (Golenbiewski & Keenan, 2019). It is also necessary to evaluate patients’ nutrition and the state of comorbidities (Golenbiewski & Keenan, 2019). Patients should be encouraged to change their diet by avoiding the consumption of food with high purine and fructose content (Wüthrich et al., 2016). Finally, educating patients about the necessity of treatment and reminding them to take their medicines are important measures. Patient education should include explaining the need for increasing physical activity and reducing excess weight.
In conclusion, gout is a disease that should be treated as soon as possible to prevent patients from experiencing chronic pain. The medications prescribed to patients with gout include NSAIDs, colchicine, or xanthine oxidase inhibitors. Their use depends on patients’ tolerance of a particular medicine and the disease stage. To ensure the effectiveness of the treatment, monitoring patients is necessary, including medical tests and reminders.
References
Engel, B., Just, J., Bleckwenn, M., & Weckbecker, K. (2017). Treatment options for gout. Deutsches Ärzteblatt International, 114(13), 215-222.
Golenbiewski, J., & Keenan, R. T. (2019). Moving the needle: Improving the care of the gout patient. Rheumatology and Therapy, 6(2), 179-193.
Perez-Ruiz, F., Dalbeth, N., & Bardin, T. (2015). A review of uric acid, crystal deposition disease, and gout. Advances in Therapy, 32(1), 31-41.
Wüthrich, H., Alromaih, F., & So, A. (2016). Guidelines for the treatment of gout: A Swiss perspective. Swiss Medical Weekly, 146, 1-7.