Urate lowering treatments are used as long-term treatments for gout. The aim of the treatment is to lower the level of urate in the blood, which is the crystal that forms and causes the flares of red, hot swollen joints as well white hard deposits in the skin.
Urate lowering treatments don’t treat the acute joint pain but help reduce the chance of flares. They are usually started after you have had a couple of attacks of gout.
As they can sometimes cause flares of gout when they are first started, they can often be prescribed alongside treatments such as colchicine at low doses.
There are a few medications that can be used, these are:
Allopurinol works to reduce the level of urate in the blood. Allopurinol reduces the level of urate by blocking the enzyme that produces urate. This helps the body dissolve the crystals and stops further attacks of gout.
Allopurinol is a tablet that you take daily. It is usually started at a low dose of 100mg daily and can be increased up to 900mg a day. To ensure it is at a level that will work, blood tests are taken to monitor the urate level. The aim of treatment is to reduce the blood urate level to less than 0.3.
During starting treatment, gout attacks can be a little more often, so treatments to prevent these are often given at the same time such as a low dose of colchicine, NSAIDs or steroids.
It can take a few months to a year to stop the attacks of gout as long as the blood level of urate remains low.
As allopurinol can affect the kidneys, the kidney function is checked regularly on blood tests.
There are a few potential side effects to be made aware of:
Most side effects usually settle within a couple of weeks of starting the medication.
Interactions with other medications
Contraindications with other conditions
During pregnancy and breastfeeding
Alcohol
Vaccinations
Febuxostat works to reduce the level of urate in the blood. Febuxostat reduces the level of urate produced by the body. This helps the body dissolve the crystals and stops further attacks of gout.
Febuxostat is a tablet that is taken daily with or without food. It is usually started at a dose of 80mg daily and increased up to 120mg depending on the level of urate in your blood. Your blood urate level is checked at regular intervals and the aim is to reduce this to less than 0.3.
During starting treatment, gout attacks can be a little more often, so treatments to prevent these are often given at the same time such as a low dose of colchicine, NSAIDs or steroids.
It can take a few months to a year to stop the attacks of gout as long as the blood level of urate remains low.
Side effects are rare when taking febuxostat, these include:
Interactions with other medications
Contraindications with other conditions
During pregnancy and breastfeeding
Alcohol
Vaccinations
Uricosuric drugs are medications that increase the amount of urate that your kidneys flush out. Urate is the substance that forms crystals the cause the joint pain and swelling in gout.
Examples of these drugs include Sulfinpyrazone and benzbromarone. They are not used very often and are only used by doctors in rheumatology.
Uricosuric medications are tablets that are taken daily and measuring blood urate levels monitors their effects. The doses of medication are started low and can be gradually increased to aim for a urate level of less than 0.3.
As with all urate-lowering treatments, it can take months to a year to fully prevent a flare, and a significantly long time to break down tophi or crystal build up.
Side effects can occur in a few people who take these medications, these include:
It is important when taking these medications to stay well hydrated.
Contraindications with other conditions
Rasburicase is currently not licensed for use in gout, but in rare circumstances can be used when other treatments have failed.
Rasburicase lowers urate blood levels and is usually given as a monthly drip into a vein.
There are more possible side effects associated with this medication such as:
To prevent side effects, the rasburicase drip is given with other medication such as paracetamol, steroids and anti-histamines.
If your need to take rasburicase, your doctor will explain things further.
Versus Arthritis: http://www.versusarthritis.org
