Gout - Treatment

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Krystexxa. The FDA approved Krystexxa (pegloticase) IV injections for the treatment of gout in September 2010. The injection is given every two weeks and reserved for patients with severe chronic gout who have not been helped by first line treatments. Krystexxa is an enzyme, or biologic, that targets uric acid directly by transforming it into a different molecule which is removed through the urine. In studies, up to 25% of patients experienced allergic reactions ranging from mild to severe. The FDA recommends that an antihistamine and corticosteroid be given prior to the injection to prevent reactions. Side effects, which can be severe, may include rash or hives, shortness of breath, nausea and vomiting, constipation, chest pain, redness and itching, wheezing, swelling of lips or tongue, blood pressure changes, or anaphylactic shock. It has not been tested in patients with heart failure.

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Colchicine. colchicine is sometimes prescribed along with allopurinol or probenicid for its preventive and anti-inflammatory effects in cases of severe chronic gout.

Rasburicase. Rasburicase helps to convert uric acid into another molecule, allantoin. It is sometimes given to adults and children receiving cancer treatment to help prevent high uric acid levels from developing. It is given as a single course of intravenous treatment. Side effects may include confusion, dizziness, fatigue, blue lips, light-headedness, shortness of breath, mouth sores, seizures, pale/yellow skin, dark urine, or irregular heart rate.

Warning Note on Drug Treatments for Gout

It should be noted that many drugs used for gout can also precipitate acute gout symptoms and so should not be used until symptoms have subsided. The patient should then start treatment with small doses that gradually increase.

Other Medications

Hypertensive Agents. People with gout have a higher risk for high blood pressure. Some of the drugs used to treat hypertension, such as thiazide diuretics, can increase the risk for gout attacks. Newer agents, such as losartan (an angiotensin II receptor antagonist) and amlodipine (a calcium channel blocker), may have beneficial effects on both high blood pressure and gout.

Other Treatments

Surgery. Large tophi that are draining, infected, or interfering with the movement of joints may need to be surgically removed. When infection is present, the procedure carries a high risk for complications. People most likely to have surgery also tend to have other medical conditions that might worsen their outlook. In one study, experts suggested that better preventive measures, such as the use of allopurinol, could reduce the need for surgery.

Several other surgical procedures are available for relieving pain and improving the function of affected joints. It is sometimes necessary to replace joints.

Hot and Cold Therapy. Rest and protecting the affected joint with a splint can also promote recovery. Both ice packs and the application of warmth have been found to relieve symptoms.

Review Date: 01/04/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).