A friend, who has been suffering from gout for many years, told Huazi that his gout is very strange, and the medication is similar every time he gets sick, but the development of the disease is different, sometimes it will be reduced, and sometimes it will be aggravated.
Huazi told him that about gout, there are basically three methods, such as pain stopping, uric acid lowering, and urine alkalinization, but many people do not know the correct way to use medicine.
1. Uric acid cannot be lowered in the acute stage.
The onset of gout is caused by an increase in uric acid levels in the human body, which causes urate to precipitate crystals in the joints, forming tophi, which produces local inflammatory irritation.
Many people think that lowering uric acid will reduce pain, but after taking uric acid-lowering drugs, the pain may worsen. This is because uric acid levels drop dramatically in a short period of time, causing the tophi surface to dissolve rapidly, forming a high concentration of uric acid stimulation locally.
Therefore, in the acute phase of a gout attack, it is not recommended to take uric acid-lowering drugs to avoid aggravation of gout symptoms. Pain relief** is required, followed by uric acid-lowering drugs after 2 weeks of resolution of symptoms. However, if you have gout while taking uric acid-lowering drugs, you do not need to stop taking the drug.
2. Correct use of analgesics.
There are 3 types of painkillers used for gout, which are non-steroidal anti-inflammatory drugs, colchicine, and glucocorticoids. Among them, colchicine and glucocorticoids have greater adverse reactions, so it is recommended to give preference to non-steroidal anti-inflammatory drugs (such as etoricoxib, celecoxib, diclofenac, ibuprofen, etc.).
Non-steroidal anti-inflammatory drugs are divided into topical and oral, and if the pain is not severe, topical drugs can be used only to relieve pain and avoid adverse reactions in the digestive tract. For more severe pain, a combination of oral and topical applications can be used to achieve optimal analgesia. When pain begins to resolve, reduce oral medications.
Colchicine may be used when NSAIDs are ineffective or contraindicated. It should be noted that the amount of colchicine is similar to the amount of poisoning, and the drug needs to be discontinued when the joint symptoms are completely relieved or diarrhea and vomiting (poisoning symptoms) appear.
Glucocorticoids (eg, prednisone, cortisone, betamethasone, dexamethasone, etc.) may be used when NSAIDs and colchicine are ineffective or contraindicated. The adverse effects of glucocorticoids are more harmful, and long-term oral administration is not recommended, and the usual course of treatment is 5-10 days.
3. Choice of urate-lowering drugs.
There are three commonly used urate-lowering drugs: allopurinol, febuxostat, and benzbromarone. Due to the adverse effects of allopurinol with severe allergies, benzbromarone is not suitable for patients with reduced kidney function and kidney stones.
At present, uric acid lowering** is only recommended for patients with gout symptoms, and controlling the blood uric acid level below 360 mol L can prevent gout attacks. If you have never had gout, but simply have hyperuricemia, you can control your diet, weight and drink plenty of water.
Fourth, the choice of drugs for alkalizing urine.
Alkalizing urine can increase the solubility of uric acid in the urine and promote uric acid excretion. Drugs used to alkalize urine include sodium bicarbonate, potassium citrate, and other drugs. The urine pH should be maintained at 6 during the medication2~6.8, because the pH value is too low to meet the ** requirements, the pH value is too high and may increase the incidence of calcium salt stones.
When alkalizing urine, it should be noted that sodium bicarbonate will increase the intake of sodium ions and increase the risk of hypertension, so it is necessary to subtract the same amount of salt from the diet or choose potassium citrate. However, if there is high blood potassium or renal insufficiency, sodium bicarbonate is more suitable for patients who need to limit potassium intake.
To sum up, uric acid lowering cannot be done in the acute phase of a gout attack, and urate-lowering drugs should be used again after 2 weeks after the pain disappears. Non-steroidal anti-inflammatory drugs are preferred, febuxostat is the most widely used in uric acid-lowering drugs, and the effect of drugs on hypertension and hyperkalemia should be paid attention to when alkalizing urine.
The drug should be used under the guidance of a doctor, if you have any doubts about the medication, please consult a doctor or pharmacist. I am Pharmacist Huazi, welcome to follow me and share more health knowledge.
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