Gout - Treatment

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Long-term treatment of hyperuricemia may be recommended for people who have:

• A risk for tophaceous gout
• Had more than two or three acute attacks of gout in the past, particularly if the attacks have not responded promptly to treatment
• Unusually severe attacks, or attacks that affect more than one joint
• Joint damage from gout, as shown on x-rays
• Uric acid kidney stones
• Evidence of kidney damage due to elevated uric acid levels
• Hyperuricemia caused by an identifiable inborn metabolic deficiency
• An inability to use the medications used to treat acute gout

Uricosurics. These drugs prevent the kidney from reabsorbing uric acid, and therefore increase the amount excreted in the urine. They may be used when the kidneys are not eliminating (excreting) enough uric acid, which is present in about 80% of gout cases. Your doctor will check a 24-hour urine to diagnose this problem. They are not used for patients with reduced kidney function or those with tophaceous gout.

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Other conditions which should be present before using uricosurics are:

• Those under 60 years of age
• Those with normal diets
• Those who have normal kidney function
• Those who have no risk of kidney stones

Probenecid (Benemid, Probalan) and sulfinpyrazone (Anturane) are the standard uricosurics. A more potent uricosuric, benzbromarone, may work for people with severe tophaceous gout and kidney impairment when other drugs do not. Because benzbromarone can cause liver failure in some patients, it is available in the U.S. only with special authorization.

Probenecid is taken two to three times a day, and sulfinpyrazone begins at twice a day and increases to three or four times daily. The initial doses should be low and gradually increased. Probenecid combined with colchicine is more effective than probenecid alone, but people respond differently, so the dose should be carefully individualized.

The possible side effects of probenecid and sulfinpyrazone include skin rashes, gastrointestinal problems, anemia, and kidney stone formation. To help reduce acidity and the risk for kidney stones, patients should drink plenty of fluids (ideally water, not caffeinated beverages). Sodium bicarbonate supplemented by acetazolamide can also reduce acidity and the risk for stones.