Arthritis Treatment: Management of Acute Gout.
In acute gout, the pain is severe, throbbing and unrelenting and can last longer than a week. The affected joint is swollen, shiny and very tender to touch and often contact with the bed sheath can cause agonising pain.
The initial treatment is an optimal dose of an anti-inflammatory drug. The commonest of these is ibuprofen. Non-steroidal anti-inflammatory drugs (NSAIDs) have side effects and risks to patients but treatment is on a short term basis. Side effects can be reduced by using the slow released formulation of the drug or a suppository. The slow release drug will pass through the stomach intact reducing the risk of nausea and vomiting. If there is a history of gastric bleeding or ulcers, NSAIDs are not recommended.
Colchicine was commonly used before the advent of NSAIDs but it is likely to cause nausea and diarrhoea. The dose is gradually increased until effective or to the limit dictated by side effects.
Azapropazone is a vey useful drug for treating gout.
In large joints the fastest relief is achieved by steroid injection into the synovial space. The commonest manifestation of acute gout is in the big toe. Injection into the joints of this toe is not recommended because the joint is small and very painful.
Phenylbutazone was used extensively in the past, and was first choice in gout treatment but the serious side effect of bone marrow depression on long term treatment has led to the drug withdrawal in most countries.
During treatment of an acute episode of gout, your doctor will not start you on allopurinol. Any attempt to reduce the level of blood uric acid during an acute attack will make your gout worse and the episode last longer.
Dr.Phil Hariram,
Arthritis Guide.
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