Gout
Gout is a form of arthritis
that primarily affects older males. Gout appears very quickly,
often overnight, causing intense swelling and pain. The skin
over the affected joints (usually those of the ankles and
feet) is normally red and shiny. The ball of the big toe is
the most common site for gout. Click
here for an illustration on gout.
WHAT CAUSES GOUT?
Gout is a condition in which uric acid, a by-product of metabolism, rises above normal
levels. Uric acid is normally flushed out of the body in the urine. When a person has gout,
the uric acid forms crystals which are deposited in the joints. These deposits give rise
to inflammation, in turn causing pain, swelling and redness.
HOW COMMON IS GOUT?
Gout affects close to one in 30 North Americans. Men are at least four times more likely
to develop gout than women. Gout occurs more frequently in countries that have a high standard
of living. Men who develop gout usually do so between the ages of 40 and 50. Women are more
likely to develop gout after the age of 60.
WHAT ARE THE WARNING SIGNS OF GOUT?
- Intense, continuous pain in a joint, usually the big toe.
- Hot, red, swollen skin and a feeling of pressure around the painful area. This may be
accompanied by a stretching or tearing sensation in the skin.
HOW DOES GOUT PROGRESS?
Without treatment, early attacks of gout usually subside within
a week. There may be months or years between successive attacks.
As Gout progresses, flare-ups become more frequent and severe
and may involve other joints.
Click here for gout risk
factors, prevention and wellness tips.
MEDICATIONS FOR GOUT
If you have been diagnosed with gout, your doctor or other
healthcare practitioner will review the best course of treatment
and pain management for you. This will likely include medication.
Based upon tests, which will probably include a 24-hour urine
sample, your doctor will determine which gout medication is
appropriate for you. Some gout sufferers overproduce uric
acid, while others fail to eliminate enough uric acid. Different
types of medications are used in each instance.
Here are the most commonly used medications for gout and how they
work.
MEDICATIONS THAT CONTROL GOUT SYMPTOMS
These include non-steroidal anti-inflammatory drugs (NSAIDs).
They help you to feel better by reducing the amount of discomfort
that you experience but they do not inhibit the disease process
itself. For this reason, they cannot prevent the damage associated
with advanced gout, such as bone and joint impairment. These
formulations typically take a few days to a few weeks to control
Gout pain effectively.
- NSAIDs
Pronounced “ensayds,” these drugs help reduce
Gout pain and swelling in the joints while decreasing stiffness.
When a low dose is taken, NSAIDs control pain, but higher
doses are required to reduce inflammation. The problem with
NSAIDs is their side effects. Taking more than one NSAID
at a time increases the possibility of heartburn and severe
side effects such as ulcers and bleeding. NSAIDs inhibit
the blood’s ability to clot properly and may therefore
interact with blood-thinning medications such as coumadin.
Kidney disease has also been reported as a side effect.
Most NSAIDs require a prescription, including naproxen (Naprosyn®),
nabumetone (Relafen®), indomethacin (Indocid®),
diclofenac (Voltaren®), piroxicam (Feldene®) and
sulindac (Clinoril®). Other NSAIDs are available over-the-counter;
these include ASA (Aspirin®, Anacin® and others),
and ibuprofen (Motrin IB®, Advil® and others.)
- COX-2 Inhibitors
This sub-class of NSAID has recently been introduced to
the North American marketplace. The most frequently prescribed
Cox-2 inhibitors are celecoxib (Celebrex®), rofecoxib
(Vioxx®), valdecoxib (Bextra®) and meloxicam (Mobicox®).
Unlike standard NSAIDs, Cox-2 inhibitors do not inhibit
proper blood clotting. Recent evidence, however, strongly
suggests that Cox-2 inhibitors have the same degree of negative
side effects as standard NSAIDs—including contributing
to kidney failure—and may increase the risk of heart
attack and other cardiovascular
problems.
*Important News Release September 2004
Vioxx®, the cox-2 inhibitor made by Merck, has been
pulled from the market because of severe lethal side effects
due to heart attack and stroke.
- CORTISONE
Cortisone may be injected directly into the joint to relieve
severe inflammation and swelling. Cortisone mimics the anti-inflammatory
effects of cortisol—a hormone produced naturally in
the body. A cortisone injection can provide almost immediate
relief for a tender, swollen or inflamed joint. However,
since corticosteroids can weaken cartilage and remove
minerals from the bone, they should only be used rarely.
Chronic use of corticosteroids may result in immune suppression
and increase the risk of infection.
SUBSTANCES THAT MAY HELP MODIFY THE DISEASE PROCESS
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