In his recent lecture dubbed: "That old enemy: Gout and hyperuricemia (Part 2)" during a lunch symposium sponsored by pharmaceutical company Merck Sharp & Dohme (MSD) at the 34th Annual Convention of the Philippine College of Physicians, Dr. Torralba highlighted that the efficacy of the pain reliever etoricoxib was comparable to the gold standard indomethacin in the treatment of acute gouty arthritis. Dr. Torralba further noted that etoricoxib was well tolerated, and exhibited a more favorable safety profile compared to indomethacin.
Talking about the ‘Clinical Pearls’ of Dr. Torralba’s lecture, he stressed that allopurinol is the drug used to lower the blood level of uric acid. The drug blocks the production of uric acid in the body and is especially helpful for people who have a high blood uric acid level and urate stones or kidney damage. However, he emphasized that allopurinol should never be used to treat an acute attack of gout, as this would only prolong and/or aggravate the attack. Allopurinol can also upset the stomach, cause a skin rash, decrease the number of white blood cells, or cause liver damage.
Dr. Torralba added that the diagnosis of gout should be confirmed, if possible by microscopy of joint aspirate (polarizing compensated microscopy). However, if microscopic examination of the joint aspirate is not readily available, one should act on the clinical diagnosis. Furthermore, a serum uric acid determination should be carried out after a few weeks, and several times if need be – to confirm the presence of hyperurecemia.
Gout is a disorder that results from deposits of sodium urate crystals, which accumulate in the joints because of high blood levels of uric acid (hyperuricemia), leading to attacks of painful joint inflammation.
Attacks of gout (acute gouty arthritis) can occur without warning. They may be triggered by an injury, surgery, consumption of large quantities of alcohol or purine-rich food, fatigue, emotional stress, or illness. The first few attacks usually affect only one joint and last a few days. The symptoms gradually disappear, the joint’s function returns, and no symptoms appear until the next attack. However, if the disorder progresses, untreated attacks last longer, occur more frequently, and affects several joints. After repeated attacks, gout can become severe and chronic and the affected joints may be permanently damaged.
In conclusion, Dr. Torralba stressed that physicians should properly diagnose gout on the basis of distinctive symptoms and examination of the affected joints. He also emphasized that the first step in treating gout is to relieve pain by controlling the inflammation, to be followed by preventing recurrences of gout attacks.
Patients seeking additional information about gout and its medical treatment should consult a doctor. Only a doctor can recommend the best treatment option and provide individual patients with realistic expectations of treatment results.
