Joint pain caused by gout is often excruciating. However, many people forget about the pain after the pain, and do not go to the hospital for further examination and treatment in time. Many people think that the only treatment for gout is painkillers, but in addition to pain relief, the more important treatment for gout is uric acid reduction therapy during the remission period. A number of gout medications have been introduced before, so today, let’s review them again in general. Gout treatment medications include both pain medications for acute attacks and uric acid-lowering medications for remission.
Drugs to control acute attacks
1. Non-steroidal anti-inflammatory drugs
Non-steroidal anti-inflammatory drugs are used more often in clinical practice and are very effective, but they cannot be used in large quantities for a long time.
Traditional NSAIDs (such as indomethacin, ibuprofen, etc.) have more side effects and may cause serious gastrointestinal bleeding, so it is recommended to take them after meals, and if symptoms of stomach discomfort occur you can add some stomach protection drugs at the same time. Celecoxib and etoricoxib are new NSAIDs that are more commonly used, with good efficacy and few side effects, but they are not suitable for patients with combined cardiovascular disease.
2. Colchicine
Colchicine is the “most familiar stranger” to gout patients, and many patients refuse to use colchicine because they are afraid of its side effects.
Nowadays, colchicine is no longer taken orally in large doses as in the past, but in small doses, which greatly reduces the side effects and has the same efficacy.
In addition, colchicine is now also mostly used for preventive use during the remission phase of gout.
It is believed that many gout patients also have gout attacks in the process of lowering uric acid. It is not that lowering uric acid is ineffective, but that gout attacks caused by fluctuations in uric acid levels in the body can be prevented by using colchicine in small doses at the same time.
3. Glucocorticoids
Only when the above two drugs cannot be used or are ineffective, doctors will consider choosing hormones. The use of hormones must be done under the guidance of a regular hospital physician.
Drugs for lowering uric acid
Uric acid-lowering drugs are divided into two main categories.
1. Inhibit uric acid synthesis
These include allopurinol and the new xanthine oxidase inhibitors (febuxostat).
2. Promote uric acid excretion
Mainly including propoxur, benzbromarone, sulfopiridone.
The above two types of drugs have different mechanisms of action and are not absolutely superior or inferior. It is recommended that the most appropriate drug can be selected by the clinician according to the comprehensive situation of the individual.
It should be noted that drugs that promote uric acid excretion are not suitable for patients with kidney stones, as they can increase the burden on the kidneys.
Drugs to alkalize urine
The main one is sodium bicarbonate or sodium potassium bicarbonate. Sodium bicarbonate is what we usually call “baking soda”.
Higher urine pH (i.e., more alkaline) may increase the risk of calcium-related stones.
Urine pH below 6.0: need to alkalize the urine.
Urine pH between 6.2 and 6.9: facilitates dissolution and elimination of urate crystals from the urine.
Urine pH > 7.0 is prone to the formation of calcium oxalate and other types of stones.
Therefore, it is important to review the pH of urine regularly when taking such drugs to adjust the medication and reduce the risk of urinary stones.
Each drug has its own indications and contraindications, and there is no specific drug for gout. It is important to visit a specialist in a regular hospital to be judged by a professional physician based on a combination of conditions.
Sometimes, if one medication does not bring the blood uric acid under control, then the doctor may consider combining several medications. Gout patients must watch for possible side effects while taking medication.