(calm music)
- Rich food and alcohol are
often a part of celebrations.
Unfortunately, after all the enjoyment,
an unfortunate thing can
occur for people at risk,
a bad gout attack.
Certain foods and alcohol drinks
contain high levels of purines,
which then produces
high levels of uric acid
when broken down in the body.
The uric acid crystallizes
and forms around the joint,
causing a very very painful joint.
So how do we treat this problem
and ensure that it does
not keep occurring?
The treatment of gout
requires two approaches.
First, we must treat the acute
attack of swelling and pain.
Meaning the immediate swelling and pain
caused by the excess food and drink,
which raised your uric acid level.
Second, we then treat the
actual cause of the gout attack,
the principle problem of the
high levels of uric acid.
We do this by lowering these
levels down through medication.
In this video we'll be talking solely
about treating the acute gout attack
or immediate swelling and
pain of the affected joint.
Pharmacologic treatment is
crucial in gout attacks.
And anti-inflammatory
medications should be given
within 24 hours of onset
to be most effective.
The goal of these medications is
to decrease pain and swelling
of the joints affected.
The choice of which agent
you would be prescribed
depends on the severity of the symptoms,
the number of joints involved,
and the other medical
issues the patient has.
Your physician will be able to talk to you
about your treatment options.
Let's get started learning
about the medications
you may be prescribed for
treating your acute gout attack.
Nonsteroidal anti-inflammatory
drugs, also known as NSAIDs,
are frequently used to
quickly relieve the pain
and swelling of an acute gout episode.
Especially if taken at the full
dose in the first 24 hours.
Commonly used NSAIDs are
ibuprofen, indomethacin,
naproxen, COX-2 inhibitors
such as celecoxib,
can be used in patients with
gastrointestinal contraindications
or intolerance to NSAIDs.
Side effects can include
stomach pain and heartburn,
stomach ulcers, high blood pressure,
liver and kidney problems,
and a tendency to bleed.
Treatment should be continued
until the acute gout
attack completely resolves.
Colchicine is another prescription
and anti-inflammatory medication,
which can be given as several
doses in succession initially,
followed by a daily dose
until the attack is resolved.
Colchicine's most common side effects
are diarrhea, nausea,
and abdominal cramps.
But more severe side effects
can occur at high doses.
To avoid side effects, lower
doses are much better received
and may be used in
combination with NSAIDs.
In patients with contraindication
to these other agents,
corticosteroids or steroids
are the next choice.
It can be administered as an injection
into the affected joint,
called intra-articular,
steroids are given
systemically such as orally,
with things such as prednisone or Medrol.
Intra-articular steroids are useful
if only one or two joints are affected.
This modality could be used in combination
with oral steroids, NSAIDs, or colchicine.
Some side effect of systemic steroids
include difficulty sleeping,
elevated blood sugar,
high blood pressure and weight gain.
These types of agents are used not only
to resolve an attack of
acute inflammation, but also
to prevent it from ever
occurring, called prophylaxis.
Although these are the types of agents
people often consider as gout treatment,
one must remember that they only work
to resolve the effects of
inflammation from gout,
and not treat the actual reason for gout,
which is the high levels of uric acid.
We will talk about these
agents in the next section.
(calm music)
