I Have Gout, Now What?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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You aren’t alone.  The reason we hear so much about gout is that the prevalence of gout has increased greatly over the past 30 years. It’s more common in men than women but women start to catch up after menopause.

Why is there more gout? There are 3 reasons: we live longer, there is more high blood pressure, and common medications like aspirin and diuretics increase risk of gout.

What are we doing wrong?  Increased consumption of carbs, proteins, and drinks containing fructose contribute to gout.

What causes gout? Gout is a problem of too much uric acid in the bloodstream leading to crystal formation of monosodium urate crystals which deposit in the joints. Big toe, ankle, and knees are the most common areas.

Where do I start if I don’t want another attack? Just decreasing intake of shellfish, beer, and red meat can lower the uric acid in your bloodstream. Yet, 60% of patients who have an attack of gout will get another one in a year, 78% in two years, and 84% in 3 years. Odds are you will have another one so be ready.

When I have an attack what do I take? NSAIDS (non steroid anti-inflammatory drugs) like Indocin, naproxen, ibuprofen and Celebrex will all work for the swelling pain and inflammation during an acute attack. These are your savior with that red, hot painful joint. Steroids aren’t a great option for many reasons and when you stop them they are likely to give you a rebound gouty attack.

Prevention is the key to success. Allopurinol is the medication you take to prevent gouty attacks. A common mistake patients make is that symptoms of your gout attack MUST RESOLVE before you start on allopurinol.

What’s new in gout?  Uloric (febuxostat), like allopurinol, is the newer medication used for the prevention of your next attack. Uloric (febuxostat) is a brand name medication with the same indication as allopurinol so it works to lower your uric acid level. Uloric can help lower uric acid level when allopurinol hasn’t worked and is safer in folks with kidney disease but it will cost you. It’s very expensive.

Dr O.

Allopurinol is included in many pharmacy discount generic programs for under $5 for 30 tablets. Coupons are available at most other pharmacies for under $10, and most insurance plans will cover it under Tier 1, meaning you’ll pay only your lowest co-pay. In contrast, Uloric will cost over $220 for 30 tablets out of pocket at most pharmacies, and you may end up paying your highest co-pay.

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