How to treat Gout

Apr 23, 2019

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"What are you watching Emily?". "Creepy Stories from Restaurants." For those of you who don't have kids, Emily was not watching TV. Kids don't watch TV, or not nearly as much as I did as a kid. She was watching YouTube videos on her phone at breakfast. While eating a Tupperware container full of stuffing and turkey bits. For breakfast. I guess I should just be happy all the Easter Chocolate in the house had already been consumed. I think the new Canada Food Guide said to not watch screens, and talk to actual people while consuming lots of colorful veggies and fruits during meal times. I wonder where Emily gets her bad habits from?

There is a type of arthritis that has a long history of being blamed on poor eating habits. Gout was written about by the Egyptians in 2640 BC. In the last 4600 years it is still the only type of arthritis that is curable. Beside diet risk factors for gout include being male, being overweight and being over 40 years old. And a love of beer. Mmmmmmm. Beeeeerrrrrrr.

A gout attack or acute gouty arthritis happens when uric acid comes out of solution and crystals form in the joints or tissue. Uric acid is a normal ingredient in your blood that is formed by the normal break down of cells. Uric acid is also formed when you eat proteins with purine in them. Foods high in purine include anchovies, asparagus, consommé, herring, meat gravies, mushrooms, mussels, organ meats, sardines and sweetbreads. Sometimes in gout there is an imbalance in how much uric acid is formed from your diet and how fast your kidneys can eliminate it. So, if you eat a lot of purine rich foods and drink a lot of alcohol (alcohol causes your body to make more uric acid and your kidneys to eliminate less) you could get gout. And unfortunately, beer seems to be the worst of the alcohols for gout. But diet isn't the only cause of gout. If your kidneys don't eliminate uric acid very well, you could get gout. Or if you inherited a gene that causes your body to make way too much uric acid you could get gout as well.

Often the first time someone knows they have gout is when their big toe hurts. The pain can be very severe, and the joint pain can appear very suddenly and often at night. The pain becomes worse and worse especially when touched or moved. The joint can get inflamed, swollen and warm and the joint can look red or purplish. What do we try to do if someone complains of gout? First send them to the doctor to get a diagnosis. If it is gout, the doctor will probably give them a prescription for a non-steroidal anti-inflammatory drug (NSAID). The most commonly used one in gout is called indomethacin. This will reduce the pain and inflammation and hopefully make the current gout attack go away.

An older treatment for gout is called colchicine. Colchicine has been used to treat gout for centuries. In pharmacy school we were told colchicine works on gout, but that we didn't really know why. Now scientists are working out that the colchicine actual changes the structure of the microtubules inside the white bloods cells that move uric acid crystals around. Colchicine can be very effective for gout, but it has some rare but nasty side effects including bone marrow suppression. Because of these rare but serious side effects, colchicine is used as a second line treatment behind indomethacin.

Surprisingly to me, steroids are being recommended more often for gout attacks. Medications like prednisone are probably safer then NSAIDS for people with kidney disease, cirrhosis of the liver and heart failure. Prednisone can be safer than NSAIDS for patients prone to stomach bleeds. Usually the dose will be prednisone 30 to 40 mg once a day for 5 days with no taper off period.

If a patient has several gout attacks per year, the doctor will then consider giving them something to reduce the number of attacks. That will usually be a drug called allopurinol. Allopurinol reduces the amount of uric acid your body produces. If you take it every day you will reduce the chance of your next attack. Allopurinol will not help reduce the pain in your current attack. In 2010, Health Canada approved the first new drug to treat gout in 40 years. It is called Uloric or febuxastat. It may reduce uric acid levels even better than allopurinol. But as it is a newer drug, it is more expensive than allopurinol.

Nonpharmacological measures should always be the first line of defense to prevent and treat gout. Yes, please listen eventhough you've heard them before. If you are overweight, try to lose some weight. Make sure you exercise, drink lots of water and quit smoking. Avoid high fructose corn syrup sweetened food and drink. Limit sugar of all types and limit the amount of salt you put on your foods. Reduce beer consumption to 2 or less per day for men and 1 or less per day for women. Wine and spirts should be consumed in moderation as well.

Guinness is definitely the perfect breakfast beer. I should probably be happy Emily is having stuffing and turkey for breakfast instead of Guinness. We should all try to get half our plates full of colorful veggies and fruit. We should all incorporate more whole grains into what we eat. After a food filled holiday like Easter, we can all think about eating better. And people like me need to ignore the siren sound of prophet Homer Simpson. Mmmmmm. Beeeerrrrr.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

 


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