The various treatments for gout

During an actual attack, as well as anti-inflammatory drugs and pain-killers, colchicine is used to combat the inflammation caused by the uric acid crystals.

To prevent or limit repeat attacks, allopurinol is prescribed to lower uric acid levels in the blood, but only when there have been several gout attacks. This is a maintenance therapy, as distinct from an acute-phase treatment.

The rapid lowering of uric acid levels at the start of allopurinol treatment may itself induce an attack, and colchicine is therefore associated at treatment initiation.

This maintenance therapy is to be kept up over the long course, if not for life. If it is stopped, uric acid concentrations rise, with a high likelihood of gout attack. For the last few years, there has been another drug, febuxostat, which causes a faster and greater decrease in uric acid. It is reserved for poor response or side-effects under allopurinol.

Finally, some dietary advice can be offered to help limit future gout attacks:

  • Drink lots of water, as water helps the organism eliminate excess uric acid by its diuretic affect. Soft drinks rich in fructose, on the other hand, are to be avoided.
  • Limit your meat consumption, especially for red meats, preserved meats and processed (delicatessen) meat, and avoid offal (liver, tongue, brain).
  • Reduce your alcohol consumption, because, as well as reduced uric acid excretion, alcohol induces development of gout.
  • Keep your weight under control, as overweight is a risk factor for onset of gout.
  • Reduce your consumption of seafood, as it is rich in purine and can trigger gout.
  • It is also advised to reduce consumption of sugary foods, as excess sugar can trigger diabetes. Some studies have shown that high blood insulin levels can lead to high uric acid levels, causing gout. Notably, avoid fructose-rich foods such as candies, cakes and chocolates.

Sometimes large tophi (uric acid crystal deposits) in the big toe cause considerable deformity resembling  hallux valgus complicated by bursitis, although palpation finds a hrad swelling and X-ray rules out bone and joint deformity.

Si ce volumineux gros orteil est douloureux il peut être indiqué de recourir à la chirurgie pour retirer ces dépôts articulaires.

L’intervention est simple et le résultat vite satisfaisant et ceci sans toucher ni aux os ni à l’articulation.

Cet article a été rédigé avec l’aide du docteur Françoise Markus, rhumatologue à la clinique du parc lyon.

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