What medications will help cure the gout
The joint is destroyed due to the deposition of urate salts
Gout is a joint disease, which is described by ancient scientists. To combat it, use both long-known medicines and new drugs. Treatment of gout is usually done in two stages.
- First, eliminate pain, then relieve swelling. In this case, redness occurs from the sites damaged by the disease. Thus, the inflammatory process during an attack is removed. Treatment is carried out until the symptoms disappear.
- The next step is to use a cure for gout, which helps reduce the level of uric acid in the blood and reduces the frequency of seizures. For the disease to recede, the drug should be taken within a few days or weeks after another exacerbation of the disease.
The duration of the course depends on the level of uric acid in the blood. In some cases, the medicine for gout will have to be taken for several years.
Features of therapy for gout
For the treatment of gout, a combined method of using medicines is used. With a short-term therapeutic course, the administration of drugs that relieve pain and inflammation with a severe attack of the disease is prescribed. For these purposes, the patient is prescribed non-steroid drugs, and not aspirin, which can lead to an aggravation of the disease. During this period, colchicine is used, which can be recommended for long-term therapy.
The use of corticosteroids, which are sometimes injected directly into the affected joint, is indicated. This is necessary when other drugs do not work on the patient or are contraindicated to him. Many medications for gout can not be used if the patient suffers from chronic kidney failure, various gastrointestinal diseases with bleeding.
Long-term treatment uses drugs that lower the level of uric acid in the blood and remove it from the body through the kidneys. To reduce the production of this substance use allopurinol. To reduce the number of seizures will help such a drug as colchicine. It is also taken for preventive purposes to prevent an unwanted exacerbation of the disease.
If treatment is started in a timely manner, relief in case of an attack may occur within a day. To do this, the doctor appoints a one-time intake of the maximum dose of one or more drugs. Subsequently, the amount of the drug taken is reduced.
All drugs that reduce the level of uric acid have many contraindications. Therefore, the doctor and the patient should be sure of the correctness of the diagnosis. The patient should not use aspirin to reduce pain, this can only intensify seizures.
Drugs for the treatment of
There are many drugs around the world that are supposed to be used to combat gout. To eliminate the increase in the amount of uric acid in the blood, the following medicines are recommended.
- Losartan. It also uses to combat hypertension.
- Fenofibrate. It affects some fats in the blood and helps to remove uric acid from the body.
- Urtoxidase. Has the same effect as the above drug.
- Phoebusostat( Y-700).Affects the amount produced by the patient's body uric acid.
These drugs are used if the doctor for any reason can not prescribe the patient allopurinol. It is also worth studying the effect of three drugs, which are most often prescribed to patients suffering from gout.
The drug is good for removing uric acid from the blood.
Fullflex is a remedy for gout and is used to eliminate the symptoms of myalgia, rheumatism, osteochondrosis, various types of arthritis. Has anti-inflammatory effect. Helps to eliminate pain in the attack of gout and removes uric acid from the body. It is prescribed to patients in the form of capsules or cream. Take it for a month for 1 tablet a day. The cream should be rubbed 2 times a day. Contraindicated in pregnancy and lactation.
Allopurinol as a cure for gout is used to control the increased amount of uric acid in the blood and in the presence of the complications caused by it. It is prescribed to patients in the form of tablets. Daily rate for gout 0.1-0.2 g. If the disease has an average severity, increase the dose to 3-4 tablets( 0.3-0.4 g).The decrease in the level of uric acid occurs after 1-2 days. The drug has no analgesic effect, but can reduce the number of gout attacks.
This remedy is contraindicated in cases of impaired liver function and during pregnancy. The main side effects: headache and dizziness, depression, general weakness, hematuria, nausea, diarrhea, vomiting. Perhaps the emergence of symptoms of hypertension or bradycardia, stomatitis. For individual intolerance, stop taking the medication immediately and consult a doctor who will choose another medication.
The medicine well anesthetizes and relieves an acute attack of the disease.
Use a medicine called "colchicine" from gout. It has a very strong analgesic effect and is used to eliminate the symptoms of an acute attack. The drug is absolutely harmless to the body, since it has a vegetable origin. Produced in the form of tablets. Used during the next attack of the disease. The dose is 1 mg. After taking the first pill after 2 hours you need to drink the second - it eliminates joint pain, for example, with gout on the legs. The patient feels considerable relief 3 hours after the first dose, and it can last for 12 hours.
Colchicine is also used for disease prevention. Contraindications to its use: renal or pulmonary insufficiency, high sensitivity to the components of the drug. At pregnancy its use should be strictly supervised by the doctor. Side effects of colchicine: nausea, vomiting, the development of diarrhea, burning on the skin or urticaria, the appearance of muscle dystrophy. In men, a reduction in the number of spermatozoa is possible. If such events occur, you must stop using the drug.
The use of any medication prior to consultation with a physician is strictly prohibited. Only a specialist can make an accurate diagnosis and pick up medications taking into account the course of the disease and the individual characteristics of the patient's body.
The cure for gout. The cure for gout "Fullflex" is the price. The best cure for gout
Gout is a pathology that develops as a result of violating purine metabolism. The disease is accompanied by the deposition of urates in the epiphyses of bones, joints, cartilaginous tissue of the auricles and is complicated by aseptic inflammation.
Most of all pathologies are affected by men after forty years. Often gout is hereditary and constitutional disease. Among other causes of the emergence of pathology should be noted the excessive use of alcohol, meat. Often the disease is accompanied by diabetes and obesity. Violations in purine metabolism lead to disorders in the release or increased formation of uric acid, the accumulation of its salts.
Signs of the pathology of
For gout, the most typical are inflammatory processes in the synovial membranes, tendon sheaths, articular bags. In the zones of urate deposition destruction of bone substance and cartilaginous tissue is noted. This, in turn, leads to subluxation and deformity of the joints. On the earlobe, in periarticular tissue, nesting urate deposits - "tofi" - are formed. They are surrounded by a connective tissue. Often deposits of urate occur in the kidneys and other organs.
What are the medicines for treating gout? What are they? What is the mechanism of their action? Is there a better cure for gout? About this further. Before talking directly about the effects of a drug, it should be noted that the pathology is accompanied by pain and stiffness of movements. In connection with this, among other things, taking medications is aimed at eliminating these symptoms. First of all, you need to visit a specialist. The doctor, based on the patient's condition, severity of course and tolerability, recommends which medications to take with gout. In the case of a pathology, self-medication is not allowed.
Medication for gout "Fullflex"
The price of the medication is within 200 rubles. The preparation is produced in a capsule form and in the form of a liniment for external application. The composition of the drug contains extracts of the willow bark of white and roots of fragrant martinia. The drug has anti-inflammatory, antimicrobial, astringent effect, shows anti-edematous effect. In the ointment, in addition to the above components, extracts of birch, chestnut, fir, juniper, eucalyptus are present. In the liniment contains and vitamins P and E. For greater effectiveness, a specialist can recommend a comprehensive treatment using both medicinal forms of the drug. In this case, patients should strictly adhere to the prescription of the doctor.
Method of application
Capsules are recommended for patients with fourteen years of 1 pc.once. The drug is taken with food. Duration of application - a month. External remedy for gout "Fullflex", the price of which is indicated above, is applied twice a day to the affected areas. Liniment can be slightly rubbed with massaging movements. If the therapy is not effective, you should not change the scheme of application yourself.
Side effect of
The described drug against gout during application can provoke bradycardia, arterial hypertension. It should, however, be said that these phenomena are noted rarely. When administered orally, patients may experience dyspepsia, diarrhea. On the background of therapy, hepatitis, stomatitis, and disturbances in liver activity are sometimes observed. To side effects, which causes this drug from gout, should also include impaired taste, neuropathy, headache, ataxia, fatigue, paresthesia. In some patients, the drug provokes hematuria, interstitial nephritis, leukopenia, infertility, diabetes mellitus. Among the negative consequences, experts also note allergic reactions in the form of furunculosis, rash, skin irritation. Probably a discoloration of the hair. The drug can cause puffiness, convulsions, depression, drowsiness.
Drug for gout "Allopurinol"
The cost of this drug varies within a hundred rubles. The drug contributes to the violation of the synthesis of uric acid, the dissolution of urate deposits. This medicine for gout, among other things, prevents the accumulation of salts of uric acid in the kidneys and tissues. The dosage regimen is set individually. The drug "Allopurinol", in contrast to the drug "Fullflex", is allowed to be administered to patients under 15 years of age. Adults are recommended to 100-900 mg in accordance with the severity of the course of the pathology. Take after meals 2-4 times / day. Children dosage is set taking into account the weight - 10-20 mg / kg. In case of impaired renal function, the maximum amount of medication is 100 mg.
No medication is prescribed for pregnant, nursing patients, patients with severe renal or hepatic impairment. Contraindications include hypersensitivity to the drug. The agent has an effect on the speed of psychomotor reactions. In this regard, it is not recommended to engage in activities that require increased attention.
When taking "Allllopurinol" it is necessary to ensure optimum fluid intake per day - at least two liters. Dose adjustment may be required for patients with impaired liver function, hypothyroidism of the thyroid gland. In patients with tumor pathologies, this medicine for gout should be taken before the start of therapy with cytostatics. In these cases, the minimum dosage is recommended. Due to the complex use of the medicament "Allopurinol" and cytostatics, a regular monitoring of the condition of the peripheral blood picture is necessary. During therapy, alcohol is not allowed. Asymptomatic hyperuricemia does not refer to indications for use of the drug. The appointment to children is carried out only in the presence of malignant neoplasms( especially leukemia) and with certain enzyme disorders.
It should be noted that pathology can occur atypically, without being accompanied by acute attacks. At the same time, changes in the joints occur gradually. Often the disease is accompanied by early atherosclerotic vascular disorders, hypertension, the formation of stones in the urinary tract. Selecting a cure for gout, the doctor should take into account the overall clinical picture. In some cases, additional diagnostic measures may be required to prescribe adequate therapy. With the systematic and timely implementation of prevention and treatment, it is possible to stop the development of pathology and prevent acute gouty attacks. Along with drug therapy, the lifestyle and diet of the patient are of great importance.
Medications for gout: what to choose the set of available funds?
Drug therapy plays a leading role in the treatment of gout. And physiotherapy, sanatorium-and-spa treatment, traditional medicine play only a supporting role. And the selection of medicines should be carried out by a rheumatologist, taking into account the phase of the disease and possible contraindications. And, before deciding what should be the cure for gout, it is worthwhile to briefly dwell on the pathogenesis and the clinic of this disease.
General principles of drug treatment
The development of gout is based on the accumulation in the body of uric acid compounds - urates. Clinically significant manifestations of this disease are specific inflammatory processes in the joints - gouty arthritis. A few years after the development of arthritis, tofu are formed - accumulations of urates in the form of subcutaneous nodules with localization in the region of the ear, joints, legs, forearms. With neglected forms of gout, it is possible to damage internal organs and develop chronic renal failure.
The complex treatment of gout with medicines has the following objectives:
- Correction of uric acid exchange
- Elimination of gouty arthritis
- Treatment of tofusi
- Prevention of renal failure
In this connection, drugs of various groups are used: tablets, ampoules for injections, ointments for external use.
Correction of metabolic processes
The effect on the metabolism of uric acid in gout involves the cessation of its entry into the body, the inhibition of its synthesis, and the enhancement of its excretion in the urine. Termination of urate intake is achieved through an appropriate diet, and medicines are not used here. Drugs from the group of uricodepressants interrupt the sequence of certain biochemical reactions, as a result of which the formation of uric acid is inhibited. To this end, use tablets from gout - Allopurinol, Thiopurinol, Allomaron. The latter has a complex effect - reduces synthesis and enhances the excretion of urates.
Urikozuricheskie means contribute to the allocation of urate in the urine. Conventional diuretics in this case are not only ineffective, but also contraindicated. Urodan, Urolesan, Benzobromarone, and Ketazon have a uricosuric effect. It should be noted that the accumulation of urate may complicate some other diseases - coronary heart disease, diabetes, thyrotoxicosis, certain bacterial and viral infections. Effective treatment of these diseases will inevitably lead to a decrease in the level of uric acid. It should be noted that the use of uricodepressive and uricosuric agents does not always facilitate the course of gouty arthritis. For example, Allopurinol is ineffective for treating gout exacerbation.
Treatment of arthritis
Aggravation occurs in the form of gouty arthritis with typical symptoms - edema, pain, stiffness of movements. The best remedy for gout gout in such cases is Colchicine. This drug affects the deposition of crystals of uric acid in the joints and inhibits the release of biologically active substances responsible for the course of inflammatory reactions. Ultimately, pain and movement limits are eliminated in gouty arthritis.And we recommend reading:
Methods of treating gout on the legs
Similar action has other drugs for gout - non-steroidal anti-inflammatory drugs( NSAIDs).These agents exert direct antiinflammatory action, and some of them, such as Phenylbutazone and its derivatives also possess uricosuric activity. However, not all NSAIDs are indicated for gout. Derivatives of Acetylsalicylic acid have the opposite effect - they prevent the excretion of urates, and therefore are contraindicated in this disease.
In general, NSAIDs for the treatment of gout are desirable to use combined, in various dosage forms. Simultaneously, pills and ointment from gout containing Diclofenac, Indomethacin, Ibuprofen are used. Naproxen and other NSAIDs. Using these medicines, one should not forget about their negative effect on the function of the liver, stomach and intestines. But these organs and so provoked with gout. Other anti-inflammatory agents, steroid hormones( hydrocortisone, Diprospan, Kenalog) is introduced directly into the joint cavity. But these drugs are used only in extreme cases, when a pronounced inflammatory process led to the accumulation of a large amount of intra-articular fluid.
Treatment of late complications
Tofusi are formed several years after the first exacerbation of gout. In most cases, they are painless. Although in some cases, increasing tofusis, localized in the projection of the joints, can complicate the course of gouty arthritis. Nevertheless, it is not necessary to open them by themselves. With timely complex antipodal treatment, they themselves decrease. Sometimes these specific granulomas can be opened independently. Opened tofusi treated with antiseptics. Dimexid, iodine-containing products, any ointments containing antibiotics are suitable for this.
Chronic renal failure( CRF) is an extremely undesirable complication of gout. To avoid chronic renal failure, abundant drinking and periodic infusions( intravenous infusions) of alkaline solutions are recommended. The alkalization prevents the deposition of urate stones in the renal pelvis. To this end, resort to infusions of sodium bicarbonate( soda), various electrolyte solutions. These solutions, as well as other drugs, should be used under careful laboratory control. In the course of laboratory studies of blood and urine, the acid-base state, the amount of urates excreted, is estimated. Therefore, all patients in the phase of gout exacerbation should be observed by a rheumatologist in a hospital.
gout treatment drugs: pills, ointments and other preparations
Gout - disease caused by violation purine metabolism, resulting in the deposition of urate( uric acid) in the joints, ear cartilage, epiphysis bone with subsequent development of asepticinflammation.
disease Treatment Treatment of gout medicines requires an individual approach aimed not only at combating this disease, but also with its attendant diseases. The basis of treatment lie - the removal of pain, prevention of new attacks, as well as complications of a chronic nature, which include kidney damage and destruction of joints.
Therapy includes taking medication and diet food. Treatment is carried out in in 2 stages of :
- Causing an attack at the time of exacerbation.
- Basic Therapy.
How is the seizure done?
During the exacerbation the patient must arrive at the hospital in special hospital departments.
purpose of this stage is the removal treatment of pain, reduction of inflammation in the joints, which affects the exchange of uric acid and restoration of normal joint mobility.
For this purpose, the following drug groups are assigned.
NSAIDs - the more effective medicines of this group of are:
- Butadione ( ointment from gout) - anti-inflammatory, analgesic, antipyretic and antirheumatic. It is applied around the affected area with a thin layer and does not require rubbing;
- Indomethacin ( tablets) is one of the effective anti-inflammatory drugs for treating gout. Has a pronounced analgesic activity. The daily dose of 150 mg is 0.05 g / 3 r./day;
- Ibuprofen ( tablets) - this medicine for gout is used primarily at the altitude of a gouty attack. The daily rate of these tablets from gout is from 1200 to 2400 mg.
Steroid hormones - drugs of this group are very powerful, but they contain many side effects. They are prescribed a short course or once in the form of injections, which do directly into the damaged joint, as a result of which the attack can be stopped, and the inflammatory process goes on decline. Basically appointed:
- Betamethasone is a hormonal drug for topical and systemic use( glucocorticoid).
- Methylprednisolone is a drug that can be used in the form of tablets, ointments and injection solutions.
Colchicine -a gout remedy derived from a cesspool is a powerful medicine that suppresses gout. Produced in tablets - 0.5 mg for takinginside and in ampoules for injections. Its intravenous administration is indicated in severe attacks.
The mechanism of action is suspension of the degeneration of lysosomal , suppression of leukocytes, hampering of phagocytosis of urates. In addition, the drug has a slight anti-inflammatory, antinininovoe, antihistamine action.
Therapy with colchicine should be started in the prodromal period. After the first reception, improvement is observed after 12 hours. The drug shows its effectiveness in 90% of cases, with timely treatment. The inflammatory process disappears within 48 hours. Lack of effect is observed after its late use.Dosage and route of administration should be specified with the physician.
This treatment is treated after the inflammation is removed. The goal of therapy is the recovery of the body as a whole. Treatment is carried out with the help of drugs that are part of the 2 large groups:
- Urinary depressants;
- Urikozuric means.
Drugs from gout are groups that affect the main pathogenesis - decreases the blood level of uric acid , as well as its salts.
The most common urinary depressants of are:
- Allopurinol ( tablets) - taken once a day, at a dose of 300 mg, after a meal.
- Hepatocatalase ( injection) - the drug is administered intramuscularly 2-3 r. / Week.
- Thiopurinol - appoint 3 r./day, inside by 0.1 g. The effect is visible after as many days from the beginning of the reception. It normalizes the concentration of uric acid in the blood plasma.
The most popular uricosuric agents are:
- Benzbromarone ( micronized powder) - suppresses the synthesis of purines. The average dose of admission is 100 mg / day;
- Probenecid ( tablets) - enhances the excretion of uric acid. During the first month of treatment, the drug is taken 2 r / day at a dose of 250 mg. If the effect is not achieved, the dose should be brought to 500 mg. / 2 rub. / Day.
Treatment of the belated complications of
After years, after the initial exacerbation of gout, the tofusi may be formed, which are mostly painless, but sometimes increase in size and cause complications. If we timely deal with their treatment, which requires an integrated approach, they will decrease themselves. Sometimes their autopsy can occur independently, without any treatment.
Opened granulomas treated with antiseptic, for this purpose use iodine-containing drugs, antibacterial ointments.
The most severe complication of gout is chronic renal failure .To avoid this, it is recommended to drink plenty of fluids and periodic intravenous infusions( infusions) of alkaline solutions.This measure prevents the deposition of urate stones in the pelvis of the liver. For alkalization use sodium infusions, electrolyte solutions, hydrogen carbonate soda. All these funds should be used under close laboratory supervision.
In the process of laboratory tests of urine and blood tests, the presence of acid is estimated, as well as the number of urates excreted in the urine. In this regard, at the time of exacerbation, patients should arrive in a hospital setting under the supervision of a rheumatologist.
Drug treatment of gout will be ineffective if you do not have to resort to additional measures, which include :
- Hardware treatment( joint irradiation);
- Heat treatment;
The whole range of procedures can be taken in special sanatoriums, where all additional methods of treatment are carried out in the complex.How to treat joint rheumatism you can learn from our article. Also, the issues of timely diagnosis and prophylaxis are considered. Treating the calcaneal spur with folk remedy is one of the most effective methods of complete cure of the disease. Detailed recipes can be found here.
Nutrition in therapy plays a big role, since individual foods are capable of provoking a recurrence of gout. From the diet it is necessary to exclude:
- Meat soups and broths;
- Smoked and preserved foods;
- Fatty and salty cheeses;
- Spicy spices;
- Some varieties of fish;
- Meat of beef and poultry;
The main menu should include:
- Fruit juices and herbal teas;
- Fruits and berries;
- Lean fish;
- Cereals and pasta;
- Dried fruits, nuts;
- Sour-milk products.
Fat is preferable to use butter and vegetable oil.
Lifestyle with gout
The effectiveness of treatment can be achieved only with complete abandonment of alcohol-containing beverages and limiting the consumption of coffee and strong black tea. Without exacerbation, daily warm up and exercise gymnastics.
Video: Principles of Nutrition and Diet for Gout
Gout is a disease in which the metabolism in the joint tissues breaks down, leading to the deposition of salts and the accumulation of uric acid, with further restriction of the mobility of the joint bag.
Treatment of gout
It should be remembered that gout in neglected form represents a danger to the state of the genitourinary system and can lead to disruption of the kidneys. In the treatment of gouty arthritis, medications play a leading role in recovery. In the acute stage of the disease, the main task of the drug is to remove the pain in the affected joint. In the remission phase, drugs are used to reduce the concentration of uric acid in the joints.
Treatment of gout in the acute stage
The acute stage of the disease usually lasts 1-2 weeks. It is advisable during this period to monitor the patient in the hospital. To remove the pain attacks of the disease in the acute stage, non-steroidal anti-inflammatory drugs are used. In a hospital, injections of anti-inflammatory drugs are used. This method of drug administration ensures that there are no side effects that can occur when taking drugs orally. A set of measures aimed at arresting an attack is usually the following:
- the appointment of non-steroidal or corticosteroid drugs( Diclofenac, Nimesulide);
- bed rest;
- a strict diet and plentiful drink.
Treatment of gout in the remission phase of
After the withdrawal of pain attacks in the acute stage, therapy is prescribed with the help of medications that promote the improvement of metabolism in the joint and the excretion of uric acid. In a complex of medicamental treatment, drugs that have different effects on the patient's body are used:
- means that reduce the production of uric acid salts( Allopurinol, Hepaktokatalaz);
- preparations that excrete uric acid( Flexin, Udrod).
Medications for gout and methods from the use of
In the treatment of gouty arthritis, a complex of medicines is used, each of which is prescribed by a doctor, depending on the severity of the disease and the appropriateness of their use. By the method of application, drugs can be conditionally divided into 4 groups:
Gout occurs in almost 0.25% of the population. Drug treatment is effective, but some drugs can accelerate the course of the disease.
Causes of gout
Gout is characterized by a sharp attack of arthritis caused by chronic deposition of monosodium salt of uric acid in the cartilage and kidneys, and nephrolithiasis of urates.
Urates with gout
Uric acid refers to purine bases( guanine, adeny), which are involved in the formation of nucleic acids. The amount of urate in the body of a healthy man who is on a diet in which there are no purines is 1200 mg, and in women about 2 times less. In patients with gout without visible salt deposits, the amount of urate in the body increases by 2 or 3 times compared with the norm, and since this amount exceeds that which can be in the dissolved state in the extracellular fluid, their microcrystalline deposits are formed. In patients with gouty nodes, the amount of urate in the body can be 15-26 times higher than normal. Urates are excreted mainly through the kidneys. At the same time, being bound to plasma proteins by only 5%, they are freely filtered through the renal glomeruli and then reabsorbed from the lumen of the tubules, and are also secreted into it from the blood. Urates that appear in the urine are the result of excess of their secretion over absorption. Both processes are active, require energy costs, they can be influenced by drugs.
To develop an attack of gout , two conditions are necessary:
a) precipitation of crystals of monosodium salt of uric acid from body fluids in hyperuricemia( a detailed mechanism for starting this process is still unclear)
b) development of local inflammatory reaction with phagocytosis in response to the presencecrystals. Actively phagocytic leukocytes produce lactic acid, which contributes to the precipitation of urate into the crystals, since they are less soluble in an acid medium.
As the crystallization increases, the processes of inflammation and phagocytosis are intensified, which causes a large amount of lactic acid and self-stimulation of the inflammatory reaction. The inflammatory process is also enhanced by the enzymes involved in the digestive processes and released from the lysosomes of leukocytes.
Hyperuricemia and gout are thus caused by two major processes:
1) inadequate excretion of urate as a result of primary abnormalities in the kidneys and the effects of drugs on the transformation of urates in tubules;these properties are possessed by all diuretics( except spironolactone), acetylsalicyl acid( in small doses), pyrazinamide, nicotinic acid and alcohol( the latter increases the synthesis of urates, and also forms lactic acid, suppressing their tubular secretion);
2) excessive formation of urates due to various defects in enzymes that enhance purine biosynthesis and excessive decay of cells with the release of nucleic acids in drug treatment or X-ray therapy in myelo- or lymphoproliferative processes.
Preparations for gout
When gout is used drugs:
a) suppressing symptoms( anti-inflammatory with analgesic effect or without it, namely azaprozon, diclofenac, indomethacin, naproxen, piroxicam and sulindac; colchicine, adrenocorticosteroids and corticotropin);
b) synthesis-preventing urates( allopurinol);
c) contributing to the release of urates( uricosuric substances, namely, probenicides, sulfinpyrazone).
Colchicine is an alkaloid from autumn crocus, has antimitotic properties and is not currently used for malignant diseases, but is effective in gout, since it relieves pain and inflammation in a few hours. It is believed that such a rapid relief of the condition can serve as a confirmation of the diagnosis, since with non-hypogratic arthritis the drug is ineffective, although failure with its use does not mean that the patient does not suffer from gout. The reason for the special ability of colchicine to stop pain with gout is not established, but the most likely explanation is that it suppresses migration of leukocytes to the inflamed area and thus interrupts the already described inflammatory cycle.
The drug is absorbed from the intestine, part of it is metabolized in the liver, and part is excreted unchanged with bile and reabsorbed from the intestine. This increases its toxic effect on the intestines.
In case of an acute attack of gout, colchicine can be given for oral administration at a dose of 1 mg, and then 0.5-1 mg every 2 hours until the pain disappears or side effects appear. Improvement of the condition usually occurs after 2-3 hours and lasts for 12 hours. As a rule, the total dose is 3-6 mg, it is inappropriate to use more than 10 mg. If an effective dose is established, the patient can take her whole attack, and then at 0.5 mg after 1 hour. Colchicine has a preventive effect on gout, if taken 0.5-1 mg / day or every other day. It is also used as a primary remedy for Mediterranean fever, preventing exhausting bouts of fever and development of amyloidosis in these patients.
Adverse reactions can be severe and accompanied by abdominal pain, vomiting and diarrhea( blood may be present in the feces).Probably, they are caused by depression of mitosis of rapidly reproducing cells of the intestinal mucosa. Can develop kidney failure and sometimes blood diseases. Large doses cause muscle paralysis.
Allopurinol inhibits xanthine oxidase, an enzyme that converts xanthine and hypoxanthine to uric acid. In patients taking it, less urate and more xanthine and hypoxanthine are released with urine. Both compounds are easily excreted in renal failure and are more soluble than urates, as a result of which xanthine stones are rarely formed. Allopurinol was first used in the treatment of patients with leukemia to prevent the oxidation of active b-mercaptopurine to the inactive metabolite, when its effect on the synthesis of uric acid was observed. The patient has a gout, treated with allopurinol;the usual doses of 6-mercaptopurine cause its potentiation.
Allopurinol is readily absorbed from the intestine, is metabolized in the liver to alloxanthin, which also has an inhibitory effect on xanthine oxidase. It is excreted unchanged in the form of alloxanthin through the kidneys.
The drug is recommended for renal insufficiency accompanied by urate lithiasis, or when a large number of gouty knots are formed in blood diseases in which spontaneous hyperuricemia occurs( due to deposition of salts around the joints) and myeloproliferative diseases, when cell destruction leads to a high urate load. Allopurinol prevents the development of hyperuricemia caused by diuretics. E can be combined with uricosuric means.
During the first 2 months of treatment, the risk of an acute attack of gout increases, despite a decrease in the level of urate in the blood.
This may be due to a decrease in the level of urate in the plasma or its fluctuations, which causes dissolution and, apparently, alternating recrystallization of urates from the foci of deposits in the gouty nodes. During this period, non-steroidal anti-inflammatory drugs or colchicine should be used as depressants, and the patient should be warned about the possibility of an attack, because otherwise he may be disappointed in the drug.
Single oral intake of 300 mg is usually sufficient for treatment, but in severe cases, the total dose can reach 600 mg or more.
Side effects, not counting exacerbations, are rare;they include a different kind of allergy, leukopenia, impaired bowel and liver function.
Uricosuric remedy for gout
Probenecid is available in 0.5 g form. It does not have analgesic effect. It began to be used at a time when penicillin was still difficult to access and there was a need for a means that could prevent its active excretion by the renal tubules and thus, with the introduction of small doses, maintain a high concentration in the plasma. Probenecid provides this action, but penicillin sal is so cheap and affordable that now the same effect is achieved with increasing its dose. However, probenecid is sometimes used in infections in which an unusually high plasma penicillin level is desired, for example, in infectious endocarditis, in the treatment of children for whom frequent administration of large doses of an antibiotic is undesirable and, if necessary, obtain the maximum effect with a single administration of the drug, for example in gonorrhea.
Probenecid inhibits the transport of organic acids through the epithelium and, most importantly, through the epithelium of the renal tubules. The effect depends on the dose: small doses prevent tubular secretion and excretion of urates, but an adequate dose inhibits their reabsorption from the lumen of the tubules and has a beneficial uricosuric effect.
The drug binds to plasma proteins by 90%, partially metabolized, and is partially excreted unchanged in the urine. The half-life period varies depending on the dose within 5-8 hours.
To prevent a gout attack, the dose is 0.5 g inside once a day for the l-th week, then it increases to 1-2 g / day. The level of urate in the plasma is initially reduced and set, reaching 60% of the initial level. Because of the large loss of urate at the beginning of the treatment, the crystals may appear in the urine if the pH is not maintained at the level of
6.0 or more in the first month of treatment with probenecid( or another uricosuric agent, for example a mixture of potassium citrate with water of 12-24 g/ day or sodium hydrogencarbonate in the form of a powder of 5-10 g / day, washed with water).The patient should be prescribed a generous drink( 3 liters / day) to avoid the danger of mechanical obstruction or formation of stones. Urine should be made to have an alkaline reaction and be diluted;To this end, take a tablet( 250 mg) of acetazolamide at night. It should be monitored for a patient with renal insufficiency( in addition, potassium citrate can cause dangerous hyperkalemia).Probenecid in this case is contraindicated, since it may be ineffective or even aggravate the kidney disease.
In some patients, it causes a violation of the function of the gastrointestinal tract and sometimes allergies, blocks tubular excretion and prolongs the action of penicillins, cephalosporins, naproxen, indomethacin, and panylurea.
Acute gout attack
With this form of gout, non-steroidal anti-inflammatory drugs are highly effective: the attack stops after a few hours after ingestion. It is important to begin treatment as early as possible. Indomethacin belongs to the drugs of choice;it can be taken orally 25-50 mg three times a day, for the fourth time( sometimes in a larger dose) it is taken at night. Side effects from the gastrointestinal tract develop less often if the drug is taken with food. It can be used in the form of candles( 100 mg).Naproxen, diclofenac, sulindac, piroxicam and azapropane are among the effective alternatives. With intolerance of non-steroidal anti-inflammatory drugs, colchicine is traditionally used. It can be a drug of choice for the first attack of severe monoarthritis, since its effect simultaneously helps to establish a diagnosis, which is sometimes difficult. Other anti-inflammatory drugs act indiscriminately.
If these drugs are ineffective, you can begin treatment with prednisolone at 40 mg / day with a dose reduction immediately, as soon as the symptomatology allows. Cancellation of the drug can cause a relapse, so it is advisable to add colchicine in order to pass this stage.
Urikozuric drugs and allopurinol are useless in an acute gout attack.
Recurrent and progressive forms of gout can be prevented by convincing the patient not to take alcohol and prescribing allopurinol and uricosuric drugs if the urate level in the plasma is above 0.6 mmol / l and the patient has already suffered three or more acute attacks of the disease.
Treatment should be started in a calm period. Usually, allopurinol is more preferable, which serves as a drug of choice in reducing renal function. It can be combined with uricosuric means. Salicylates can not be administered simultaneously with other uricosuric drugs, as they interact. Paracetamol can be used as an analgesic.
Colchicine also prevents a gout attack. It does not affect the excretion of urates.
Rapid reduction of urate levels in plasma by any method can promote an acute attack, probably due to the dissolution of salts. In this regard, in the first 2 months of treatment withallopurinol and uricosuric agents, it is recommended to carry out anti-inflammatory treatment with indomethacin in order to prevent acute attacks, while urine should be alkaline and its volume large to avoid crystalluria.
The beneficial effect caused by a decrease in the level of urate in the plasma, is invisible for several weeks. It is necessary to select the preparations in such a way as to maintain the level of urate in the plasma within the limits of the norm. Neglect this is not recommended. Prevention of one colchicine or indometacin is undesirable, since urate in the urine remains at a high level, which causes the progression of the disease( the formation of gouty nodes in places of salt deposition, kidney damage).
Chronic gout with the formation of gouty nodes.
Gouty sites sometimes decrease in size and even disappear when treated with allopurinol or its combination with uricosuric agents. In acute pyrophosphate arthropathy, treatment is the same as in acute gout.
Exacerbation of gout attacks with diuretics.
Any active diuresis can contribute to an acute attack of gout due to a decrease in the volume of urine, which leads to an increase in the reabsorption of all substances, including urates, normally reabsorbed from the proximal tubules;antagonistic effect have allopurinol and uricosuric substances.
Diet, alcohol and gout
Usually, gout patients have an excess body weight, and when it decreases, the level of urate in urine decreases. However, in obese persons, gout can develop gout due to ketosis, which causes precipitation of urates in tissues( due to acid reaction);some experts recommend taking allopurinol during this period. It has long been known that alcohol induces acute attacks of gout, as it increases the formation of urates and causes lactic acidosis, which contributes to the deposition of urate in the tissues and blocking their excretion by the renal tubules.