Best prescription medications for chronic gout treatment

Introduction

Chronic gout is a painful and debilitating form of inflammatory arthritis. Gout is caused by the buildup of uric acid crystals in the joints, and can lead to frequent flare-ups, joint damage, and pain. In this article, we will explore what chronic gout is, common prescription medications used to treat it, the effectiveness of these treatments, potential side effects, and lifestyle changes that can help manage the condition.

What Is Chronic Gout?

Chronic gout is a long-term condition that happens when high levels of uric acid in the blood cause uric acid crystals to form in the joints. 1,2 These crystals trigger an inflammatory response, causing severe pain, swelling, redness, and warmth in the affected joint. 1,2 While the big toe is most commonly affected, gout can occur in any joint, including the ankles, knees, wrists, and fingers. 1,3

The cause of chronic gout is too much uric acid in the blood. 4 Uric acid is waste formed from the breakdown of purines, which are found in many foods and produced naturally in the body. 4 Normally, uric acid dissolves in the blood and is removed by the kidneys. However, when there is too much uric acid or the kidneys cannot remove it well enough, uric acid levels rise, causing crystals to form and gout. 1,4

Several factors can raise the risk of developing chronic gout, including being overweight, having high blood pressure, diabetes, or kidney disease, and taking certain medications like diuretics. 33,34 Additionally, eating foods high in purines, such as red meat, seafood, and sugary beverages, can contribute to hyperuricemia (high uric acid levels). 33,34

Chronic gout often coexists with other health conditions. 4 These include hypertension, chronic kidney disease, diabetes, obesity, high cholesterol, and heart disease.4 These conditions not only increase the risk of developing gout but can also make it harder to treat. 4

Common Prescription Medications for Chronic Gout

Treating chronic gout involves managing acute attacks and preventing future episodes through long-term uric acid reduction. 11,12 For acute gout flare-ups, healthcare providers may prescribe non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids to reduce inflammation and pain. 11,12 These medications can be taken orally or injected directly into the affected joint for fast relief. 11,12

For long-term management of chronic gout, the main goal is to lower uric acid levels and prevent crystals from forming. 11,12 Uric acid-lowering drugs, such as allopurinol and febuxostat, are commonly prescribed for this purpose.11,12 These medications work by either blocking the production of uric acid (allopurinol) or helping the kidneys eliminate it (febuxostat). 11,12

Uric acid-lowering prescription medications are an important part of long-term gout management. When considering a uric acid-lowering prescription medication, it is important to work closely with a healthcare provider to pick the most appropriate option for you. This is based on factors such as kidney function, other health conditions, and potential side effects. Regular monitoring of uric acid levels and kidney function is also needed to monitor the medication's effectiveness and safety.

In severe cases of chronic gout that do not respond to typical therapies, a newer medication called pegloticase may be used. 12,13 Pegloticase is an injectable drug that converts uric acid into a compound that the body has an easier time flushing out. 12,13

Effectiveness of Chronic Gout Treatments

Gout medications have been proven to be effective through numerous studies. Allopurinol, a uric acid-lowering drug, has been shown to effectively reduce uric acid levels and prevent gout flare-ups in the majority of people taking it. 29,30 Similarly, febuxostat can lower uric acid levels and improve clinical outcomes in people with gout. 18,26

Recent studies have shown the effectiveness of newer therapies and combination treatments for chronic gout. Pegloticase, for example, has shown promise in treating severe, refractory gout cases. 16,17 Combining pegloticase with methotrexate has been found to reduce serum uric acid levels over 12 months. 14,15

Ultimately, the effectiveness of chronic gout treatment depends on a comprehensive, personalized approach that considers your specific needs and circumstances. 9,10 Working closely with healthcare providers can help make sure that treatment plans are tailored to address comorbidities, risk factors, and personal preferences, while providing support. 9,10

Potential Side Effects of Chronic Gout Medications

While prescription medications for chronic gout can be highly effective, they can also cause side effects. 18,22 Common side effects include nausea, vomiting, diarrhea, and skin rashes. 18,22

• Allopurinol: This drug causes a rash in about 1 in 100 people who take it. 19,22 In rare cases, this rash may be a sign of a severe allergic reaction, particularly in people with kidney disease. 19 If you develop a fever, cold-like symptoms, or a rash while taking allopurinol, seek prompt medical care. 19,22
• Febuxostat: This medication has been associated with an increased risk of cardiovascular death. 18,26 Febuxostat is now recommended only for people who cannot tolerate allopurinol or have not had success with allopurinol. 26,23 People with a history of cardiovascular disease should use febuxostat with caution. 26,23
• Colchicine: Used to reduce inflammation during gout flare-ups, this medication can cause gastrointestinal side effects like nausea, vomiting, and diarrhea, especially at higher doses. 20,27 Long-term colchicine use has also been linked to a rare side effect called reversible axonal neuromyopathy, which can cause muscle weakness and pain. 20,28

People taking gout medications should be closely monitored by their healthcare providers, with regular blood and kidney function tests to check for side effects. 20,21 Any unusual symptoms should be reported to the provider immediately. 20,21

Gout treatments can sometimes trigger new gout attacks, especially when first starting therapy. 18,20 Healthcare providers may prescribe additional medications to help prevent these flare-ups. 26,21

Lifestyle Changes to Manage Chronic Gout

In addition to prescription medications, lifestyle changes can help you manage chronic gout. 36 Dietary changes, weight management, exercise, and staying hydrated can all help reduce uric acid levels and prevent gout flare-ups. 37,38

• Dietary changes: Limit foods high in purines, such as red meat, seafood, and sugary drinks, which can increase uric acid levels. 37,38 Instead, a diet rich in fruits, vegetables, whole grains, and lean proteins is recommended. 39,40 Reducing the intake of fructose, found in high-fructose corn syrup and sugary beverages, can also help manage hyperuricemia and gout. 53
• Weight: Maintaining a healthy weight through a balanced diet and regular exercise is another important lifestyle factor in gout management. 41,42 Being overweight or obese increases the risk of developing gout and can worsen symptoms. 41,42 Gradual weight loss through a combination of diet and low-impact exercises like walking, swimming, and cycling can help lower uric acid levels and reduce the frequency of gout attacks. 43,44
• Hydration: Staying hydrated by drinking plenty of water can help flush out excess uric acid and reduce the risk of crystals forming in the joints. 45,46
• Alcohol: Limiting alcohol consumption, especially beer, is recommended, as alcohol can increase uric acid production and trigger gout attacks. 47,48
• Supplements: Complementary approaches, such as traditional Chinese herbal remedies (e.g., TFK, biomass-derived activated carbons), probiotics (e.g., Lactobacillus plantarum CCFM8610), and calcium supplementation, may help manage gout by reducing uric acid levels and inflammation. 51,52 However, these approaches should be used with, rather than as a replacement for, conventional medications. 49,50

During an acute gout flare-up, self-care strategies like taking over-the-counter NSAIDs, applying ice packs, elevating the affected joint, and using a cane to reduce pressure on the joint can provide relief. 54,55 If the pain is severe or persists, seek medical attention, as stronger medications may be available. 54,55

Ultimately, the most effective approach to managing chronic gout is a personalized plan that considers your preferences, comorbidities, and potential barriers to care. 56,57 Working closely with a healthcare provider to develop a treatment plan that combines medication, lifestyle changes, and complementary therapies can help you manage chronic gout. 56,57

Conclusion

By understanding the underlying causes, risk factors, and available treatment options, people with gout can work with their healthcare providers to develop personalized plans that effectively control symptoms and prevent long-term complications.

Prescription medications, such as uric acid-lowering drugs, NSAIDs, colchicine, and corticosteroids, play an important role in managing acute gout flare-ups and preventing future attacks. However, these medications can also cause side effects.

It is important to work closely with a healthcare provider to develop a personalized approach to managing chronic gout. 56,57 This involves considering your preferences, comorbidities, and potential barriers to care when creating a treatment plan. This plan will combine medication, lifestyle changes, and complementary therapies. 56,57

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<11>Gout is a type of inflammatory arthritis that causes sudden and intense joint pain, often in the big toe and at night.1,2 The condition occurs when uric acid crystals build up in the joints, leading to swelling, redness, and discomfort.1,2 Gout can affect various joints, including the ankles, knees, and fingers, and is more common in men over 40 and women after menopause.1,2</11>

<12>Certain factors can increase the risk of developing gout, such as being overweight, having high blood pressure, diabetes, or kidney disease, and taking certain medications like diuretics and beta-blockers.1,2 Diet also plays a role, as consuming too many purine-rich foods like red meat, seafood, and sugary beverages can contribute to high uric acid levels.1</12>

<13>Treating gout involves managing the acute attack and long-term prevention of future episodes. For acute attacks, over-the-counter or prescription non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids can help reduce inflammation and pain.3,4 Applying ice packs and resting the affected joint can also provide relief.4</13>

<14>Improved joint and patient-reported health assessments with pegloticase plus methotrexate co-therapy in patients with uncontrolled gout: 12-month exploratory outcomes of the MIRROR open-label trial. (John K Botson, Katie Obermeyer, Brian LaMoreaux, Lin Zhao, Michael E Weinblatt, Jeff Peterson, Arthritis research & therapy, 2022)</14>

<15>A Randomized, Placebo-Controlled Study of Methotrexate to Increase Response Rates in Patients with Uncontrolled Gout Receiving Pegloticase: Primary Efficacy and Safety Findings. (John K Botson, Kenneth Saag, Jeff Peterson, Naval Parikh, Stephen Ong, Dan La, Karon LoCicero, Katie Obermeyer, Yan Xin, Jason Chamberlain, Brian LaMoreaux, Supra Verma, Stephen Sainati, Suneet Grewal, Amar Majjhoo, John R P Tesser, Michael E Weinblatt, Arthritis & rheumatology (Hoboken, N.J.), 2022)</15>

<16>Pegloticase is a recombinant uricase enzyme that has been approved for the treatment of chronic refractory gout, a severe form of the disease that is resistant to conventional urate-lowering therapies. Several studies have examined the efficacy and safety of pegloticase in this patient population.

A review article published in the journal Drugs & Therapy Perspectives provides a guide to the use of pegloticase in the treatment of treatment-refractory chronic gout in the European Union. The article discusses the pharmacology, efficacy, and safety of pegloticase, as well as its place in the management of this condition (Pegloticase: a guide to its use in treatment-refractory chronic gout in the EU | Drugs & Therapy Perspectives, 2013).

Another review article published in the journal Arthritis Research & Therapy examined the resolution of tophi (deposits of uric acid crystals) in patients with chronic refractory gout who had persistent urate-lowering responses to pegloticase. The authors found that pegloticase treatment led to significant tophus resolution in these patients (Tophus resolution in patients with chronic refractory gout who have persistent urate-lowering responses to pegloticase | Arthritis Research & Therapy, 2018).</16>

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