Gout

Okay. From your answers, a medicine to lower blood urate level may be a good idea. This will help prevent sudden attacks of gout and will help to prevent complications of gout such as joint damage.

• allopurinol - this medicine reduces the synthesis of uric acid. It's a highly effective medicine and the dose can be adjusted to get the uric acid level down to where attacks of gout and complications (such as joint damage seen on x-rays or kidney stones) become very unlikely. Typical doses are 100 to 300 mg daily and monitoring includes measurement of blood counts and liver tests. Serious side effects are rare but include hepatitis, abnormal blood counts or allergic reactions.

• probenecid - this medicine lowers blood urate by encouraging the kidney's excretion of urate into the urine; typical doses are 500 to 1000 mg once or twice daily and monitoring includes measurement of the urinary urate to be sure it is not so high that it increases the risk of a kidney stone. Fortunately, side effects are rare and include headache, upset stomach and allergic reactions.

• sulfinpyrazone - this medicine lowers blood urate by encouraging the kidney's excretion of urate into the urine; typical doses are 200 to 600 mg daily; monitoring includes measurement of the urinary urate to be sure it is not so high that it increases the risk of a kidney stone. Side effects are unusual but include upset stomach and allergic reactions.

Some doctors routinely start with allopurinol for this situation, while others measure a 24-hour urine collection to see how much urate is being removed in the urine to help make the decision between these agents.

When any urate-lowering therapy is started and until the urate level is low and stable, there is an increased risk of an attack of arthritis; for this reason, colchicine (in a low dose) or an anti-inflammatory medicine (such as ibuprofen, again, in a low dose) are often prescribed. However, once the urate is low (in the range of six mg/dl or less) and stable, the colchicine or NSAID can usually be stopped.

Would you like to learn more about treating sudden attacks of gout?

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