An acute attack of gout is normally treated by giving non steroidal anti-inflammatory drugs (NSAIDS). Unfortunately these have a number of side effects:
Colchicine (a derivative of meadow saffron) is considered to be highly effective in dealing with acute attacks of gout. Patients are advised to take colchicine until the side effects of vomiting and diarrhoea appear. The British Medical Journal suggests that a dose of 0.5mg every eight hours may be preferable to higher doses.
Colchicine can also be delivered by injection but its toxicity is considered to be too high for this use.
The European League against Rheumatism (EULAR) recommends that "Intra-articular aspiration (the removal of fluid from around the affected joint) and injection of a long-acting steroid is an effective and safe treatment for an acute attack".
Eular goes on to point out that there no research evidence to support the use of joint aspiration.
It does however point out that the intra-articular injection of a long-acting steroid is effective at relieving the pain of an acute attack and that it may be especially useful for patients with a single joint attack and in those in whom "an NSAID and colchicine are contraindicated".
Further attacks of gout may be prevented by use of allopurinol which has been used for many years to reduce the levels of urate in the blood. There is some debate as to whether this medication should be given to all patients after an initial attack of gout or only those who have had a number of attacks.
The consensus would seem to be that doctors should take each individual's history and characteristics into account when deciding when to prescribe.
Although the normally prescribed dose is 300mg per day, the EULAR guidance puts forward the view that allopurinol should start with a dose of 100mg which is increased until the urate level in the blood starts to fall.
Allopurinol isn't suitable for everyone, for those patients that react badly there are a number of alternatives available. These include other xanthine oxidase inhibitors or uricosuric agents.
It is felt that non-pharmacological measures are also important in reducing the likelihood of further attacks, these include patient education, weight loss, reducing alcohol consumption and making dietary modifications to reduce intake of foods high in purines.
The Eular guidance states that "Patient education and appropriate lifestyle advice regarding weight loss if obese, diet, and reduced alcohol (especially beer) are core aspects of managment".
