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Medications that control uric acid levels

  • Long term management of patients with gouty arthritis is to reduce blood uric acid levels so that future episodes of gouty attacks can be prevented. This is achieved by medications such as Allopurinol or uricosuric agents (i.e. medications that result in increased urate excretion from the kidneys).
    • These medications do not relieve the pain and inflammation of an acute episode and are usually started after the acute episode of gout is treated.
    • They may occasionally cause you to have more gout episodes when they are first started, hence you may be prescribed Colchicine or NSAIDS to be taken at the same time.
  • Allopurinol decreases the blood uric acid level and has to be taken daily.
    • It can also reduce tophi size and prevent formation of crystal deposits in joints and other tissues.
    • The most common side effect is skin rash and Allopurinol has to be discontinued if you develop any rashes or itch.
    • Allopurinol is usually taken daily, and for years.
    • It should not be stopped during an acute episode of gout.
  • Uricosuric drugs such as probenecid lower the blood level of uric acid by increasing its excretion in the urine.
    • They are not as effective as Allopurinol and do not work as well in people with renal impairment.
    • Patients should drink plenty of water as the excretion of uric acid in the urine may lead to the formation of stones in the kidney.

Ultimately, your doctor will advise you regarding the types of medication(s) you need and monitor their side effects.

Other problems in gout

Gout may be associated with high blood pressure, diabetes, kidney diseases and obesity. It may be important to screen for these diseases. Uric acid crystals can form deposits in the kidneys or the ureter leading to renal or ureteric stones. This can lead to renal impairment.

Dietary advice if you have gout

Diet plays an important role in the management of gout. Patients with gout should avoid foods with high purine content. It is also important to drink lots of water (at least 2 litres per day) unless instructed by a doctor not to do so. Patients should also reduce their consumption of alcoholic beverages and reduce weight. However, crash dieting is not advised.

Foods high in purine content (restrict your intake)

  • Asparagus, cauliflower, mushroom, oatmeal, wholegrain, wheat germ, red meat

Foods highest in purine (abstain completely if possible)

  • All internal organs of animals and birds, liver, kidney, brain, pancreas
  • Rich game – venison, gamebird pigeon, black chicken
  • Meat extracts – gravies, chicken essence, bak kut teh
  • Certain fish / shellfish – salmon, herring, mackerel, anchovies, sardines, cockles, mussels, scallops, prawns
  • Certain vegetables – spinach, peas, beans, peanuts, carrots
  • Products of beans – beancurd, soya bean drink, bean sprout, bean cake, moon cake, legumes
  • Fruits – strawberries, strawberry jam, durian, tomato, tomato sauce
  • Alcohol – beer, champagne, brandy, whisky, port

Specialist services available at the following institutions:

Ref: S13