Gout is an ancient disease caused mainly by abnormal purine metabolism and is common in young men. As the “main force” of gout patients, young men often have a need for fertility, so many male patients ask: how to use medication if they plan to have children?
I. Acute attack medication
The treatment of acute gout attack is mainly based on anti-inflammatory and analgesic, so the drugs in line with this concept mainly include three first-line drugs: NSAIDs, colchicine and glucocorticoids, in addition to biological agents and topical analgesic creams can also be used for the treatment of acute gout attack.
1.Non-steroidal anti-inflammatory drugs.
That is, the people’s so-called painkillers, including Fotarine, Ibuprofen, Loxone, Anacin, Ciloxib and Meloxicam, etc. In the U.S. FDA pregnancy drug classification belongs to category B, that is, animal experiments confirmed that it is not harmful to the fetus, but the evidence of human trials is not sufficient. Some animal experiments have confirmed that Ciloxib does not affect sex hormone secretion and spermatogenesis, but there is a lack of in vivo studies on the effects of such drugs on male fertility, so the lowest effective dose of NSAIDs is recommended for men to take during pregnancy preparation with reference to the principles of female pregnancy medication. Therefore, topical painkillers in the form of creams are also available.
2. Colchicine.
It is an alkaloid that mainly interferes with the formation of microtubules by binding to microtubule proteins of granulocytes, while inhibiting the release of leukotriene B4, glycoprotein chemotactic factor and interleukin-1 and other inflammatory factors by neutrophils and monocytes, which together achieve the inhibition of deformation and chemotactic movement of inflammatory granulocytes, thus exerting anti-acute inflammatory effects. It is an effective drug for acute gout attacks and is also the drug of choice recommended by the 2012 ACR guidelines for the prevention of gout reoccurrence during uric acid lowering. Although it belongs to category D in the FDA pregnancy drug classification, some studies suggest that the application of colchicine has no clear negative impact on the fertility of men and women, so male gout patients can use this drug during pregnancy preparation, but a low-dose treatment regimen of one tablet three times a day is recommended.
3. Glucocorticoids.
That is, the people say hormonal drugs, often used when they cannot tolerate non-steroidal anti-inflammatory drugs, colchicine or the presence of peptic ulcers, or have contraindications such as liver and kidney insufficiency. Some patients with single joint involvement may also receive intra-articular injections of long-acting glucocorticoids. It belongs to Class B (short-acting: prednisone, medrol) and Class C (long-acting: dexamethasone) in the US FDA pregnancy drug classification. There is a lack of directly relevant evidence on the effect of glucocorticoids on male fertility, so it can be recommended that male gout patients can use the lowest effective dose of short-acting doses of glucocorticoids during pregnancy preparation.
4. Biological agents.
It can be used to treat refractory gout patients when they are unable to control their attacks. Several studies suggest that the treatment of tumor necrosis factor alpha inhibitor does not affect male fertility, so it can be recommended that male patients can use tumor necrosis factor alpha inhibitor (Enzyme/class gram/Xumel) during pregnancy preparation.
Second, the stable period of drug use
During the stable period of gout, in addition to low purine diet and drinking more water, it is also necessary to use drugs for the treatment of hyperuricemia, the most commonly used is uric acid-lowering drugs including drugs to promote uric acid excretion and drugs to inhibit uric acid synthesis.
1, to promote uric acid excretion drugs.
(1)Benzbromarone, which reduces uric acid level in blood by inhibiting uric acid reabsorption by renal tubules. So far, there is still a lack of reports on the effects of benzbromarone on male fertility and pregnancy outcomes, so for safety reasons, it is recommended to stop using the drug 3 months before planning pregnancy.
(2) Sodium bicarbonate: commonly known as baking soda, it can promote uric acid excretion by alkalinizing urine. Under normal circumstances, the male epididymis is an acidic environment containing a low concentration of bicarbonate to ensure the normal spermatogenic process. In contrast, the female uterus and fallopian tubes are alkaline environments containing high concentrations of bicarbonate to provide for sperm capacitation and normal fertilization.
Although there is a lack of evidence that long-term use of sodium bicarbonate can affect male fertility, but theoretically high doses of sodium bicarbonate can interfere with the acidic microenvironment within the epididymis, thus affecting the spermatogenic process, so it is still recommended that men do not use this drug during pregnancy preparation to ensure high quality sperm.
2. Drugs that inhibit uric acid synthesis.
(1) Allopurinol: inhibits the synthesis of uric acid by inhibiting the activity of xanthine oxidase, which belongs to category C in the FDA pregnancy drug classification. So far, there is still a lack of directly relevant animal/human test data, and only animal studies suggest that 200 mg/kg of allopurinol once before and after ischemia-reperfusion can inhibit the apoptosis of rat germ cells and improve spermatogenesis at the same time. However, this drug can cause fetal malformations in women during pregnancy, so for safety reasons, it is recommended that allopurinol should be stopped for at least 3 months before planning pregnancy.
(2) Febuxostat: The mechanism of action is the same as that of allopurinol, but there are no reports on the effects of this drug on male fertility, so for safety reasons, it is recommended to stop using the drug 3 months before planning to get pregnant.
In conclusion, it is possible for young men with gout to use medication during acute attacks of gout while preparing for pregnancy, but they should stop taking uric acid-lowering medication regularly when their condition is stable before planning for pregnancy. However, fortunately, gout is an episodic disease, and the most painful symptoms appear during the acute attack.