Treatment During a Gout Attack
Sep 07, 2021
Source: Cainiu Health
Dr. Yang Xirui
Introduction
1. Immobilize the affected limb and elevate it appropriately. Avoid high-purine foods, and moderately reduce meat intake. Increase fluid intake to promote uric acid excretion.
2. Oral sodium bicarbonate may be administered to alkalinize the urine, thereby reducing the risk of uric acid stone formation and preventing renal impairment.
3. Pharmacologic analgesia is recommended; each class of analgesic should be initiated early and at an adequate dose. Once effective pain relief is achieved, the medication should be gradually tapered and discontinued.
The primary treatment goals during a gout flare are to alleviate joint pain and rapidly control the acute arthritis episode. Specific therapeutic measures include the following:
1. Immobilize the affected limb and elevate it slightly if appropriate. Avoid high-purine foods—such as organ meats and seafood—and reduce overall meat intake. Increase fluid intake to at least 2,000 mL per day to promote uric acid excretion.
2. Oral sodium bicarbonate may be administered to alkalinize the urine, thereby reducing the risk of uric acid stone formation and preventing renal impairment.
3. Pharmacologic analgesia is achieved using one of three classes of medications: nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, or glucocorticoids. For optimal efficacy, each class should be initiated early and at adequate doses; once clinical improvement is observed, the dose should be gradually tapered and discontinued.
4. Patients who were already receiving uric acid–lowering therapy prior to the acute gout attack should continue this treatment during the flare.
