Gout: Difference between revisions
imported>Robert Badgett (started page with a recent trial) |
imported>Robert Badgett |
||
| Line 5: | Line 5: | ||
==Prevention== | ==Prevention== | ||
[[Allopurinol]] can reduce frequency of attacks. However, when [[allopurinol]] is started, [[colchicine]] 0.6 mg twice daily should also be used. In a [[randomized controlled trial]], co-treatment with colchicine 0.6 mg twice daily while allopurinol was tapered up from 100 mg/day until 3 months after the serum urate concentration < 6.5 mg/dl, reduced flares of gout from 77% in the placebo broup to 33% with colchicine prophylaxis. Most of these patients had tophi.<ref name="pmid15570646">{{cite journal |author=Borstad GC, Bryant LR, Abel MP, Scroggie DA, Harris MD, Alloway JA |title=Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis |journal=J. Rheumatol. |volume=31 |issue=12 |pages=2429–32 |year=2004 |pmid=15570646 |doi=}}</ref> | |||
Allopurinol should be increased as possible to achieve a goal serum urate of <u><</u>6 mg/dl (360 micromoles/liter).<ref name="pmid17907217">{{cite journal |author=Perez-Ruiz F, Lioté F |title=Lowering serum uric acid levels: What is the optimal target for improving clinical outcomes in gout? |journal=Arthritis Rheum. |volume=57 |issue=7 |pages=1324–8 |year=2007 |pmid=17907217 |doi=10.1002/art.23007}}</ref> | |||
==References== | ==References== | ||
Revision as of 21:57, 22 October 2007
Treatment
A randomized controlled trial found similar benefit from nonsteroidal anti-inflammatory drugs and oral glucocorticoids; however, less adverse drug reactions occurred in the glucocorticoids group.[1] In the nonsteroidal anti-inflammatory drugs group, each patient initially received diclofenac (75 mg) intramuscularly, indomethacin 50 mg orally, and acetaminophen 1 g orally. The patient was received a 5-days of indomethacin (50 mg orally every 8 hours for 2 days, followed by indomethacin 25 mg every 8 hours for 3 days), and acetaminophen 1 g every 6 hours as needed. The glucocorticoids patients received prednisolone 30 mg orally, and acetaminophen 1 g orally. The patient was then given prednisolone 30 mg orally once per day for five days.
A randomized controlled trial found that patients who used ice packs had better relief of pain with no negative side effects.[2]
Prevention
Allopurinol can reduce frequency of attacks. However, when allopurinol is started, colchicine 0.6 mg twice daily should also be used. In a randomized controlled trial, co-treatment with colchicine 0.6 mg twice daily while allopurinol was tapered up from 100 mg/day until 3 months after the serum urate concentration < 6.5 mg/dl, reduced flares of gout from 77% in the placebo broup to 33% with colchicine prophylaxis. Most of these patients had tophi.[3]
Allopurinol should be increased as possible to achieve a goal serum urate of <6 mg/dl (360 micromoles/liter).[4]
References
- ↑ Man CY, Cheung IT, Cameron PA, Rainer TH (2007). "Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute goutlike arthritis: a double-blind, randomized, controlled trial". Annals of emergency medicine 49 (5): 670–7. DOI:10.1016/j.annemergmed.2006.11.014. PMID 17276548. Research Blogging.
- ↑ Schlesinger N, Detry MA, Holland BK, et al (2002). "Local ice therapy during bouts of acute gouty arthritis". J. Rheumatol. 29 (2): 331–4. PMID 11838852. [e]
- ↑ Borstad GC, Bryant LR, Abel MP, Scroggie DA, Harris MD, Alloway JA (2004). "Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis". J. Rheumatol. 31 (12): 2429–32. PMID 15570646. [e]
- ↑ Perez-Ruiz F, Lioté F (2007). "Lowering serum uric acid levels: What is the optimal target for improving clinical outcomes in gout?". Arthritis Rheum. 57 (7): 1324–8. DOI:10.1002/art.23007. PMID 17907217. Research Blogging.