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I'm not getting the results I expected from drug therapy for my gout. What else can I do?

You are not alone! Gout is the most common inflammatory disease affecting joints. The number of people who are affected has more than doubled in the last 20 years. Although men are affected most often, women can have this problem, too. Gout is a problem with the breakdown of uric acid, a compound that forms when purine is metabolized and passed out of the body through urine. Too much uric acid in the body causes crystals to form in the joints. The result is attacks of joint pain, swelling, and even oozing of crystals from the affected joint. The big toe is a common target for crystal formation in gout, but the ear and elbow are also common sites for crystal formation. There are three basic ways to get control of your gouty symptoms. The first is to make sure you have been diagnosed accurately. Other joint diseases such as septic (infectious) arthritis or pseudogout can look like gout. In fact, it's possible to have both gout and one of these other joint problems. An accurate diagnosis depends on removing fluid from the joint and examining it under a microscope. The presence of urate crystals is the "gold standard" for making the diagnosis. Other imaging studies may be ordered such as X-rays, ultrasound, CT scans or MRIs. Each of these tests offers a little piece of information that helps define the location, severity, and extent of disease. In many cases, a change in diet is enough to resolve the symptoms. This can be the downfall of success with treatment for some people. Eliminating purines is important. Purines are found in high concentration in meat and meat products, especially internal organs such as lunch meats, liver, and kidney as well as some fish products. The increased intake of fructose-sweetened soft drinks has also been linked with an increased risk of gout. Food does account for about one-third of the body's daily uric acid load. The rest comes from mechanisms within the body that produce this compound. When it is not passed out of the body through the kidneys and intestines, just the right conditions in the body result in the formation of uric acid crystals called tophus. That's where medications can be helpful. Not everyone responds the same to the drug options available. It may take a bit of time to work with your physician to find the right choice (and optimal dose) that's best for you. Some of the drug choices include antiinflammatories, steroids, and serum uric acid-lowering agents. Other joint diseases such as septic (infectious) arthritis or pseudogout can look like gout. In fact, it's possible to have both gout and one of these other joint problems. An accurate diagnosis depends on removing fluid from the joint and examining it under a microscope. The presence of urate crystals is the "gold standard" for making the diagnosis. Other imaging studies may be ordered such as X-rays, ultrasound, CT scans or MRIs. Each of these tests offers a little piece of information that helps define the location, severity, and extent of disease. Nonsteroidal antiinflammatory medications (NSAIDs) are used to combat the inflammatory process. Steroid-based anti-inflammatories called corticosteroids (oral by mouth or injected into the joint) can also be used to decrease swelling and relieve pain. Another common medication that has been found effective with gout is called colchicine. Colchicine has an anti-inflammatory effect. It also inhibits urate crystal from forming deposits. Studies show that low-doses of this drug within 12 hours of an acute attack are very successful. One other group of medications available to lower urate levels in the body is allopurinol. This drug is one of the serum uric acid (SUA)-lowering therapies. It works by inhibiting a substance called xanthine oxidase, which then reduces the production of urate. Zyloprim is the brand name for allopurinol. Zyloprim does not take away the acute attacks of gout. But it is useful in preventing recurrence. Other allopurinol drugs on the market include Allohexal, Allosig, Progout, and Zyloric. Whatever is keeping you from getting control of your gouty symptoms must be identified and corrected. You will need to see your physician and let him or her help you get to the bottom of the problem and find a solution that will work for you. New experimental drugs are under investigation that might help patients who have done everything possible but still experience recurrent attacks.

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