A new uric acid-lowering drug, polyethylene glycol recombinant uric acid oxidase (pegloticase) injection, was approved and marketed by the FDA in 2010 and is recommended for the uric acid-lowering treatment of refractory gout in adult patients with refractory gout who have failed to respond to other conventional uric acid-lowering medications or for whom there are contraindications to the use of these medications.Pegloticase is a polyethylene glycolated uric enzyme produced by a genetically engineered strain of Escherichia coli. strain of Escherichia coli, which catalyzes the oxidation of uric acid to allantoin, a more soluble end product that is excreted in the urine to lower uric acid levels in gout patients.

The drug is given by intravenous injection every two weeks.

The results of two 6-month clinical trials conducted abroad with 212 subjects showed that the drug was able to lower uric acid levels and reduce uric acid crystal deposits in joints and soft tissues. However, the study also found that 1 in 4 patients treated with Krystexxa experienced severe allergic reactions, so medical staff should prescribe and administer steroids and antihistamines to reduce the risk of allergic reactions. Other adverse reactions seen in clinical trials included sudden onset gout, nausea, bruising and swelling at the injection site, nasal irritation, constipation, chest pain, and vomiting, and the FDA cautions physicians to use caution when prescribing the drug to patients with congestive heart failure, as the drug has not been studied in clinical trials in these patients.

It is therefore intended for the treatment of refractory gout and is not suitable for the treatment of asymptomatic hyperuricemia and for patients with gout who are effective on ordinary uric acid-lowering therapy. The European League Against Rheumatism recommends[1]:In patients with normal renal function, allopurinol is recommended for first-line uric acid-lowering therapy, starting at a low dose (100 mg /day) and increasing in increments of 100 mg every 2-4 weeks, if needed, to achieve the uric acid target value. If goals cannot be achieved with appropriate doses of allopurinol, allopurinol should be converted to febuxostat or pro-uricosuria, or combined with a pro-uricosuric agent. If allopurinol is not tolerated, febuxostat or uricosuric agents may also be used. Just the use of allopurinol in Asians may have potential drug allergy, exfoliative dermatitis occurs, so before using allopurinol is recommended to carry out genetic HLA-5801 gene screening, the gene positive blood, use allopurinol with caution.

Polyethylene glycol recombinant enzyme (pegloticase) injection) is recommended for severely debilitated patients with chronic gout and poor quality of life in whom uric acid compliance cannot be achieved with any other available medication at the maximum dose (including combinations).

参考文献：[1].Richette P, Doherty M, Pascual E, et al，2016 updated EULAR evidence-based recommendations for the management of gout.Annals of the Rheumatic Diseases 2017;76:29-42.

Thanks for the invite.

Gout is a crystal-associated arthropathy caused by the deposition of monosodium urate crystals. It is caused by the precipitation of crystals and their deposition at the joints and other tissues as the blood uric acid level rises and the uric acid exceeds the saturation level. Therefore, the key to gout stent is to control the blood uric acid level, promote the dissolution and discharge of formed urate crystals, which requires us to carry out lifestyle intervention and uric acid-lowering drugs for comprehensive treatment, the treatment should be carried out under the guidance of a doctor, the regular diagnosis and treatment is essential for the long-term stable control of gout.

Pharmacological treatment for gout patients should be carried out under the guidance of a doctor, choosing a suitable individualized program, the general principle is to actively anti-inflammatory and analgesic mainly in the acute stage, and pay attention to lowering uric acid in the remission period. Non-steroidal anti-inflammatory drugs (e.g. ibuprofen, diclofenac sodium, etoricoxib, etc.) or small-dose colchicine can be chosen in the acute stage, and oral glucocorticosteroids (e.g. prednisone, trimethoprim, etc.) can also be chosen if the side-effects are not tolerated. Gout in remission in one to two weeks, should promptly start uric acid lowering drug therapy, can choose to inhibit uric acid production of allopurinol, febuxostat or promote uric acid excretion of benzbromarone. In the use of drugs, pay attention to the monitoring of adverse drug reactions, regular review. It should be noted that for the existence of patients with renal function abnormalities, be careful with allopurinol and benzbromarone.

Gout in the drug treatment at the same time, should be long-term adherence to good living habits, specific recommendations are: ① strictly limit the intake of high-purine food, do not eat animal offal, shell seafood and broth, eat less animal meat, fish, dried mushrooms, etc.; ② eat more fresh vegetables, coarse grains, drink more water, preferably plain water, but also soda, tea and coffee, should not drink fruit juice, cola and other fructose-rich drinks; ③ active cessation of smoking, limiting alcohol consumption is best, do not drink wine strictly during the acute stage, the condition is stable can be appropriate to drink red wine; ④ appropriate regular exercise, pay attention to warmth, avoid intense exercise and sudden cold; ⑤ regular exercise, pay attention to warmth, avoid the cold, avoid the cold, avoid the cold. Active smoking cessation, limit alcohol consumption, no alcohol is best, the acute stage need to strictly abstain from alcohol, when the condition is stabilized can be appropriate to drink red wine; ④ appropriate and regular exercise, pay attention to warmth, to avoid strenuous exercise and sudden exposure to cold; ⑤ to maintain a good state of mind and regular work and rest; ⑥ to control the weight of the obese people pay attention to weight loss.

We should correctly recognize gout, gout is not scary, it is preventable and controllable, focusing on regular diagnosis and treatment, maintain good living habits and regular medication. We hope that we should not be biased, so as not to delay the condition, resulting in irreversible consequences.Thanks for reading and good health to all. This article was originally written by General Practice Sweeper on Today's Headlines & Wukong Q&A, all rights reserved.

Many people like to ask: what kind of medication is best for their health problems? But in fact, due to the differences in personal constitution, different disease conditions, differences in sensitivity to drugs and other aspects of the impact, there is often no such thing as which drug is the "best", but only which drug is the most suitable for you.

Take gout as an example, the onset of gout is based on hyperuricemia, when the body's blood uric acid exceeds the normal level, the micro-soluble urates have a certain chance of precipitation of urate crystals, these urate crystals are deposited in the joints, causing the joints to cause the immune system to react, resulting in severe pain, redness, swelling, burning sensation and other sensations, it is the gouty joint attack. Gouty arthritis is divided into several stages, including acute gouty attack, gouty intermittent period after the acute gouty attack, if not well controlled, it will also develop into chronic gouty arthritis with gouty stones, in different stages, the medication is also different, today we will briefly introduce the gouty commonly used drugs.

Pharmacologic treatment of acute attacks of gout

When an acute attack of gout occurs, symptoms such as severe pain, redness and swelling in the joints, affecting normal activities, are often very painful and tend to last for a longer period of time if not treated with intervention. Therefore, early medication is the best option when an acute gout attack is detected at this stage.The main considerations for medication at this stage are pain relief and relief of inflammatory response, whereas uric acid-lowering therapy is usually not recommended during an acute gout attack. The main medications to consider taking at this stage are-

1. Non-steroidal anti-inflammatory drugsThe types of NSAIDs are very many, our common aspirin, acetaminophen belongs to this category, and the newer etoricoxib, celecoxib, etc. also belong to this category, most of this type of drugs have anti-inflammatory and analgesic effect, analgesic effect, the risk of adverse reactions is mainly gastrointestinal irritation, the use of drugs with a high degree of safety, has gradually become the most commonly used in clinical use of drugs for acute attacks of gout It has gradually become one of the most commonly used drugs for acute gout attacks in clinical practice. For acute gouty attacks, clinically commonly used non-steroidal anti-inflammatory drugs older diclofenac sodium, indomethacin, naproxen, etc., and newer etoricoxib, etodolac, rofecoxib, etc., these drugs can be used to alleviate pain and improve the inflammatory response.

2. Colchicine, colchicine used to be the drug of choice for gout patients after an acute attack, and early application of colchicine during an acute attack of gout would result in significant relief of gout symptoms within 24 hours, but this drug has a high incidence of gastrointestinal adverse effects and a risk of serious adverse effects that can lead to exfoliative dermatitis (which occurs at a very low incidence), so nowadays, if the administration of non-steroidal anti-inflammatory drugs is able to effectively control the disease without contraindications to the use of the drug has been less frequently applied. The incidence of adverse reactions to colchicine is closely related to the dosage and route of administration, therefore, in general, those who apply colchicine should take it orally rather than by injection, and should not choose a high dose if they can take a low dose.

3. GlucocorticoidsMany friends talk about hormones, but in fact, the correct and reasonable application of hormones can sometimes achieve good results that cannot be achieved by other drugs. In acute gout attack, in addition to the above two types of drugs, short-term application of low-dose hormones to relieve pain and inflammatory response, its effect is also very clear, research shows that the short-term application of hormones for the treatment of gout, and taking non-steroidal anti-inflammatory drugs effect is comparable to that of non-steroidal anti-inflammatory drugs, and safety is good, for the taking of non-steroidal anti-inflammatory drugs with colchicine contraindications or intolerance to the gout patients, the choice of short-term application of glucose Corticosteroids are also a good choice, prednisolone, tretinoin and other drugs, are gout patients can be short-term application, relief of pain and inflammatory response of hormone drugs.

Pharmacologic treatment of gouty intervals and chronic gouty stone arthritis

Acute gout attack will usually be gradually relieved within 1~2 weeks with therapeutic intervention and sufficient rest and recuperation, and the pain and other symptoms will gradually disappear, but the disappearance of the symptoms does not mean that the disease has been cured, as long as the problem of high uric acid is not effectively controlled, the gout may still come back and recur under certain triggers, so for the intervals between the gout, controlling the level of uric acid, and reducing the gout chances of having another attack, it becomes the most important issue.

The main task in the period between gout is - to lower uric acid!

In the gout interval, control the uric acid level, try to control the uric acid below 360μmol/L, can effectively reduce the chance of recurrent gout attacks. The first thing you should do to lower uric acid is to find out the possible causes of high uric acid from yourself. Do you eat too much seafood and other high-purine foods? Do you drink a lot of alcohol, especially beer, for a long time? Do you usually drink less water? Are you overweight and obese? Is the body's high uric acid problem belongs to the excretion of bad or excessive generation type, or mixed type? For these cases, while improving the bad habits, life adjustments to lower uric acid, for gout attacks 2 times a year and above, in the intervals between gout, it is usually recommended to choose the appropriate drugs to control uric acid levels.

Uric acid-lowering drugs are still mainly two categories, one is always uric acid production, the other is to promote uric acid excretion.

Drugs that inhibit uric acid productionThe main thing is to inhibit the activity of the enzymes that catalyze the production of uric acid in the body, so as to reduce the synthesis of uric acid in the body of the pharmacological effect. Allopurinol, febuxostat belongs to this class of drugs, from the effect of the effect, these two drugs are good effect of uric acid drugs, febuxostat than allopurinol newer, uric acid effect is also stronger, but in recent years, the FDA has issued a cardiovascular disease caused by the risk of elevated warning, therefore, cardiovascular disease patients should be cautious.

Drugs to promote uric acid excretionThe main reason is to inhibit the reabsorption of uric acid in the renal tubules, probenecid and benzbromarone, probenecid has a higher incidence of adverse reactions, and benzbromarone is currently the first choice to promote uric acid excretion, compared to the inhibition of uric acid production of drugs to promote uric acid excretion of drugs tend to lower uric acid more significantly, this is because about 90% of the patients with high uric acid are poor excretion of uric acid type, there is no contraindication in the In the absence of contraindications, the choice of benzbromarone to promote uric acid excretion often has a better effect on lowering uric acid. However, it should be noted that friends with kidney stones or related medical history of severe renal insufficiency are not advised to take such drugs. In addition, during the period of taking this kind of drug, also pay attention to drink more water, with the taking of sodium bicarbonate and other drugs to alkalize the urine.

If the uric acid level can be adequately controlled, the chances of gout reoccurring will be significantly reduced, but how should the medication be used for patients whose gout recurs over a long period of time and eventually develops into chronic gouty stone arthritis? Usually, if the gout stone symptoms are mild, there is no compression of the nerve problem of friends, usually still to lower uric acid treatment, the choice of uric acid-lowering drugs can be referred to the two types of drugs we talked about earlier, and for patients with gout stone, uric acid control to reach the standard value is recommended to be lower, it is generally recommended to control the following 300, but not less than 180 best; and for if there is a gout stone has been compressed If the gout stone has pressed on the nerves and caused neuropathy, you can consider surgery to remove the gout stone and take uric acid-lowering drugs (generally preferred allopurinol) to control and improve the condition.

The most common manifestation of gout is gouty arthritis, according to the presence or absence of acute attacks, gouty arthritis is divided into acute attacks and remission, the condition is in a different period of time, the use of medication is not the same. So, what kind of medicine is the most effective for gouty arthritis at different times? Next, Medical Xin will analyze for you.

The main goal of treatment for patients with acute attacks of gout is to relieve arthritic symptoms. Cold compresses on the affected joints and elevation of the affected limbs during an acute attack can increase reflux and reduce edema. In terms of drug selection, both colchicine and NSAIDs can be effective. The key to which of the two works best is who you tolerate better, and if you can tolerate them, each works better. The higher the dosage of colchicine, the higher the incidence of gastrointestinal adverse effects, whereas a small dose of colchicine (1mg first dose, followed by a continuation of 0.5mg an hour later) provides relief from the symptoms of arthritis while reducing the incidence of adverse effects. The main cause of intolerance to NSAIDs is gastrointestinal adverse effects. If there is intolerance to both colchicine and NSAIDs, glucocorticoids are the best choice.

In patients with gout in remission, the main purpose of treatment is to lower uric acid and reduce gout attacks. For patients with medication pointers, the drugs available are divided into two main categories: those that inhibit uric acid production, including allopurine and febuxostat, with febuxostat preferred; and those that promote uric acid excretion, mainly benzbromarone. As for who is the most effective of these two types of drugs, it depends on the cause of the patient's elevated uric acid. If the cause of the increase is excessive production of uric acid, the best choice is febuxostat; if the cause of the increase is a decrease in uric acid excretion, the best choice is benzbromarone. It is important to note that patients on initial pharmacologic uric acid-lowering therapy are recommended to take a combination of medications to prevent acute gout attacks, such as colchicine and nonsteroidal anti-inflammatory drugs, because fluctuations in uric acid can increase the risk of gouty attacks.

In summary, patients with acute attacks of gout, colchicine and non-steroidal anti-inflammatory drugs are good, the key to the use of medication is who you are more tolerant; patients with gout in remission, if the cause of the rise in uric acid is too much uric acid production, the choice of febuxostat is the most effective, and if the cause of the rise in uric acid excretion is reduced, the choice of phenylbromarone is the most effective.

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What are the best medications for gout?

Li Qing, Tianjin TEDA Hospital

Medications for gout include painkillers used in acute gout attacks and uric acid-lowering medications in normal times.

I. Painkillers for the treatment of acute gouty attacks

Three classes of drugs are commonly used: colchicine, non-steroidal anti-inflammatory drugs (antipyretics and painkillers) and hormones, of which the first two are first-line drugs and should be preferred.

1. Colchicine:

It is an effective medicine for the treatment of gout. The earlier the medicine is used, the better the efficacy, and the efficacy is significantly reduced beyond 36 hours. Specific usage: start to take 2 tablets (0.5mg/tablet) orally, 1 tablet after 1 hour, and then 1 tablet after 12 hours; thereafter, 1 tablet each time, 2 to 3 times a day.

Colchicine has a lot of side effects and the side effects are clearly related to the dosage, and the ones that are common side effects are:

①Gastrointestinal symptoms: vomiting, diarrhea, abdominal pain and loss of appetite, the incidence of up to 80%, long-term users may appear serious malnutrition or hemorrhagic gastroenteritis.

② Bone marrow suppression: reduction of white blood cells, platelet decline, leading to aplastic anemia in severe cases, sometimes life-threatening.

(iii) Liver damage: elevated transaminases, jaundice, etc.

④ Kidney damage: hematuria, oliguria, elevated blood creatinine, etc., and acute renal failure in severe cases.

⑤ Others: rhabdomyolysis, alopecia, rash, fever, convulsions and impaired consciousness.

It should be noted in particular that the therapeutic dose of colchicine is very close to the toxic dose, and when the treatment is effective, the dose is not far from the toxic dose.

Literature suggests that colchicine poisoning firstly presents gastrointestinal symptoms within 24 h, and then enters into multiple organ failure, and in severe cases, death occurs within the 24th-72nd h after taking the drug. The cause of death is cardiogenic shock and respiratory failure.

2. Non-steroidal anti-inflammatory drugs:

Also known as antipyretic analgesics, this class of drugs is a large family with many members. Commonly used are anti-inflammatory pain, Fitalin, Ibuprofen, etc., as well as newer painkillers (selective COX-2 inhibitors) Nimesulide, Meloxicam, Celecoxib, etc., the latter of which is recommended because of its low side effects.

① Gastrointestinal symptoms: the most common side effects of these drugs, nausea, vomiting, epigastric discomfort, peptic ulcers, gastrointestinal perforation, upper gastrointestinal bleeding.

② Kidney damage: hematuria, elevated blood creatinine, etc., long-term use leads to chronic renal failure, the incidence of which is higher than that of traditional Chinese medicine.

③ Coagulation disorders: prolong bleeding time, can cause bleeding in severe liver damage, low prothrombinogen, vitamin K deficiency and hemophiliacs.

③ Allergic reactions: urticaria and asthma are the most common.

④Salicylic acid reaction: large doses can cause dizziness, nausea, vomiting, tinnitus, hearing loss, etc. In severe cases, it can lead to hyperventilation, acid-base balance imbalance, and high fever.

3. Glucocorticoids:

It is what we often call hormones, which are not preferred for use, but only when the above two types of drugs are ineffective, or when renal function is not good enough to use the above drugs. The use of intermediate-acting hormones such as prednisone (prednisone) or methylprednisolone, the use of prednisone: 0.5 mg / kg / day, equivalent to prednisone or methylprednisolone 6 to 7 tablets per day, once in the morning, once a tonic dose, the use of 2 to 5 days after the gradual reduction of dosage, the total course of treatment for 7 to 10 days.

There are many side effects of long-term hormone use; short-term use can lead to gastrointestinal reactions such as gastric and duodenal ulcers and gastrointestinal bleeding; long-term use leads to centripetal obesity, infections, calcium loss, osteoporosis, diabetes mellitus, and gastric ulcers.

For people with severe gout and severe pain, a combination of drugs can be used: for example, colchicine + glucocorticoid hormone, or colchicine + non-steroidal anti-inflammatory drugs. The combination of non-steroidal anti-inflammatory drugs + glucocorticoid hormones is not advocated, because both of them damage the gastrointestinal mucosa significantly, which can easily lead to gastrointestinal bleeding.

II. Uric acid-lowering drugs

Common uric acid-lowering drugs include: allopurinol and febuxostat, which reduce uric acid production, and benzbromarone, which promotes uric acid excretion.

1. Allopurinol:

The initial dose for adults is 50～100mg/day, and the maximum dose is 600mg/day. Patients with renal insufficiency should reduce the dosage, and the dose is 50-100mg/d when the glomerular filtration rate is ≤60ml/min, and should be contraindicated when the glomerular filtration rate is ≤30ml/min.

Adverse reactions are:

①Allergy: the incidence of rash is 3% to 10%, which may be itchy papules or urticaria, or blistering reaction.

In severe cases, exfoliative dermatitis may occur. Exfoliative dermatitis is a lethal hypersensitivity reaction, which often occurs in people with positive HLA-B*5801 gene, and is also prone to occur in people with concomitant application of thiazide diuretics and renal insufficiency.The positive rate of the HLA-B*5801 gene in Han Chinese, Koreans, and Thais is significantly higher than that of Caucasians, and it is recommended to screen for this gene prior to taking allopurinol treatment, and it is contraindicated in those who are positive.

(ii) Gastrointestinal reactions, hepatic and renal impairment.

2. Febuxostat:

Initial dose 20-40mg/day, maximum dose 80mg/day. Safe for kidneys, no need to reduce the dosage for mild to moderate renal insufficiency, use with caution in severe renal insufficiency (glomerular filtration rate ≤30ml/min).

Adverse reactions include hepatic impairment, nausea, and rash. Cardiovascular adverse reactions have been reported recently, mostly in high-dose (80 mg per day) users, and the exact harm will have to wait for detailed studies to confirm.

3. Benzbromarone:

Adults starting dose 25-50 mg/day, maximum dose 100 mg/day, after breakfast. Safe for kidneys, 50mg/day is recommended for glomerular filtration rates of 20-60 ml/min, and is contraindicated for glomerular filtration rates <20 ml/min, or in patients with uric acid nephrolithiasis.

Adverse reactions are

①Uric acid kidney stones: Benzbromarone promotes excretion of uric acid, leading to elevated urinary uric acid concentration and inducing uric acid kidney stones.

(ii) Gastrointestinal reactions, hepatic and renal impairment, etc.

Gout is mainly caused by high blood uric acid concentration, which leads to its accumulation in the cartilage tissue of the bones and kidney tissues to become larger, and the appearance of urate crystals in the bones and joints, etc., which produces inflammatory mediators that irritate the joints and produce pain. The main causes of high uric acid are.

1, the body of purine metabolism generation disorders, so that the synthesis of uric acid is abnormal. 2, uric acid excretion in the body of obstacles, can not be through the renal excretory system out of the body.

Therefore, in addition to NSAIDs, drugs that inhibit uric acid production and promote uric acid excretion can also be used in the treatment of gout. These drugs include: febuxostat, etoricoxib, celecoxib, colchicine, allopurinol, benzbromarone and so on.

Drugs to inhibit uric acid production

flagship drug:: Febuxostat, allopurinol

They inhibit uric acid production by inhibiting the enzyme xanthine oxidase. Allopurinol is a purine analog that, in inhibiting xanthine oxidase, affects enzymes related to the purine and pyrimidine metabolic pathways, and it is more damaging to the kidneys. While febuxostat is a non-purine structure of the inhibitor, the effect on purines and so on may be less, the damage to the kidney may not be as big as allopurinol. But febuxostat compared to allopurinol, treatment cost is higher, short-term treatment benefit is better than allopurinol, but long-term treatment benefit allopurinol will be better than febuxostat.

nonsteroidal anti-inflammatory drug (NSAID)

flagship drug:: Etoricoxib, celecoxib, diclofenac sodium

This class of drugs can treat gouty arthritis pain through its anti-inflammatory action. It can provide relief for gouty pain and is recommended for short-term use, not long-term symptomatic treatment.

Drugs to promote uric acid excretion

benzbromarone

It can produce anti-gout effects by inhibiting uric acid reabsorption in renal proximal tubules, promoting uric acid excretion, and thus reducing the concentration of uric acid in the blood. It can be used for chronic gout, primary or secondary hyperuricemia.

colchicine drug

The anti-gout effect of colchicine may be through the binding of neutrophil microtubule protein, thus preventing the formation of microtubules by microtubule protein, leading to a decrease in the migration, chemotaxis and phagocytosis of neutrophils, which is mainly used in acute gouty arthritis, and is ineffective in chronic gout.

The treatment of gout mainly includes lifestyle intervention and medication. We should formulate an individualized plan after comprehensively evaluating the condition under the guidance of a professional doctor in order to effectively control the condition, reduce the number of acute gout attacks and the occurrence of complications such as gout stones and renal insufficiency, and improve the quality of life.

Pharmacological treatment of gout mainly includes anti-inflammatory pain relief in the acute stage and uric acid lowering in the remission stage, in which non-steroidal anti-inflammatory drugs or colchicine or glucocorticosteroids can be chosen in the acute stage of gout in order to rapidly alleviate pain and improve the quality of life. While in the remission period of gout, uric acid should be actively lowered, and allopurinol, febuxostat, which inhibits uric acid production, or benzbromarone, which promotes uric acid excretion, can be chosen.

We recommend that gout patients keep their blood uric acid level within 360umol/L. If there is gout stone formation or frequent occurrence of chronic gouty arthritis, it should be controlled within 300umol/L to maximize the dissolution and discharge of urate crystals, but it should not be lower than 180umol/L for a long period of time, so as not to increase the occurrence of Alzheimer's disease and multiple sclerosis.

Gout patients should also pay attention to strictly limiting the intake of high-purine foods, quitting smoking and limiting alcohol, exercising regularly, drinking more water, keeping warm, controlling body weight, working and resting regularly, and maintaining a good mindset in their daily life. They also need to pay attention to monitoring the changes of the condition and regular review, in order to stabilize the control of the condition and reduce the occurrence of complications.

If you have any questions, please feel free to leave a comment at the end of the article to discuss. Follow the author for continuous daily updates on health knowledge.

Thank you for your question.

(1) Gout is the second largest metabolic disease after diabetes, mainly due to purine metabolism disorders in the body or uric acid is too high and reduced excretion of the body, the sodium salt of uric acid oversaturation to form crystals, deposited in the joints, soft tissues, cartilage and kidneys and other places, which leads to arthritis, urinary tract stones and kidney disease. Gout is also following high blood pressure, high blood sugar, high blood fat after the new "high", collectively known as "four high".

(2) Medications for gout:

1) Medications for acute attacks of gout:

Specialty/preferred drugs - drugs that inhibit the inflammatory response - colchicine: the first dose of 0.5mg-1mg at once, and then every 2 hours until the pain is relieved; colchicine, the sooner the drug is administered, the better the efficacy, and the efficacy is significantly reduced beyond 36 hours;

Analgesics-indomethacin, initial dose 25mg-50mg given every 8 hours; ibuprofen, 0.2-0.4g 3-4 times a day; celecoxib, 0.2g twice a day; diclofenac sodium extended-release tablets, 75mg twice a day;

Glucocorticoid drugs, such as prednisone, 3-4 times a day, 10mg each time, the symptoms of relief gradually reduce the amount to stop; methylprednisolone 6-7 tablets a day, once in the early morning tonic, after 2-5 days of medication gradually reduce the amount of the total course of treatment of 7 to 10 days.

2) Chronic gout intermittent medication:

Drugs to promote uric acid excretion - Benzbromarone (Rigelixan), 25-100 mg once a day with meals;

Probenecid, initial dose 0.25g, 1-2 times a day; maximum dose 3g per day;

Inhibitors of uric acid production - Allopurinol, usually started 2 weeks after the acute gout attack has stabilized, long-term use from a small amount, usually an initial dose of 50mg, 1-2 times a day, the maximum dose of a day does not exceed 600mg;

Febuxostat, 40mg or 80mg once daily;

Febuxostat, an initial dose of 40mg once a day, 80mg is recommended for patients with serum uric acid above 60mg/L; for the prevention of acute gouty attacks for at least 6 months;

Benzosulfanilone, starting dose 100mg twice daily, maximum dose 800mg daily;

Sodium bicarbonate tablets, 0.5g-1g 3 times daily;

3) Herbal and topical medicines:

Shu Tong Drink, the main components of the formula: half maple lotus 15 g, money grass 15 g, save Bianyin 20 g, Sichuan hyssop 15 g, Bu Jie Leaf 20 g, two-faced needle 20 g, licorice 10 g. 1 dose per day, decoct 300 mL, divided into the morning and evening 2 times the warm dose.

The main ingredients of yellow water for injuries are yellow dock, gardenia, comfrey, peppermint, can clear heat and cool blood, swelling and pain, used for arthritis, bruises, soft tissue and bone injuries. Usage: external, wet compresses on the affected area, covered with sterile gauze, l ~ 2 times a day.

For people with gout, drink at least 2,000mL of extra water (including tea and coffee) every day.

I hope you find it helpful!

The authoritative interpretation of Pharmaceutical Affairs, unauthorized reproduction, plagiarism will be punished.

Medicines to control the symptoms of gout are:

Anti-inflammatory painkillers: e.g. Etoricoxib, Celecoxib, Fitalin, Ibuprofen. Etoricoxib is recommended.

Glucocorticoids: e.g., oral methylprednisolone, intra-articular injection of compound betamethasone.

Then there's the classic drug colchicine.

Regardless of the kind you use, it's best to use it within 12 hours of a gout attack for the fastest gout control.

And only after the gout is completely under control can you use uric acid-lowering medications (unless the person who is normally the one who has been regularly using uric acid-lowering medications can continue to take them during a gout attack, or else these uric acid-lowering medications can cause fluctuations in uric acid values and allow gout to flare up)

Uric acid-lowering drugs include:

Allopurinol, Febuxostat, Benzbromarone, Probenecid, and more.

All of the above are classic, reliable and standardized medications.

Foods that can assist in lowering uric acid are:

Milk, cherries, water.

Regarding the effective and more scientific treatment of gout, it depends on which period of gout you are in, if you are not in an acute gout attack, the main principle of treatment is to quickly stop the pain, and then try to ensure that the joints have normal activities.

Specific medications can be glucocorticoids, non-steroidal anti-inflammatory drugs, and colchicine.

And if you are out of remission from gout, the main focus is to control uric acid levels.

There are two main classes of drugs that are currently used in clinical practice to lower uric acid levels.

The first category is medications that inhibit the production of uric acid in the body like allopurinol and febuxostat for example.

The second group of drugs are those that promote uric acid excretion, e.g., benzbromarone.

Specifically which drugs should be selected, generally by the clinician to decide, according to some of the characteristics of the patient's condition as well as complications to make a choice, it is recommended that you do not arbitrarily take their own drugs.

For questions about hyperuricemia as well as gout, please feel free to leave a comment for Dr. Chen.