To Prevent And Treat Acute Gout, What Should We Pay Attention To When Choosing Drugs?

Gout refers to a group of diseases caused by excessive blood uric acid deposited in joints and tissues, causing various damages. The natural course of gout is divided into the asymptomatic hyperuricemia phase, acute attack phase, inter-attack phase, and chronic tophi phase. Among them, typical gout attacks often occur at night, with sudden onset and progressive intensification of pain, reaching a peak in about 12 hours. The pain is tearing, cutting, or biting, and is unbearable. When patients suffer from unbearable pain during a gout attack, they often use non-steroidal anti-inflammatory drugs, colchicine, glucocorticoids, and other drugs to relieve symptoms. This article mainly introduces the treatment and prevention of acute attacks of gout.

Click to Cistanche for kidney disease

Drug treatment of gout in the acute phase

The principle of treatment in the acute phase of gout is to quickly control the symptoms and pain of arthritis. You should rest in bed and elevate the affected limb. It is best to start taking drugs to control acute inflammation within 24 hours of the onset. The guidelines for the diagnosis and management of gout published by the National Institute for Health and Clinical Excellence (NICE) in June 2022 stated that the first-line treatment for gout attacks is non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or short-term oral corticosteroids. This is consistent with the recommendations of domestic diagnosis and treatment standards: first-line treatment drugs are colchicine and NSAIDs. When there are contraindications to treatment or the treatment effect is poor, short-term anti-inflammatory treatment with glucocorticoids can also be considered.

Colchicine is used for the anti-inflammatory and analgesic treatment of gout. When gout attacks occur, it is recommended to initiate early, low-dose colchicine treatment. Specifically, it is recommended that the first dose of colchicine is 1 mg, followed by 0.5 mg twice a day. It is best to start taking medication within 12 hours of an acute gout attack. The efficacy will decrease significantly after 36 hours. If the patient's eGFR is 30~60ml/min, the colchicine dose should be ≤0.5mg/d; if the patient's eGFR is 15~30ml/min, the colchicine dose should be ≤0.5mg/2d; and the drug is contraindicated in patients with eGFR<15ml/min or dialysis patients.

In acute gout attacks, a sufficient amount of fast-acting NSAIDs should be used as soon as possible. NSAIDs carry risks of peptic ulceration, bleeding, and perforation, and NICE guidance states that adding a proton pump inhibitor to patients taking NSAIDs may be considered. Renal damage may also occur when NSAIDs are used, so renal function should be monitored carefully; patients with eGFR <30ml/min and who are not on dialysis should not use them.

Glucocorticoids are mainly used in patients with acute gout attacks accompanied by systemic symptoms, or patients with colchicine and nonsteroidal anti-inflammatory drugs that are ineffective or contraindicated, or with renal insufficiency. It is generally recommended that prednisone 0.5 mg/kg/d be used continuously for 5 to 10 days and then discontinued, or the dosage should be gradually reduced after 2 to 5 days of use, with a total treatment course of 7 to 10 days. It is not suitable for long-term use. NICE guidance also states that intra-articular or intramuscular glucocorticoid injections may be considered to treat gout attacks.

If the patient has contraindications, intolerance, or ineffectiveness to all three types of drugs, NSAIDs, colchicine, and glucocorticoids, interleukin-1 (IL-1) inhibitors can be used.

Uric acid lowering treatment

At present, various versions of guidelines or clinical treatment standards have not yet clarified whether urate-lowering treatment should be initiated during an acute attack of gout. Because fluctuations in blood uric acid can lead to acute attacks of gout, most gout guidelines do not recommend the use of uric acid-lowering drugs at the beginning of an acute gout attack. They must be used as appropriate after 2 weeks of anti-inflammatory and analgesic treatment. However, if an acute attack of gout occurs during stable urate-lowering treatment, urate-lowering drugs can be continued to be used along with anti-inflammatory and analgesic treatment.

Currently, commonly used urate-lowering drugs in my country include allopurinol, febuxostat, and benzbromarone. In addition, new urate-lowering drugs such as polyethylene glycol recombinant uricase, URAT1 inhibitors, and caspase-1 inhibitors have also shown certain efficacy; anakinra and canakinumab are also effective alternative therapies for the treatment of acute gout attacks.

In addition to the above medical treatments, NICE guidance recommends that people with a gout attack apply cold compresses to the affected area to help relieve pain.

Measures to prevent acute attacks of gout

Gout is prone to recurring attacks during uric acid-lowering treatment, and preventive treatment can be performed. For example, low-dose oral colchicine (0.5 mg, 1 to 2 times/d), NSAIDs, or glucocorticoids (5 to 10 mg/d). In addition, adjusting your lifestyle can also help prevent and treat gout. According to the "2016 Chinese Gout Diagnosis and Treatment Guidelines", gout patients should be advised to follow the following 10 recommendations:

(1)Liquor limit;

(2) Reduce the intake of high-purine foods;

(3) Prevent strenuous exercise or sudden cold;

(4) Reduce the intake of fructose-rich beverages;

(5) Drink plenty of water (more than 2000ml per day);

(6) Control weight;

(7) Increase the intake of fresh vegetables;

(8) Eat and rest regularly;

(9) Regular exercise;

(10) No smoking.

How Does Cistanche Treat Kidney Disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.

Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.

Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.

In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.