Treatment

According to the Gale Encyclopedia of Medicine, the goals of treatment include treating

pain, followed by prevention of future episodes of acute gout attacks as well as the

prevention of further joint tissue damage. It is important to distinguish between therapy

for acute gout, where the goal is to reduce inflammation, and therapy to prevent gout,

where the goal is to manage hyperuricemia (Frey, R., Odle, T., & Cataldo, L., 2015).

Treatment of Acute Episodes of Gout Attacks

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) such as naproxen sodium

(Aleve) or ibuprofen (Advil) These may be avoided if patient has history or

current diagnoses of peptic ulcer disease or Renal Disease.

• Colchicine (Colbenemid)

• Corticosteroids such as prednisone (Deltasone) or Adrenocorticotropic hormone

(Acthar) to reduce inflammation

• Aspirin is avoided can worsen gout

• Non-pharmacological interventions include hydrotherapy alternating 3 minute hot

compresses with 30-second cold compresses) can help dissolve the crystals and

resolve the pain faster.

 Figure 1 Shows Uric Acid Crystal deposits on the first metatarsal, which in response causes edema and

pain of the tissue. Illustrated by Electronic Illustrators Group from Cengage Learning.

Prevention of Future Acute Episodes of Gout and Managing Uric Acid

Levels in Blood

• Medications to help lower Hyperuricemia

o Uricosuric Drugs help lower levels of urate in the blood by excretion in

the urine

o Allopurinol blocks urate production in the body and can also treat

nephrolithiasis or kidney stones especially staghorn uric acid crystal

stones
Patient Education

• Weight loss and limiting the intake of alcohol and purine-rich foods, obesity

increases risk of hyperuricemia and gout acute gout attack

• Limit alcohol intake, excess alcohol increases risk of hyperuricemia and acute

gout attack

• consuming garlic has been recommended to help prevent gout

• Increasing fluid intake, dehydrate can promote urate crystal formation and deposit

• According to Dr. Rebecca Manno at Johns Hopkins Arthritis Center, avoiding

foods that are high in purines (organ meats, sardines, anchovies, red meat, gravy,

beans, beer, and wine), purine converts to uric acid in the body by the kidneys,

overproduction of uric acid leads to hyperuricemia

o Very High Purine Foods– Hearts, herring , mussels, yeast , smelt, sardines,

sweetbreads

o Moderately High – Anchovies, grouse,mutton, veal, bacon, liver, salmon,

turkey, kidneys, partridge, trout, goose, haddock, pheasant, scallops

(Manno, R., 2015).

• Eat low-fat Dairy, a study revealed that eating more low-fat dairy products could

reduce risk of developing gout (Frey, R., et. al, 2015).

Gout Treatment Guidelines by the American College of Rheumatology

 • Increased intake of vegetables

• Decreased intake of purine-high foods such as meat and seafood

• Reduced alcohol consumption, especially beer, and no alcohol during an acute

gout attack

• Medications such as allopurinol (Zyloprim) and febuxostat (Uloric) to lower uric

acid levels

• Screening tests to determine allopurinol hypersensitivity before initiating therapy

Other Guidelines by the American College of Rheumatology

• Allopurinol dosing begins at 100 mg/day and less for renal patients, with gradual

increases in dose to at least 300 mg/day

• Uric acid levels should be less than 6 mg/dl

• Use of pharmacological interventions alone do not effectively lower uric acid

levels

• Medications should be used within 24 hours of acute episode of gout attack

• Use of nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and

corticosteroids are preferred for initial treatment of an acute episode of gout

• Continue use of urate-lowering drugs during an acute episode of gout attack.

However; do not initiate a new therapy of urate-lowering drugs during an acute

attack

• Continue use of anti-inflammatory therapy after an acute episode if serum uric

acid levels have not been reduced

Prognosis

In conclusion, eating a healthy balanced diet of low-fat proteins, low-fat dairy and

vegetables. Even though Gout cannot be cured it can be managed successfully. Lowering

uric acid in the blood also helps to prevent or improve the kidney problems that may

occur in addition to gout.

 References

Frey, R., Odle, T., & Cataldo, L. (2015). Gout. In J. L. Longe (Ed.), Gale Encyclopedia

of Medicine, Vol. 4. (5th ed.). Detroit: Gale. Retrieved April 12, 2017, from Nursing

Resource Center via Gale:

http://find.galegroup.com.medford.usclancaster.sc.edu/nrcx/infomark.do?&source=gale&

userGroupName=uscmedford&prodId=NRC&tabID=T001&docId=DB3000340798&typ

e=retrieve&contentSet=GREF&version=1.0

Morelli, J. (2012). Gout Treatment Guidelines by the American College of

Rheumatology. Retrieved April 12, 2017, from The Arthritis Foundation via:

http://www.arthritis.org/about-arthritis/types/gout/articles/gout-treatments-guidelines.php

Manno, R. (2017). Treatment of Acute Gout, Hopkins Arthritis Organization. Retrieved

April 12, 2017, from Johns Hopkins University via:

https://www.hopkinsarthritis.org/arthritis-info/gout/gout-treatment/