The fastest way to reduce gout swelling

Gout is an arthritis disease. When it occurs, the joints will become very painful and swollen. This not only affects people's normal ability to move, but also makes many people lose hope of complete treatment. Therefore, many people will be concerned about gout. In fact, don't underestimate the joint swelling and pain caused by gout. You can choose appropriate methods to slowly regulate it, which can achieve certain therapeutic effects.

How to reduce swelling during a gout attack?

The therapeutic effect of colchicine is generally very significant. Symptoms usually begin to ease 12 hours after treatment and disappear completely within 36 to 48 hours. The usage and dosage of colchicine is 1 mg orally every 2 hours until the therapeutic effect is achieved or until diarrhea or vomiting occurs. Patients with severe attacks may need to take 4 to 7 mg (average 5 mg). The dose given for one attack should not exceed 7 mg within 48 hours.

This treatment often causes diarrhea. If the digestive tract cannot tolerate colchicine, it can also be administered intravenously. Dilute 1 mg of colchicine to 20 ml with sodium chloride solution and inject slowly (>2~5 minutes). The dosage should not exceed 2 mg within 24 hours. Prophylactic oral colchicine combined with intravenous colchicine can cause severe bone marrow suppression and even death. Colchicine-induced diarrhea can cause serious electrolyte imbalances, especially in the elderly, which can lead to serious consequences.

Aspiration of joint fluid followed by injection of a corticosteroid may also control acute attacks of gout. Depending on the size of the affected joint, inject 10-50 mg of prednisolone tert-butyl ethyl ester. A single dose of ACTH80u intramuscular injection is a very effective treatment, as is intravenous colchicine, and is particularly suitable for patients with gout attacks who are unable to take medication after surgery. In case of polyarticular attacks, prednisone can also be used for a short period of time, such as 20~30mg/d. Occasionally, a combination of drugs is used to treat an acute attack of gout.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective for acute attacks of established gout. It is usually taken with food for 2 to 5 days. NSAIDs can cause many complications, including gastrointestinal upset, hyperkalemia (in patients who rely on prostaglandin E2 to maintain renal blood flow), and fluid retention. Patients who are particularly at risk for NSAID use include the elderly, the dehydrated, and particularly those with a history of renal disease.

To promote uric acid excretion therapy, oral probenecid (500 mg tablets) or sulfinpyrazone (100 mg tablets) can be used, and the dosage should be adjusted to maintain serum urate concentration within the normal range. Start by giving half a tablet twice daily. Gradually increase the dose to 4 tablets per day. Sulfinpyrazone is more potent than probenecid, but also more toxic. Salicylates can counteract the urate excretion-promoting effects of the above two drugs and should be avoided. Acetaminophen has analgesic effects similar to salicylic acid, but does not affect uric acid excretion.

Allopurinol 200-600 mg/d (in divided doses) can inhibit uric acid synthesis and also control serum urate concentration. When used in combination with acid-promoting drugs, the initial dose should be small and gradually increased until the uric acid level approaches 4.5 mg/dl (0.26 mmol/L). In addition to blocking the action of the enzyme in the formation of uric acid (xanthine oxidase), the drug can also correct the excessive synthesis of purines. This is particularly helpful in treating patients with recurrent uric acid stones or renal dysfunction. Clearly established uric acid stones can be dissolved by treatment with allopurinol. The main side effects of allopurinol are mild gastrointestinal discomfort, potentially dangerous rash, hepatitis, vasculitis and leukopenia.

For adjuvant therapy, all gout patients need to drink plenty of fluids, at least 3L per day, especially those who have previously suffered from chronic uric acid stones. Take 5g of sodium bicarbonate or trisodium citrate 3 times a day to alkaline the urine. Taking 50 mg of acetazolamide before going to bed can effectively alkalize morning urine. Care should be taken to avoid alkalinization of the urine, as this may promote the deposition of calcium oxalate crystals. Because drugs are quite effective in lowering serum urate concentrations, strict restriction of dietary purines is usually not necessary.