The way gout is treated conventionally is supposed to start with discussion of lifestyle modification, usually targeting sugar, alcohol and high purine foods.
You might also have a discussion with your doctor about weight loss and/or regulating your blood sugars and cholesterol levels, since Gout and metabolic syndrome tend to hold hands.
If these less aggressive measures don’t work, or they’re not even discussed (which happens more often than you think), some of the more aggressive treatments include:
- Medications that inhibit the production of uric acid, which we call xanthine oxidase inhibitors.
- Those that increase the excretion of uric acid, referred to as uricosuric agents.
- And then medications that break uric acid down while it’s in your body.
We’re going to visit a new finding in the New England Journal of Medicine regarding the Xanthine Oxidase inhibitors- allopurinol and febuxostat because these are the most widely prescribed.
If you go to your doctor because you woke up one morning with midfoot, ankle or pain in your hands and it was determined to be gout, you’re probably going to be started on allopurinol or febuxostat.
The investigators in this new study compared risk of complications between these two drugs in gout patients. Consistent with previous study, they found that febuxostat put patients at greater risk for death from both all causes and cardiovascular mortality.
The reality is sometimes medication is indicated and there’s a way we can go about it more safely.
But the good news is, it’s probable that you don’t need to be on either of these medications for life. Gout is incredibly responsive to non-drug approaches.
Do you take medication for gout? Does your doc have you on febuxostat or allopurinol?
Further Reading
CARES trial suggesting febuxostat has higher risk of complications relative to allopurinol in the treatment of gout
White, William B., et al. “Cardiovascular safety of febuxostat or allopurinol in patients with gout.” New England Journal of Medicine 378.13 (2018): 1200-1210.