The drug sometimes doesn’t matter, it’s the way you apply it that matters. The same drug can have different efficacy depending on the way you apply it.
1.First, let’s talk about colchicine
Colchicine is a common drug for gout, and almost all of my friends with gout have used it, and it is the first drug recommended by pharmacies outside. I do not like to use it as a painkiller, because the side effects are more, the acute phase is mainly gastrointestinal reactions. Foot pain like a tiger bite, eat colchicine, the beginning of the effect is not obvious, eat 0.5mg every hour, when the effect, and so you eat vomiting and diarrhea (most appear to stomach comfort, diarrhea), he also took effect, no more pain. Colchicine is a drug that causes diarrhea in different amounts for each person, and if you take it for a long time, you may develop a certain tolerance and need more doses. I have a patient told me to start eating 7 or 8 tablets will be diarrhea, (diarrhea watery, milky white, like milk) but a long time to find, eat to 12 tablets, or not pull, not diarrhea, swelling and pain does not go away. 12 tablets is enough, the day dare not eat again, after an interval of 2 days, then eat to 12 tablets, and diarrhea, feet well, began to catch a cold, bronchitis. Chinese medicine says that diarrhea hurts the stomach, earth does not produce gold, gold Qi deficiency will feel evil. I always say, the medicine to cure our rheumatism, there is no side effect is not useful.
However, this drug has a role to play in preventing gout attacks. Smaller doses (such as 0.5mg tid taken for 1-3 months, or even smaller doses such as 0.5~1mg daily or every other day) can reduce the prevention of gout attacks. The acute phase of gout may be only one week per attack, but the chronic pain may last for 1 month. If you only take some painkillers when it hurts, then it is easy to relapse within 1 month. Then you have to add allopurinol, for example, because the initial addition of this drug makes the condition easy to recur, and patients often have gout attacks somehow. There is a way to take half a tablet of colchicine each time, 1-2 times a day, so that eating allopurinol gout will not flare up. In addition, due to the outstanding clinical efficacy of this drug, experimental treatment is available for cases with diagnostic difficulties, which can help in differential diagnosis.
2. Talking more about natural colchicine
Colchicum is the bulb of the perennial herb Lijiang Mountain Cichlid, white in color, harvested in summer and autumn, washed and dried in the sun. The drug is bitter, warm in taste and has side effects (commonly known as a small poison) mainly used for anti-tumor, for tumors in the breast, nasopharynx, lung, esophagus, uterus and skin, this product contains colchicine, which can inhibit the mitosis of cell nucleus, skin cancer can be made into a cream directly applied externally. His side effects are mainly gastrointestinal discomfort, polyneuritis, leukopenia, etc. Because it contains colchicine, it can now be used again for anti-gout, and has good pain relief effect on pain caused by acute gout. Because of its side effects, it should be explained to the user first so that he or she can be prepared, mainly for gastrointestinal reactions, and is prohibited for people with gastric ulcers and intestinal discomfort. Long-term use of the drug is considered to have leukopenia and polyneuritis, so the method of stopping the disease should be adhered to (that is, after the disease is controlled, then change to other methods of treatment). Colchicum is also available in Tongxiang Sulunjiang capsule, which can be used to treat gout. It is important to note that patients with hemorrhoids cannot use this medicine.
3.Talk about non-steroidal drugs
Fotalin, pain relief effect is good, but should pay attention to the protection of the gastrointestinal tract, the use of drugs for more than a week must be added to the gastrointestinal mucosa protector. Fotalin also has ointment, and although there is no feeling when used topically, there is evidence-based evidence that it is effective.
For the first time, you can take two tablets, i.e. 0.4mg, and then one tablet every 12-24 hours, which has a good pain relief effect and quick effect with less gastrointestinal side effects. The first dose of two tablets is indeed more effective than one tablet.
The patient with obvious pain will tell you after 20 minutes that the painful area is a little numb and better. If the swelling is obvious, you will be told that you will feel relieved after 20 minutes. But this medicine can only be taken for 5 days, one tablet a day. The main concern is the side effects. Acute treatment is generally maintained for 1 to 2 weeks, stopping the drug too soon, easy to repeat.
4.Capsaicin ointment
Topical use in the acute phase, with few side effects, effective. In fact, moderate pain below the first can use topical drugs, foreign topical drugs used quite a lot, in the domestic people still like to take orally, always feel that eat to the belly to be real. The external medicine like to choose cream, always feel that the cream is not much use. In fact, topical medicine should be used on time, as well as internal medicine, according to the amount, generally after the external application to massage 5 to 10 minutes, so that the cream can be fully absorbed. If you do not massage, or can not be used 3 times a day, the effect will be discounted.
5.Dexamethasone
The effect is good, short-term application of side effects are not a lot, can quickly control inflammation, generally with three days, but three days after the drug can not be immediately stopped, if immediately stopped, and no other drugs to continue, it is easy to relapse. There are two methods, one is to slowly reduce the amount, you can use the method of 53221; then is to add non-steroidal anti-inflammatory drugs to continue through.
6.Deboxone
With a shot of efficacy can be maintained 1 to 2 weeks, some can reach 1 month, the effect is also fast, more convenient drugs, but hormonal drugs, side effects or to pay attention to, there are many patients with the drug will rash, after a period of time themselves will disappear. There was also a patient who went to do acupuncture after using the drug and fainted, I do not know if there is any relationship with this drug. There is no follow-up with Depo-Provera, and gout will come back soon. But overall it is very safe. After the gout attack 1 to 3 months are the acute period, this period must be careful, a little inattention will be relapsed, so the medication to maintain continuity, not just stop.
Glucocorticoids are a good choice, especially for patients who are ineffective or have contraindications to NSAIDs or colchicine. They are usually given orally in moderate doses for several days and then gradually reduced. Glucocorticosteroids, too, are not only for the treatment of acute attacks. We treat gout, in addition to controlling the symptoms in the acute phase, a very important one is to control and reduce complications, such as gouty kidney, which mostly involves the interstitial kidney and urinates a lot at night, when the use of hormones is beneficial and can relieve interstitial nephritis. However, long-term use of hormones for gout is not recommended, as hormones have adverse effects on metabolism and may also have an increased risk of gout stones. Especially in patients with diabetes, the use of hormones can lead to increased blood sugar fluctuations. Some drugs for pain can be chosen to be taken after dinner, because gout tends to strike at night.
7.Baking soda tablets
The first is based on the diet, such as these days you eat more acidic food, you will baking soda tablets to eat a little, or increase the amount. Of course, the more scientific method is to measure the ph value of urine, keep it between 6.0 and 7.0, high and low are not conducive to the excretion of uric acid. Patients who need a low-sodium diet, such as those with high blood pressure and edema, should be aware that baking soda tablets contain more sodium. Some studies have shown that the combined application of baking soda and allopurinol is more effective than the latter alone.
8. Allopurinol
”The only drug that inhibits uric acid synthesis so far is allopurinol, which inhibits xanthine oxidase so that hypoxanthine and xanthine cannot be converted into uric acid, but gradually oxidized in the body to produce water-soluble isoxanthine (oxipurinol) excreted through the urine, and can be converted into the corresponding nucleotide in the presence of PRPP. The corresponding nucleotides are consumed in the presence of PRPP, which can also inhibit phosphoribosyl pyrophosphate amide convertase (PRPPAT) and reduce IMP synthesis, thus rapidly reducing blood uric acid concentration, inhibiting the synthesis of gout stones and kidney uric acid stones, and promoting the dissolution of gout stones, initially 100mg once a day, gradually increasing the dosage up to 200mg three times a day. Combination with uric acid-removing drugs can enhance the efficacy, but generally do not need to be used in combination. Individual patients may have fever, allergic rash, abdominal pain, diarrhea, leukocyte and platelet reduction, and even liver function damage and other side effects, stopping the drug and giving the appropriate treatment can generally recover, occasionally necrotizing dermatitis occurs, the condition is serious, should be immediately rescue treatment. Some of the exfoliative dermatitis may not be recoverable. This drug is not allergic when you start using it, it does not mean that you will not be allergic in the future, so although it is the only drug that inhibits the production of uric acid, there is always the feeling of throwing a mouse. Uric acid transfer gout attacks can also occur during the use of the drug, and can be treated with colchicine.
That said, allergy to this drug is still different from the general drug. The general drug allergy, which mostly occurs with re-dosing and can be triggered by just a little dose, is most commonly a penicillin allergy. Allopurinol’s allergy is related to the dose and the course of treatment, and side effects usually occur within 8 weeks, and should be stopped as soon as they occur. The fixed erythema caused by him is still better, if it is exfoliative dermatitis, it is very dangerous and generally considered irreversible, the treatment time should be long, hormone withdrawal should be slow, because it is easy to repeat. hla-b5801 positive people often occur side reactions, this can be checked. In Europe and the United States, benzbromarone is prohibited, and most of them use allopurinol, to which Europeans and Americans are rarely allergic. The allopurinol is different for yellow people, who are allergic to 15%, so it is safer to take allopurinol in small doses and it is equally effective. Can allopurinol be used in renal insufficiency?
Hyperuricemia with renal insufficiency is one of the indications for allopurinol, but patients with poor renal function can allow alloxanthine to accumulate in the body, increasing the adverse effects of this agent. Therefore, it is important to drink plenty of water and make the urine neutral or alkaline to facilitate uric acid excretion while taking the drug, and to test renal function, etc.
If there are side effects that may be related to allopurinol, contact your doctor for prompt treatment.
9. Hydroxychloroquine
Recently, I have seen people use hydroxychloroquine to treat gout, but I have not tried it. I’ve never tried it, but I’m writing here to give some ideas to those who are doing research.
10, febuxostat
It is a new non-purine xanthine oxidase inhibitor, clinically used to treat hyperuricemia (gout), no less effective than allopurinol, and less allergic. The domestic febuxostat, which has been marketed, is now more expensive but effective, especially for patients with allopurinol allergy. The point to note is that the starting dose should not be large, it is best to use with anti-inflammatory drugs (and so on uric acid stable after the withdrawal), because this drug is still relatively fast to lower uric acid, easy to induce gout attacks, especially with gout stones or gout more serious patients.
11. IL-1 antagonists
Inhibitors of TNF such as etanercept. It is thought that it can be tried for those patients who have difficulty in analgesia.
12. Glucosamine capsule
It is ideal for gout combined with osteoarthritis. Gout crystals can destroy cartilage and this drug can protect cartilage and is a drug that can be used.
13. Corsoa
Lowering high blood pressure will not raise uric acid.