Do you know all the 16 details of gout medication?

For gout patients, in addition to the usual attention to avoid alcohol, limit the intake of high purine food, and actively control weight, the scientific and rational use of drugs is also a very important part of the entire treatment, among which there are many details that need to be paid attention to

Detail 1: During the acute onset of gout, "analgesics" need to be used as soon as possible

According to the 2019 edition of the "Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout in China", "nonsteroidal anti-inflammatory drugs" and "colchicine" are first-line drugs for anti-inflammatory and analgesic drugs in the acute stage of gout, and "glucocorticoids" are second-line drugs

Detail two: take "non-steroidal anti-inflammatory drugs", pay attention to protect the digestive tract

The "nonsteroidal anti-inflammatory drugs" commonly used in the clinic mainly include ibuprofen, diclofenac sodium (futaline), celecoxib (celebrex), eicoxib (ankangxin), etc.

Detail three: "Colchicine" advocates the use of "small dose therapy"

"Colchicine" is a special drug to terminate the acute onset of gout, and the disadvantage is that diarrhea, vomiting and other digestive tract reactions are larger

Detail four: "Glucocorticoids" are limited to second-line medications

When the efficacy of first-line analgesics such as nonsteroidal anti-inflammatory drugs and colchicine is not good or there are contraindications to medication (such as patients with renal insufficiency at the same time), glucocorticoids such as prednisone (i.

Detail five: single drug pain relief effect is not good, can be taken combination of drugs

For patients with poor monotherapy and severe pain, a combination of drugs such as "colchicine + glucocorticoid hormone" or "colchicine + nonsteroidal anti-inflammatory drugs"

Detail 6: Those who are at greater risk of gastrointestinal bleeding can choose topical painkillers

Topical analgesics such as futaline latex, piroxic patches, or ketoprofen patches may also be selected for gout patients who are at higher risk of bleeding (e.

Detail 7: During the acute onset of gout, it is not advisable to temporarily add uric acid-lowering drugs

If the patient has been taking uric acid-lowering drugs before the acute onset of gout, continue to take them without stopping; However, if you have not previously taken uric acid-lowering drugs, do not add uric acid-lowering drugs in the acute phase to avoid recurrence or aggravation
of the condition due to significant fluctuations in blood uric acid.

Detail 8: If the diet treatment is not up to standard, uric acid-lowering drugs should be used

Studies have confirmed that relying solely on a low-purine diet can only reduce blood uric acid levels by 10% to 15% (70 to 90umol/L), so most gout patients can not control the blood uric acid control standards simply by controlling the diet, but need to take uric acid lowering drugs
for a long time.

In general, patients with initial gout should initiate uric acid-lowering drugs after 2 weeks of relief of symptoms in the acute phase of gout
.

Detail 9: Before taking allopurinol for the first time, it is recommended to do HLA-B5801 genetic testing

Allopurinol has the potential to cause severe skin allergic reactions such as exfoliative dermatitis, with a case fatality rate of up to 30%.


It has been confirmed that this is closely related to the HLA-B*5801 gene, which is carried by about 10% to 20 Han Chinese
.

If conditions permit, it is recommended to test HLA-B 580 before taking allopurinol, and then use allopurinol to ensure the safety
of medication.

Detail 10: Patients with gout with cardiovascular disease, use febustazta with caution

Febus is a novel xanthine oxidase inhibitor with rare allergic reactions and less effect on the liver and kidneys than allopurinol, suitable for patients
with allopurinol allergy or gout with mild to moderate renal insufficiency.

In recent years, the cardiovascular safety of the drug has attracted considerable attention, and the research conclusions are not completely consistent, and it is recommended that patients with gout with cardiovascular diseases should be used with
caution.

Detail 11: During the period of taking uric acid excretory drugs, pay attention to drinking more water

"Benzbromarone" and "probenecid" are both uric acid excretion drugs, after taking such drugs, a large amount of uric acid is excreted with the urine, the concentration of uric acid in the urine increases, easy to form urate crystals, causing urinary tract stones
.

Therefore, patients must pay attention to drinking more water (more than two liters per day) during the period of taking such drugs to increase the amount of urine, promote the excretion of uric acid, and avoid the formation of urate crystals
.

In addition, gout patients with moderate or severe renal insufficiency or urinary stones and allergic to benzbromanium are contraindicated in phenormalone
.

Detail 12: Rational use of alkaline drugs

Commonly used alkaline drugs in clinical practice are sodium bicarbonate, potassium citrate and so on
.

By alkalizing the urine, it can promote the dissolution of urate crystals and the excretion of uric acid, preventing the formation of urinary tract stones
.

However, it is not the higher the PH value, the better, to maintain the urine pH at 6.
2 ~ 6.
9 is appropriate, excessive alkalinization of urine (urine pH > 7.
0), not only will lead to alkalosis, but also easy to form calcium salt stones
.

Therefore, during the administration of uric acid-stimulating excretion drugs (such as benzbromomarone), the patient's urine pH should be monitored regularly, and alkaline drugs
should be added and adjusted as appropriate according to the test results.

Detail 13: Uric acid-lowering drugs should start in small doses and adjust the dosage step by step

Large fluctuations in blood uric acid have been shown to be an important trigger for gout attacks
.

The faster and more amplitudes the decrease in blood uric acid concentrations, the higher the risk of "metastatic gout" in patients
.

Therefore, uric acid-lowering drugs must start in small doses and gradually increase the amount
.

For example, febuxitata should start from 20 to 40 mg/day, and after 2 weeks, if the blood uric acid is not up to standard, the dose can be gradually increased, and the maximum dose is 80 mg/day; Allopurinol should start at 50 to 100 mg/day and gradually increase to 300 mg/day
for conventional treatment.

In addition, in order to prevent gout attacks induced by fluctuations in blood uric acid caused by the use of uric acid-lowering drugs, it can be maintained for 3 to 6 months
in combination with oral low-dose colchicine in the early stage of uric acid-lowering therapy.

Detail 14: Uric acid-lowering drugs should not be discontinued without authorization

As with chronic diseases such as diabetes and hypertension, gout patients often need long-term maintenance medication
.

Unauthorized discontinuation of the drug is likely to lead to a rise in uric acid and recurrence
of the disease.

Patients should be guided by a specialist, in conjunction with lifestyle interventions, to control blood uric acid within the target range with a minimum dose to reduce possible drug side effects and treatment costs
.

Detail 15: Do a good job of regular review, beware of the side effects of uric acid-lowering drugs

All uric acid-lowering drugs (such as allopurinol, febuxbustax, benzbromomarone, etc.
) have certain side effects, during the medication, it is necessary to regularly review blood routine, liver and kidney function and urinary ultrasound, observe whether there is skin damage, bone marrow suppression, liver and kidney dysfunction and urinary stones, once the problem is found to be dealt with
in time.

Detail 16: In patients with gout with "three highs", the effect on uric acid needs to be considered when choosing a drug

Many patients with gout have "three highs" at the same time, and it is recommended to give preference to therapeutic drugs
with uric acid-lowering effects.

In the case of hypertension, it is recommended that the antihypertensive drug losartan and (or) calcium channel blocker be preferred; In the case of hypertriglyceridemia, lipid-modulating drugs are recommended as the first choice of fenofibrate; In concomitant hypercholesterolemia, lipid-modifying drugs recommend atorvastatin calcium as the first choice; When diabetes mellitus is concomitant, it is recommended to prefer SGLT-2 inhibitors, metformin, GLP-1 receptor agonists, DPP-4 inhibitors, and so on
.