Three Major Classes of Medications for Treating Gout

Gout is clinically characterized as a type of metabolic arthritis, primarily caused by the deposition of uric acid in the joint cavity, which triggers an inflammatory response leading to symptoms such as joint pain, swelling, or deformity.

When not in an acute flare-up, one might forget its presence; however, once it strikes, the pain can be unbearable.

This article introduces three major classes of medications used in the treatment of gout.

1. Analgesic Drugs
– Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These are the drugs of choice for gout. NSAIDs are divided into selective COX-2 inhibitors (such as celecoxib, etoricoxib, etodolac, and meloxicam) and non-selective COX inhibitors (such as diclofenac sodium, ibuprofen, NIMESULide, and loxoprofen sodium). Compared to non-selective COX inhibitors, selective COX-2 inhibitors have a smaller impact on gastrointestinal mucosa but carry a greater risk to the cardiovascular system.
– Colchicine: It is also a frontline treatment for acute gout flares. Due to the narrow therapeutic window of colchicine, overdosing can easily lead to toxic reactions. Moreover, there is no significant difference in the effectiveness of treating gout between low and high doses of colchicine. Therefore, current guidelines both domestically and internationally recommend using low-dose colchicine to significantly reduce adverse reactions. However, common side effects of colchicine include diarrhea, abdominal pain, and nausea. If severe diarrhea occurs, discontinuation is necessary, and potential liver and kidney damage as well as bone marrow suppression should be monitored regularly through liver and kidney function tests and blood counts. During the urate-lowering treatment period, to prevent acute gout flares,

2. Urate-Lowering Drugs
– Inhibitors of Uric Acid Production
Allopurinol and febuxostat are both drugs that inhibit uric acid production. Compared to allopurinol, febuxostat has advantages in three main aspects: stronger urate-lowering effect, higher safety, and rare occurrence of allergic reactions; it can be excreted through both liver and kidney pathways, making it suitable for patients with liver or kidney dysfunction.
One disadvantage of febuxostat is the increased risk of cardiovascular events with long-term use, so patients with congestive heart failure need to weigh the pros and cons. Conversely, allopurinol can improve endothelial function and local blood flow in patients with heart failure accompanied by hyperuricemia, indicating that allopurinol can provide additional cardiovascular protection.
Both allopurinol and febuxostat have renal protective effects, hence they are preferred overbenzbromarone for patients with renal insufficiency.
– Enhancers of Uric Acid Excretion
Benzbromarone belongs to the class of drugs that promote uric acid excretion. By inhibiting the reabsorption of uric acid and enhancing its excretion, it reduces serum uric acid levels. Therefore, benzbromarone is recommended for patients with poor uric acid excretion. Research indicates that most hyperuricemic individuals in China have poor uric acid excretion, making benzbromarone potentially more suitable for the Chinese population.
The severe adverse reaction of benzbromarone is hepatotoxicity, which increases when used in combination with other drugs such as allopurinol, simvastatin, atorvastatin, and leflunomide. In 2004, the National Medical Products Administration warned about the risk of liver damage from benzbromarone. Benzbromarone can also increase the incidence of urinary stones. It is contraindicated in patients with urinary stones or moderate renal insufficiency. During treatment, it is necessary to drink plenty of water to increase urine output or to alkalinize the urine to prevent the formation of uric acid crystals.

3. Drugs for Alkalinizing Urine
– Sodium Bicarbonate Tablets: These are commonly used clinically to alkalinize urine. Since sodium bicarbonate produces carbon dioxide in the stomach, increasing the intragastric pressure, long-term and excessive use can lead to alkalosis and may induce congestive heart failure and edema due to increased sodium load. When uric acid is acidic in the morning, acetazolamide can be taken at night to increase uric acid solubility and prevent stone formation.
– Potassium Citrate Hydrogen Salt Granules: These are used to alkalinize urine and should not be used in patients with acute or chronic renal failure, or in those with severe acid-base imbalances (alkalosis) or chronic urease-splitting bacterial infections in the urinary tract.

Note: Gout patients should avoid long-term use of medications that may cause elevated blood uric acid levels, such as thiazide diuretics, loop diuretics, low-dose aspirin, tacrolimus, cyclosporine, pyrazinamide, ethambutol, methotrexate, insulin, etc.

Gout patients should actively treat metabolic and cardiovascular risk factors associated with elevated blood uric acid levels, and actively control obesity, type 2 diabetes, hypertension, hyperlipidemia, coronary heart disease, stroke, or chronic kidney disease. Metformin, dapagliflozin, atorvastatin, fenofibrate, losartan, etc., while lowering blood sugar, lipids, and blood pressure, all have varying degrees of urate-lowering effects and can be given priority.

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Managing Uric Acid Levels: A Comprehensive Guide for Gout Patients

Gout, a metabolic disorder characterized by elevated uric acid levels in the blood, can be considered a “threshold” disease. The primary goal of dietary management for individuals with gout is to prevent sudden spikes or large accumulations of uric acid in the body. This approach aims to reduce the burden of urate crystals, thereby preventing recurrent gout flare-ups and altering the disease’s progression. Additionally, addressing the nutritional concerns that arise from patients’ tendency to overcorrect their diets due to fear of exacerbating their condition is another critical aspect of dietary management.

Dairy and Eggs: Essential Daily Intake

Dairy products and eggs are particularly friendly for those with gout, as evidenced by their minimal purine content. Considering that many individuals with gout also struggle with being overweight or obese, it is recommended to consume 250-300ml of low-fat milk daily (there’s no need for full fat removal). As for eggs, limiting egg yolks to one per day and consuming 1-2 egg whites is advisable.

Meat Consumption: Strategic Selection

When it comes to meat, both the type and amount are crucial. Which meats are preferable? It is advised to limit consumption of beef, lamb, and pork, while leaning towards poultry and freshwater fish. Generally, meat intake should be capped at 100g per day. With additional daily intake of 300ml of low-fat milk, 1-2 eggs, and some soy products, there should be no concerns about insufficient nutrition.

It is important to note that processed meats such as bacon, cured meats, and salted ham contain relatively concentrated amounts of purines and salt due to dehydration and salting during preparation, making them best avoided.

Vegetables: Abundant and Beneficial

The majority of leafy greens, melons, tubers, and roots are low in purines, and consuming ample amounts of fresh vegetables is beneficial for controlling blood uric acid levels and improving metabolic syndrome. Dried mushrooms, seaweed (such as kelp and wakame), and plant embryos generally have higher purine content; however, these are lower when fresh or rehydrated. Moderate inclusion as part of a dish, like adding mushrooms to stir-fried greens or kelp to winter melon soup, or mixing a small amount of wheat germ into rice, are safe and healthy practices.

Soy Products: Enjoy in Moderation

Gout patients need not shy away from soy! While it is true that dried soybeans like black beans have high purine content, the process of making tofu, soy milk, and other soy products removes some purines through the liquid, reducing the risk of purine intake. For instance, 100g of plump tofu, enough to fill a palm, contains only 68mg of purines, equivalent to the purine content of just 25g of dried beans.

The type of purines found in soy differs from that in meat; the metabolism of adenine in soy to uric acid is more complex compared to the quicker conversion of inosine in meat. Studies on Asian populations have found that consuming soy and other legumes may reduce the risk of developing gout. Soy lovers with gout can relax: moderate soy consumption is beneficial and harmless, and substituting meat with soy products can enhance health.

Fruits: Alluring but Best in Moderation

While it may seem tempting to indulge in fruits that are rich in water, fiber, and flavor, especially when meat consumption is limited, this is not without caution. Excessive intake of fructose and sucrose has been linked to gout flare-ups. Careful selection is advised for fruits high in fructose, such as apples, oranges, longans, lychees, pomelos, persimmons, and pomegranates.

Why might sweet fruits lead to painful consequences? Fructose accelerates the conversion of purines, increasing uric acid production and reducing kidney excretion of uric acid. Additionally, a genetic variant affecting the function of a transport protein (SLC2A9) has been identified in individuals with gout, which promotes hyperuricemia after sucrose intake. For gout patients, a daily fruit consumption of around 200g is appropriate – remember not to overindulge!

Hydration: Prioritize Plain Water

Many individuals with gout understand the importance of staying hydrated, aiming for a substantial intake of water. It is recommended to use a marked cup to measure water intake, striving for a daily total of 2500ml.

Juices: Minimize Consumption

Just as it’s important to limit meat broths for those with gout, many are unaware that juice consumption should also be minimized. Given the aforementioned effects of fructose on uric acid production, sugary juices and fructose-containing beverages should be avoided, including freshly squeezed orange, apple, grape, and pear juices, as these are easily consumed in excess.

Tea and Coffee: Enjoy Without Worry

Individuals with gout often harbor natural concerns about tea and coffee, as if the dark color of these beverages directly correlates with increased uric acid levels. However, the reality is quite different. The metabolic byproducts of caffeine, theobromine, and theophylline are methyl urate salts, distinct from the urate salts associated with gout. Therefore, these natural beverages can be enjoyed without worry. Considering that many people with gout also have cardiovascular diseases, it is important to avoid consuming excessive amounts of strong tea or coffee.

Alcohol: Best to Limit

Alcohol is one of the risk factors associated with gout flare-ups, with both acute binge drinking and regular consumption of beer, spirits, and wine contributing to the onset and progression of gout. Alcoholic beverages are inherently unfavorable for managing chronic diseases and metabolic syndrome. Therefore, individuals with gout are advised to steer clear of alcoholic drinks.

Numerous studies have highlighted the protective role of certain foods or nutrients against gout, such as cherries, coffee, and vitamin C. However, relying on these foods to prevent gout is insignificant compared to the therapeutic effects of medication in lowering uric acid levels. Instead, focus on adopting dietary habits that control uric acid and reduce body weight, such as consuming fresh vegetables, actively including low-fat dairy products, selecting fruits in moderation, reducing red meat intake, and avoiding sugary drinks.

The Intricacies of Exercise for Gout Patients: Timing, Intensity, and Alternatives

Gout and hyperuricemia often prompt medical professionals to prescribe increased physical activity. Yet, many patients find this advice perplexing, as exercise can exacerbate their pain, leading to doubts about the validity of such recommendations. Understanding the nuances behind exercising with gout is crucial for managing the condition effectively.

When to Begin Exercise During Gout Management

For those with gout, the timing of exercise is critical. During acute flare-ups, rest is paramount, and exertion can worsen symptoms or lead to chronic arthritis. Even when symptoms subside, immediate resumption of physical activities should be avoided to prevent relapses. Ideally, under a physician’s guidance, patients should wait until their arthritis has been stable for three months before initiating appropriate exercise regimens.

Defining “Appropriate Exercise” for Gout Patients

“Appropriate exercise” is a vague term that requires careful consideration. Patients should educate themselves on various types of activities, especially those beneficial for individuals with gout, such as jogging, swimming, cycling, yoga, and tai chi. Additionally, medical advice should take into account the progression of the patient’s condition, including whether they have experienced gout attacks or have other comorbidities like heart disease or chronic joint damage.

By synthesizing this information, doctors and patients can collaboratively devise a personalized exercise plan with specific intensity and frequency. However, the challenge lies not only in creating the plan but also in its execution and adherence. Gradual progress and finding a sustainable routine are essential.

Running Tips for Gout Sufferers

Running is a popular and accessible form of exercise favored by many. It is vital to maintain an appropriate intensity, described as feeling warm and slightly sweaty during the activity, with the ability to speak but not sing. The target heart rate should be around 60% of maximum, calculated as (220 – age). Warm-up and cool-down periods are also important to prevent muscle soreness and enhance flexibility and coordination.

However, running can trigger gout attacks, particularly in the feet and knees, which bear more weight and movement during the activity. If these joints have significant damage or a history of recurrent attacks, running may not be the best choice.

Exploring Alternative Exercise Options

Swimming and cycling are recommended due to their low joint impact, making them suitable for individuals with gout. Yoga and tai chi, while not high-intensity, are beneficial for knee osteoarthritis patients and can help alleviate pain and improve function and quality of life. Mat exercises like crunches, glute bridges, and planks offer joint-friendly resistance training but should be performed at moderate intensity to avoid increasing blood uric acid levels.

Basketball and Soccer: Can Gout Patients Participate?

During acute episodes, intense sports like basketball and soccer are discouraged. However, once stable, patients can resume normal activities. While competitive sports are generally not advised for gout patients, those with a passion for these activities should ensure proper gear, adequate warm-up, controlled intensity, and post-exercise stretching and nutrition.

Strength training can also help improve joint stability, reducing the risk of injury from sudden high-intensity movements. In conclusion, while exercise is fundamental to health, gout patients must tailor their activities based on individual circumstances to maintain a scientifically sound and manageable exercise plan.

Strategies for the Prevention and Management of Gout

Gout, a metabolic disorder characterized by recurrent arthritis attacks, is often described as the “king of pain” due to its excruciating joint pain that typically strikes at midnight or early morning. Understanding that gout is a symptom of hyperuricemia, it becomes clear that managing high uric acid levels is crucial for both preventing and treating this condition. In this article, we will explore various strategies to combat gout effectively.

1. Pharmacological Interventions

The onset of a gout attack necessitates immediate medical attention to alleviate symptoms such as joint pain and skin discoloration. Medications that either inhibit uric acid production or promote its excretion are commonly prescribed. Timely intervention not only benefits the patient’s well-being but also helps prevent recurrences, which could prolong the agony over weeks or even months.

Consistency in medication is paramount; discontinuing drugs upon symptom improvement can lead to relapsing gout episodes, complicating subsequent treatments. During acute gout flares, elevating the affected limbs while lying flat can enhance blood circulation, thereby mitigating pain. Additionally, applying cold compresses to the affected areas for approximately 15 minutes can provide temporary relief.

2. Adopting a Healthy Diet

A low-purine diet is essential for individuals with gout. High-purine foods such as seafood, beer, shellfish, and animal offal should be avoided. Fruit juices and beverages are also best limited, as fructose metabolites can compete with uric acid excretion. While spicy foods should be consumed sparingly, incorporating more vitamin and calcium-rich foods into the diet is advisable.

3. Hydration

Since uric acid is primarily eliminated through urine, adequate hydration is critical for reducing the burden of gout. A daily water intake of around 2.5 liters is recommended for gout patients. This level of hydration maintains healthy metabolism, accelerates uric acid excretion, and improves uric acid concentration, thus controlling gout.

4. Joint Care and Warmth

Joint warmth is another aspect to consider, as exposure to cold can trigger gout attacks. Patients should ensure their joints are kept warm and avoid overexertion, which could lead to fatigue and exacerbation of symptoms.

In conclusion, while a typical gout attack may resolve within 1-2 weeks, persistent episodes warrant further investigation. A comprehensive medical examination and professional guidance from healthcare providers are essential for effective long-term management of gout. By implementing these strategies—pharmacological interventions, dietary modifications, hydration, and joint care—gout patients can significantly improve their quality of life and reduce the impact of this debilitating condition.

Can Soda Water Prevent and Treat Gout?

Before discussing whether soda water is useful, it is essential to understand why gout occurs. Only by knowing the cause of gout can we comprehend the underlying reasons. Gout can be divided into primary and secondary types, with unclear etiology and pathogenesis. However, it is certain that it is closely related to hyperuricemia. Primary gout is more associated with genetic and environmental factors, with most patients suffering from uric acid excretion disorders, and about 10% of patients have excessive uric acid production. Secondary gout is mainly caused by kidney disease or medication-induced reduction in uric acid excretion.

You may often hear friends with gout mentioning high purine levels. Indeed, gout is closely related to abnormal purine metabolism. Problems with purine metabolism lead to increased blood uric acid concentration, and the accumulation of urate crystals in joints results in gout. Factors such as high blood pressure, high cholesterol, dietary habits, and obesity can make you more susceptible to gout. It is also important to note that not all individuals with hyperuricemia will develop gout, with only 5%-10% showing clinical symptoms.

Triggers of Gout:

1. Lifestyle and Psychological Stress: Irregular living habits, frequent staying up late, and excessive psychological stress can lead to metabolic disorders and increase the likelihood of triggering gout.
2. Alcohol Consumption: The metabolism of alcohol absorbs a lot of water, causing an increase in blood concentration. Saturated uric acid then enters soft tissues to form crystals, gradually developing into gout. It is still necessary to control alcohol intake and reduce drinking. Additionally, beer metabolism produces excess lactic acid, which competes with uric acid excretion, and many beers are made from wheat, which produces uric acid upon metabolism.
3. Diet: Excessive consumption of high-purine foods is an important factor in triggering gout. The breakdown of purines produces uric acid, leading to a series of subsequent reactions. Many people enjoy eating seafood, hot pots, and animal offal. Long-term intake of large amounts of purine substances may cause kidney uric acid excretion disorders, eventually leading to gout.
4. Diseases: Liver and kidney diseases can cause abnormal metabolic functions of these organs, leading to problems with high-purine substance metabolism. If combined with alcohol consumption and improper diet, it can further trigger gout.

Can Soda Water Prevent and Treat Gout?

Soda water is alkaline and can neutralize uric acid, promoting its dissolution and excretion, thus having a certain effect on gout. However, the content of sodium bicarbonate in soda water is not high, so its effect is quite limited. Regular consumption of soda water can affect the concentration of stomach acid, leading to indigestion, diarrhea, or constipation. Therefore, soda water plays a more supportive role in preventing and treating gout.

Additionally, individuals with heart and kidney dysfunction, as well as those with high blood pressure, are advised not to consume soda water. The excessive sodium load can affect their condition, and its use should be under the guidance of a professional doctor.

Finally, it must be emphasized that the soda water we refer to is made from baking soda tablets, not the commercially available soda drinks on the market. Many additives in soda drinks not only fail to alleviate gout symptoms but can also reduce uric acid excretion levels.

How Can Gout Patients Incorporate Meat into Their Diet Safely?

Title: How Can Gout Patients Incorporate Meat into Their Diet Safely?

Since being diagnosed with gout, saying goodbye to a variety of delicious meats seemed inevitable due to their high purine content, which exacerbates the pain associated with gout. However, it is possible for individuals with gout to include meat in their diet, provided they pay attention to the type of meat, portion sizes, and the severity of their gout symptoms.

Gout primarily arises from elevated levels of uric acid in the blood. Therefore, for those with gout, controlling their diet to prevent excessive increases in uric acid is crucial. Gout, also known as gouty arthritis or gouty tophi, is a condition caused by a significant rise in blood uric acid levels. When the blood cannot fully dissolve the excess uric acid, it leads to the formation of urate crystals that precipitate in various joints and skin connective tissues, causing pain.

Gouty tophi commonly develop in areas such as the ears, big toes, finger joints, wrists, and elbows, rarely affecting the body’s larger joints.

When selecting foods, the purine content is a critical factor to consider. Many individuals with gout avoid meat because they believe it contains high levels of purines that could increase uric acid levels. However, not all meats are high in purines. Commonly consumed meats like chicken, beef, and lamb are not particularly high in purines and can still be part of a balanced diet.

Moreover, meat is an excellent source of high-quality protein and minerals, which are essential for health. Individuals with gout need these nutrients, making meat a valuable addition to their diet.

Choosing Meats Low in Purines

For those with gout, it’s advisable to avoid high-purine meats, such as various animal offal (liver, kidneys, brain, spleen), certain seafood (sardines, anchovies, oysters, scallops, dried small fish, king prawns), and thick soups (meat, chicken, fish broths, hot pot soups).

Moderate consumption of medium-purine meats is permissible. These include common livestock (pork, beef, lamb), fish (salmon, bass, carp, crucian carp, eel, snakehead), some other seafood (fresh scallop meat, crabs, shrimp, lobsters), and poultry (chicken, duck, goose, pigeon).

Low-purine meats are particularly recommended and include dairy and dairy products, eggs, sea cucumber, and jellyfish. Dairy and eggs are excellent sources of high-quality protein.

Cooking Methods Matter

In addition to choosing the right type of meat, different cooking methods can significantly affect purine content. Boiling is the best way to reduce purines in meat since purines are water-soluble. When preparing meat, slice it into strips or pieces and blanch it before proceeding with other cooking methods. This allows some purines to dissolve in the water, reducing intake. You can boil the meat and then mix it with seasonings for a flavorful dish.

Eat the Meat, Not the Broth

Many people enjoy soups for their nutritional value and taste. However, since purines dissolve in water, broths can be high in purines. It’s best to consume the meat and avoid the broth.

Limit Processed Meats

It’s advisable to eat less processed meat products like ham, sausages, and hot dogs. They are high in salt, which is detrimental to gout sufferers, and consuming processed meats can also increase the risk of cancer.

Meat is rich in high-quality protein, and individuals with gout should still include it in their diet. Not all meats are high in purines; common poultry and livestock (pork, beef, lamb, chicken, duck) and some fish fall into the medium-purine category and can be consumed in moderation.

By choosing medium to low-purine meats, paying attention to cooking methods, eating meat without broth, and limiting processed meats, individuals with gout don’t have to completely eliminate meat from their diet.

Uric Acid Levels Have Dropped, So Why Does Gout Still Flare Up?

Often, patients find that despite having their uric acid levels under control, they still experience joint pain and even increasingly frequent gout symptoms. How can gout flare-ups occur when uric acid levels have been reduced? There are three main reasons.

Although the patient’s uric acid levels have decreased, it may not have dropped to the ideal level. This means there is still a significant amount of uric acid in the body that can deposit in the joints and cause damage, leading to frequent joint pain. In essence, this is due to insufficient reduction of uric acid to the desired level.

When patients take medication to lower uric acid levels, if the reduction occurs too rapidly, it can also cause discomfort in the body and lead to frequent gout attacks. This is likely because while blood uric acid has decreased, the uric acid levels in the joints remain high, with deposits of urate crystals still present. Therefore, although blood uric acid levels have decreased, any trigger can provoke a gout attack, causing joint pain.

Urate crystal formation is another cause. An analogy is sometimes used: “After taking medication, uric acid levels drop quickly, like a snowman melting in the sun on a winter day. As the temperature rises, bits of snow start falling off.” The snowman represents the urate crystals in the patient’s body, and the snow debris symbolizes the dissolved urate particles. These particles, breaking off from larger urate crystals, can then deposit in other joints, creating new points of pain. While this analogy may not be entirely scientific, it does hold some truth.

The above explains why gout can still frequently occur even when uric acid levels have been lowered.

This also indicates that controlling uric acid levels and ensuring a steady decline is crucial. Taking medication regularly as prescribed by a doctor over time will gradually eliminate urate crystals or particles, which is part of the drug’s effect. Steadily reducing uric acid levels in the body, ensuring both blood and joint uric acid levels decrease, is most beneficial for health and will gradually help keep gout at bay.