Treatment of gout by various means: "Allopurinol"
Inflamed joint is destroyed by the action of uric acid salts
Among the many diseases that occur in humans, a special place is occupied by metabolic disorders. Normal metabolism ensures optimal functioning of all organs and systems of the human body. At present, a disease such as gout is very widespread. It is characterized by the deposition of salts of uric acid in various organs, including bones. A sick person who has applied for medical help should begin treatment of gout as soon as possible."Allopurinol" is the main medicinal product.
According to modern data, approximately one in every thousand people suffer from gout in our country. Men are sick more often than women. Prevalence of gout is much higher in old age.
This pathology is dangerous for its possible complications, which include the deposition of kidney stones and the development of renal failure, severe joint deformity and impaired motor activity. All this can lead to disability. Let's consider in more detail what the etiology and clinic of the disease is, when drug therapy and other methods of treatment are conducted.
Etiology and pathogenesis of the disease
To correctly diagnose and prescribe appropriate treatment, the physician should know the main causes of gout. This pathology has been known for a very long time. In the distant past, gout was described by Hippocrates. What is the peculiarity of this pathology? Gout is a disease that occurs as a result of a violation of the exchange of purine bases, characterized by the deposition of urate in tissues and hyperuricemia. The mechanism of this process is quite simple. In the course of metabolic disorders, the kidney function suffers, as a result of which it is difficult to remove uric acid from the body. This leads to an increase in its content in the bloodstream.
The X-ray image shows the practical absence of cartilaginous tissue and severe damage to the bones of the joint
Under normal conditions, a healthy person decomposes purines to uric acid and utilizes the latter from the body. With gout, this process is disrupted. Urat crystals can be deposited in the tissues of the body. Very often they are found in the joints and bones. Against the background of a metabolic shift, an inflammatory process arises( arthritis).Very often multiple joints are affected and polyarthritis develops. Often, salts contribute to the formation of kidney stones. In this case, urolithiasis develops.
Gout may have a different etiology, the main causes of the disease include:
- irrational nutrition( consumption of a large number of purines with food);
- autoimmune diseases;
- a violation of the synthesis and excretion of uric acid from the body;
- taking certain medications( antitumor drugs, diuretics, cyclosporins);
- some somatic diseases( obesity, diabetes, hypertension, blood diseases, psoriasis).
The most common reason is poor nutrition. Often it is combined with a metabolic disorder in the body. Excess in the diet of red meat, spinach, tea, coffee, chocolate can lead to gout.
It should be borne in mind that the precursors of uric acid in large quantities are contained in beer, so the abuse of this drink is a risk factor.
Clinical manifestations of gout
Gout has specific clinical signs that simplify the diagnosis. This pathology proceeds in several stages. At the first concentration of uric acid in the blood is increased, but the patients do not make any complaints. The inspection also shows no changes.
The second stage is called acute gouty arthritis. It is of the greatest importance, since it is during this period that the joints and other organs are more affected. The third stage is the intercritical period. The fourth is characterized by a chronic course, with the symptoms being less pronounced.
The appearance of kidney stones can be in the second, third or fourth stage. As for the defeat of the joints, in the acute period very often the fingers suffer from this ailment. In this case, there is a sharp pain, swelling and hyperemia of the joint. At a palpation the sharp morbidity is defined.
In patients with people, body temperature may increase. In addition, there is weakness, malaise. It is important that the pain syndrome is able to disappear on its own in a few days. The specific sign of gout is the formation of tofus. They are small nodules. Tofusi and bony growths are the cause of deformity of the joints.
Treatment measuresTreatment of gout should be comprehensive. It is impossible to be limited only by medicamental therapy. The tactics of treatment are determined by the stage of the disease. The doctor should pursue the following main goals: reducing the concentration of uric acid in the body and normalizing the metabolism, treating arthritis, relieving the patient of the pain syndrome and other acute manifestations of the disease, preventing possible complications. In the presence of acute arthritis caused by gout, anti-inflammatory drugs are used. The main and most effective representative of this group is colchicine.
It is an alkaloid and is prescribed until the patient is better. In case of adverse reactions, treatment should be stopped. Admission of this drug should be carried out at an early stage of the disease when the first symptoms appear. The optimal way to administer the drug is intravenous. With it, the active substance quickly enters the blood. In addition, the intravenous route eliminates the risk of gastrointestinal tract damage, which is very often observed with oral administration.
Various anti-inflammatory drugs
You can take with this disease not only colchicine. The expressed anti-inflammatory effect is possessed by NVS - non-steroidal anti-inflammatory drugs. Most often for the treatment of gout used drugs such as indomethacin, naproxen and some others.
Each drug has side effects, it should be considered when prescribing treatment. The side effects of indomethacin include depression of the central nervous system, sodium retention in the body, a violation of the function of the digestive tract. Carrying out the treatment of gout, the doctor must remember that allopurinol and drugs that improve the excretion of uric acid from the body, with an acute attack of arthritis are not used.In a situation where NSAIDs and colchicine do not bring the desired therapeutic effect, you can use glucocorticoids. They are administered intravenously or directly into the cavity of the affected joint. Glucocorticoids have a powerful anti-inflammatory effect.
In order for the therapeutic effect to be the highest, it is recommended to administer long-acting drugs into the joint cavity. In a similar situation, it is advisable to use triamcinolone.
When Allopurinol is used
Allopurinol is used in complex gout therapy to prevent an acute attack of the disease. Treatment should be started with a small dose, then it is gradually increased. It is recommended to take the drug after eating with a glass of water. Allopurinol is not used in the acute period of gout, when there is a serious dysfunction of the joints. Allopurinol is a antidotal drug, which helps to reduce the synthesis of uric acid. Allopurinol inhibits the production of the enzyme xanthine oxidase, which is directly involved in the formation of uric acid.
This drug is in most cases very well tolerated. Despite this, some of the patients may experience the following side effects: nausea, vomiting, stool disruption by type of diarrhea, allergic reactions, depression, sleep disturbance, changes in blood."Allopurinol" is contraindicated in the presence of a patient with kidney failure, in the period of bearing a child and with individual intolerance. It must be remembered that renal failure is one of the complications of gout. In the case of its development, "Allopurinol" can not be used. Of great importance is that the drug in question can be combined with other drugs that have a uricosuric effect.
Treatment of gout involves the use of uricosuric medicines. These include butadion, aspirin, ketazone, anturane and some others. All of them are applied at the raised maintenance in blood of uric acid without increase in daily excretion. In addition, these medications should be used only for people younger than 60 years and with normal kidney function. Urikozuricheskie funds can not be prescribed in the presence of kidney stones. This is due to the fact that they increase the burden on the kidneys. The main mechanism of their action is a decrease in urate absorption in the renal tubules.
If colchicine is used in the acute period of gout, all of the above uricosuric drugs are effective in the chronic course of the disease. All of them, like allopurinol, are used for a long course. In some cases, treatment can last for years. When choosing the safest and most effective drug the doctor should take into account the age of the sick person, the presence of complications, contraindications. In a situation where there are multiple tofusi, this group of drugs is not capable of eliminating them.
If tofusy large size or there are serious skin defects( ulceration), then surgery is performed.
The need for adherence to the
diet An important aspect in gout therapy is proper nutrition. It is required to exclude the use of products containing purine bases: liver, red meat, kidneys, chicken meat, coffee, black tea. It is also important that patients are not allowed to drink alcohol, because it worsens the excretion of uric acid from the body.
Some products can not be completely excluded from food, but it is necessary to limit their use. Such products include spinach, sorrel, eggplant, fish, mushrooms, caviar. It is recommended to introduce cherries, currants, strawberries into the diet, as they reduce the uric acid content in the blood.
Thus, the treatment of gout depends on the stage of the disease. It should include not only the intake of medicines, but also rational nutrition, physiotherapy procedures. If the movement of the joints is difficult, the physician has the right to prescribe therapeutic gymnastics.
Allopurinol for gout: treatment efficacy, reviews
Therapeutic properties of
Patients' feedback indicates that allopurinol does not relieve pain in gout, but is used as a remedy to prevent its attacks .Its main effect is directed to the root cause of the disease, i.e. hyper-hyperemic, to reduce the amount of uric acid in the blood plasma.
It is important to carefully select the correct dosage of allopurinol, since an acute attack of gout or its transition to a chronic form may occur.
Depending on the stage of the disease, an individual set of treatment measures is assigned. Therapy is as follows:
• it is necessary to stop the attack;• preventive measures are designed to avoid repeated exacerbations.
It should be ensured that the disease does not go into a chronic stage.
The use of allopurinol in the chronic course of the disease is based on the prevention of seizures and the reduction of uric acid in the blood. Basic therapy is performed when arthritis reminds itself 3-4 times a year, and if there are gouty nodes.
Antidepressant treatment is based on the intake of allopurinol. Also, tablets are prescribed if persistent hyperuricaemia has been observed, and in the past there has been at least one attack of arthritis.
Features of the course of treatment of
In the treatment of the disease, the following cautions should be followed:
- It is better to start gout therapy with small medicinal doses, 100 mg per day. This approach will prevent the development of allergic reactions and possible acute attacks of arthritis that may occur at the initial stage of treatment. Also reduce adverse reactions from the drug. To check the chosen dose is possible by the rate of reduction of uric acid. Hyperuricemia should decrease by a tenth of the baseline in one month when taking tablets.
- The level of uric acid rises very quickly when the drug is withdrawn, in 3-4 days.
- In case of a pain attack in the joint, it is recommended to stop it first, and then begin treatment with allopurinol. If the pain has developed against the background of the treatment, then it is necessary to reduce the prescribed dose of the drug. To abolish it completely is not recommended, since at the heart of any treatment the principle of initial deterioration of health operates, and only then positive progress.
- At the beginning of treatment, in order to avoid an acute attack of gout, provoked by a drug, prescribe drugs such as colchicine or NSAIDs in small doses.
- The level of uric acid during exacerbation of arthritis, which is manifested by attacks, is lower than in the period between attacks, therefore control of urate in dynamics is necessary, that is after removal of exacerbation.
Efficiency of treatment
After 2-3 days, the level of uric acid in the blood decreases, and on the 7-10th day the indicators come back to normal. With decreasing uricemia, it is also necessary to reduce the dose of the drug. Resistance of normal results comes in six months, or a little earlier. After this, the patient is transferred to a maintenance dose of 100 mg / day to prevent relapse.
Treatment should be continuous. To reduce seizures, as the reviews show, it takes up to a year. After a while, the intensity of the disease decreases, the seals of the subcutaneous tissue begin to dissolve. After prolonged use of the drug, the possible complete disappearance of joint manifestations of the disease. The use of allopurinol continues uninterruptedly for many years.to table of contents ↑
Dosages and administration of
The drug is available in the form of tablets of 0.1 and 0.3 g. It is recommended to take allopurinol after a meal, to reduce the side effect in the form of an intestinal disorder. During treatment, it is necessary to use a lot of liquid to ensure the excretion of urine in a volume of 2-2.5 liters, if there is no contraindication from the vessels and heart. In the analysis, the urine reaction should be slightly alkaline. This will prevent the formation of stones. To do this, it is necessary to include in the diet the use of acidic berries of fruit vegetables, which will cause alkalinization of urine.
Allopurinol for gout: how to take medicine, reviews of patients
Allopurinol is released in tablet form.
The drug is prescribed for the treatment of gout. It suppresses the enzymatic activity of substances, including the cascade mechanism of metabolic processes, leading to the formation of uric acid.
How does it work?
The absorption process of allopurinol after taking is very fast. Already after an hour and a half you can determine the maximum concentration of the substance in the blood. The action of Allopurinol reduces to the following main points:
- inhibition of xanthine oxidase - an enzyme that transforms hypoxanthine into xanthine, and then into uric acid;
- decrease in the concentration of urate in the bloodstream and their tissue crystallization;
- enhanced renal excretion of the readily soluble components of the purine metabolism of ( hypoxanthine, xanthine).
Route of administration and dose of
Allopurinol is indicated for gout after eating inside .The dose of the drug for oral administration is calculated based on the concentration of uric acid, which is determined by a biochemical blood test.
Doses of the drug are selected individually:
- the average therapeutic dose per day can be up to eight tenths of a gram;
- with a moderate concentration of uric acid - up to 0.4 g, continuing to take several weeks;
- to maintain biochemical parameters take a prophylactic dose of 0.3 g per day, dividing the dose into three doses;
- for complications specialists adjust the dose individually;
- before the age of six, the calculation of the dose is carried out according to the scheme of 5 mg per one kilogram of the child's body weight;
- from 6 to 10 years, the dose is doubled.
The list of contraindications for taking Allopurinol is motivated by its ability to influence metabolic processes. Therefore, allopurinol should not be taken with:
- renal filtration failure;
- child bearing and breastfeeding;
- hypersensitivity to the components of the tablet preparation.
In this article you will find information about the features of treating gout with medicines. What kind of diet is indicated for gout? Benefits, diet, tentative menu for a week.
Pathological changes from taking
tablets Allopurinol therapy is usually well tolerated by patients. Sometimes there may be an exacerbation of gouty symptoms. This is due to the release of uric acid from the depot and its concentration.
dyspepsia very rarely develops: nausea, vomiting, diarrhea, pain in the stomach.
Allergy : rash, itching, redness, arthralgia.
Deviations in the blood picture : increase or decrease in the number of leukocytes and eosinophils.
Nervous Disorders: sleep and amnesia disorder.
Reviews of patients
- After taking Allopurinol, even in a half dose, after 10 days there is an improvement in health.
- Most people do not notice symptoms of intoxication and side effects.
- Patients with gout consider the drug effective in connection with a significant reduction in pain in the short term after the initiation of therapy.
No doubt, the tablet preparation can be attributed to the most effective for gout. But self-administration leads to serious metabolic disturbances of .Therefore, it is best to consult a specialist before going to reception.
Severe liver and / or kidney dysfunction, pregnancy, lactation, hypersensitivity to allopurinol.
Set individually, under the control of urate and uric acid concentrations in the blood and urine. Adults with oral administration - 100-900 mg / day, depending on the severity of the disease. The frequency of taking 2-4 times / day after eating. Children under the age of 15 years - 10-20 mg / kg / day or 100-400 mg / day.
Maximum doses: for violations of kidney function( including those caused by urate nephropathy) - 100 mg / day. An increase in the dose is possible in those cases when, on the background of the therapy, an increased concentration of urate in the blood and urine remains.
With simultaneous use of allopurinol enhances the action of coumarin anticoagulants, adenine arabinoside, as well as hypoglycemic drugs( especially for violations of kidney function).
Uricosuric agents and salicylates in high doses reduce the activity of allopurinol.
With the simultaneous use of allopurinol and cytotoxic agents, myelotoxic effect is more common than with separate application.
With simultaneous use of allopurinol and azathioprine or mercaptopurine, cumulation of the latter in the body is observed.in connection with the inhibition by allopurinol of the activity of xanthine oxidase necessary for the biotransformation of drugs, their metabolism and elimination are slowed down.
Pregnancy and lactation
Contraindicated in pregnancy and lactation( breastfeeding).
Side effects of
Cardio-vascular system: in isolated cases - arterial hypertension, bradycardia.
On the part of the digestive system: , dyspeptic phenomena( including nausea, vomiting), diarrhea, transient increase in the activity of transaminases in the serum are possible;rarely - hepatitis;in isolated cases - stomatitis, violations of the liver( transient increase in the activity of transaminases and alkaline phosphatase), steatorrhea.
From the side of the CNS and the peripheral nervous system: in isolated cases - weakness, fatigue, headache, dizziness, ataxia, drowsiness, depression, coma, paresis, paresthesia, seizures, neuropathies, visual impairment, cataracts, changes in the papilla of the optic nerve,disturbance of taste sensations.
On the part of the hematopoiesis system: in some cases - thrombocytopenia, agranulocytosis and aplastic anemia, leukopenia( most likely in patients with impaired renal function).
From the urinary system: rarely - interstitial nephritis;in single cases - edema, uremia, hematuria.
On the part of the endocrine system: in single cases - infertility, impotence, gynecomastia, diabetes mellitus.
From the side of metabolism: in isolated cases - hyperlipidemia.
Allergic reactions: skin rash, hyperemia, pruritus;in some cases - angioimmunoblastnaya lymphadenopathy, arthralgia, fever, eosinophilia, fever, Stevens-Johnson syndrome, Lyell's syndrome.
Dermatological reactions: in isolated cases - furunculosis, alopecia, hair discoloration.
Caution should be applied to allopurinol for violations of the liver and / or kidney function( in both cases, a dose reduction is necessary), hypothyroidism of the thyroid gland. In the initial period of the course of therapy with allopurinol, systematic evaluation of liver function parameters is necessary.
During the treatment with allopurinol, the daily amount of fluid consumed must be at least 2 liters( under the control of diuresis).
At the beginning of the course of treatment for gout, there may be an exacerbation of the disease. For prevention, you can use NSAIDs or colchicine( 0.5 mg 3 times / day).It should be borne in mind that with adequate therapy with allopurinol, large urate stones can be dissolved in the renal pelvis and their subsequent entry into the ureter.
Asymptomatic hyperuricemia is not an indication for the use of allopurinol.
Children are used only for malignant tumors( especially leukemia), as well as for certain enzymatic disorders( Lesch-Nichin syndrome).
To correct hyperuricemia in patients with tumorous diseases, it is recommended that allopurinol is used before the start of treatment with cytostatics. In such cases, the minimum effective dose should be used. In addition, in order to reduce the risk of xanthine deposition in the urinary tract, measures should be taken to maintain optimal diuresis and urine alkalinization. With the simultaneous use of allopurinol and cytostatics, more frequent monitoring of the peripheral blood pattern is necessary.
During the reception of allopurinol, alcohol is not allowed.
Influence on the ability to drive vehicles and manage mechanisms
Use with caution in patients whose activities require high concentration of attention and rapid psychomotor reactions.