Preventing Gout Flares When Starting Allopurinol

Pharmacy pearls drug therapy that works

week's episode of pharmacy pearls I'm

going to show you how to reduce the risk

of guilt flares from starting treatment

with allopurinol gout is a kind of

arthritis caused by uric acid crystals

forming in one or more joints uric acid

is a waste product that forms when your

body breaks down a substance called

purines in people who have gout uric

acid builds up and then forms sharp

crystals inside the joints gout affects

men more often than women

although the gender gap narrows with age

the annual incidence is one case for

every a thousand men ages 40 to 44 and

1.8 cases for every a thousand men ages

55 to 64 high blood uric acid levels are

the single most important risk factor

approximately 60% of patients have a

second attack within the first year and

78% have a second attack within two

years by comparison only 7% of patients

do not have her occurrence within a ten

year period while a wait-and-see

non-drug approach is sometimes justified

after the first gout attack most experts

recommend starting preventive treatment

after two or three have occurred the

medication called allopurinol is the

most widely prescribed agent for the

long term prevention of recurrent gout

attacks it works to lower blood uric

acid levels by blocking its production

in the body recently a second option for

Buxa stat entered the market with that

being said there is one big problem uric

acid lowering therapies actually trigger

acute flares at the beginning of

treatment in as many as 75 percent of

patients this is because when blood uric

acid levels drop uric acid crystals

temporarily form in cartilage and soft

tissues when a medication used to

prevent GERD actually worsens it albeit

temporarily it significantly lowers the

likelihood that patients will adhere to

treatment in order to deal with this

problem doctors often recommend using a

medication called colchicine to prevent

gout flares when starting allopurinol a

2004 randomized control

trial published in the journal of

Rheumatology sought to determine the

effectiveness of this approach by

comparison comparing colchicine with

placebo over six months and forty-three

patients who are starting treatment with

allopurinol in the placebo group 77% of

patients experienced a gout flare

compared to only 33% of patients in the

colchicine group thus over six months

for every two to three people treated

with colchicine a gout flare was


additionally colchicine decreased the

average number and severity of flares

the effect also persisted over the

entire six-month period

the dose of colchicine used in the study

was 0.6 milligrams twice daily

however if diarrhea occurred patients

were encouraged to lower their dose to

once daily while nausea abdominal

discomfort and diarrhea are common with

colchicine occurring in as many as 50 to

80 percent of patients all study

participants were able to tolerate it

this study does leave some unanswered

questions for instance while once daily

colchicine dosing was better tolerated

by patients we do not know whether or

not it is equally effective this could

be further explored additionally a high

proportion of study participants had

advanced gout raising the question of

how applicable the results are to less

severe cases finally non-steroidal

anti-inflammatory drugs such as

ibuprofen are also recommended for the

Prevention of flares but evidence to

support their use is lacking it would be

nice to know how they compare with

colchicine okay now you know how to

reduce the risk of gout flares when

starting treatment with allopurinol

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