2) In acute attacks of gout:
The goal of treatment, in this case, is to relieve the pain. We should use ice packs and pain killer medications, such as:
1. Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs are the first-line medications in acute attacks of gout. We can use any of them, such as indomethacin, diclofenac, and ibuprofen. But, we should avoid aspirin; it may worsen the attack because it alters the uric acid level. NSAIDs have some side effects, such as peptic ulcer, salt and water retention, induction of bronchial asthma, skin rash, and nephrotoxicity. Thus, doctors may avoid them in patients with some problems, such as hypertension, heart failure, renal failure, bronchial asthma, and peptic ulcer. In patients with gastric problems, the doctors should describe proton pump inhibitors, such as omeprazole, with the NSAIDs to protect the stomach. Also, the doctors should avoid prolonged use of NSAIDS as possible (no longer than 2 or 3 days), the combination of more than one of them, and overpass the therapeutic dose.
2. Colchicine: It is a medication that relieves gout pain. It decreases the swelling around the affected joint and decreases the synthesis and deposition of uric acid crystals in the joint. It is useful for those who can’t tolerate NSAIDs due to any cause, such as hypertension, bronchial asthma, or peptic ulcer. Colchicine isn’t analgesic; thus, don’t use it in any painful condition without prescription from your doctor. It is effective at lower doses (1.2 mg for the first time, then 0.6 mg one hour later). In higher doses, some side effects may occur, such as diarrhea and vomiting. Patients with kidney failure should avoid colchicine.
3. Short term steroids: Steroids are as effective as NSAIDs, but doctors don’t prefer them due to their side effects. When the patient can’t tolerate NSAIDs or colchicine, as in renal failure, the doctor may prescribe a steroid, such as prednisone or prednisolone. But, the doctor should use the steroid at the least effective dose and for a short duration to avoid the risk of side effects.
