The choice of medication for gout is important, but attention should be paid to kidney function!

Gout is a recurrent inflammatory disease that can cause acute arthritis and tophi as well as interstitialnephritis, and can even induce joint deformity and joint dysfunction. Many patients only take medicine when they have an acute attack of gout, and stop taking it directly after it is relieved, but this practice can harm the kidneys. Almost all drugs are metabolized by the liver and excreted by the kidneys, and it is necessary to pay attention to the liver and kidney function in terms of medication. Patients with gout and chronic kidney disease should choose urate-lowering drugs and drug dosages individually according to the stage of kidney disease to avoid drug accumulation and poisoning.

How do gout patients choose their medications?

1. Allopurinol

Allopurinol is metabolized in the liver into active hydroxypurinol, and finally excreted through the kidneys. However, renal insufficiency can cause these substances to accumulate in the body, leading to drug poisoning. If the glomerular filtration rate is greater than 60 milligrams per minute, the initial dose of allopurinol per day is 100 mg, and the maximum dose should not exceed 800 mg; When the glomerular filtration rate is 15~59 ml per minute, try to start with about 50 mg per day, and the maximum dose per day should not exceed 200 mg; If the glomerular filtration rate is less than 15 milliliters per minute, these drugs are contraindicated.

2. Benbromarone

After oral administration, 50% of benzbromarone is absorbed by the body, and the metabolites are excreted through the biliary tract. People with mild to moderate renal insufficiency can use these drugs to better reduce uric acid, avoid drug accumulation, and prevent further damage to the kidneys. However, people with a glomerular filtration rate of less than 30 milliliters per minute cannot use these drugs.

3. Febuxostat

Febuxostat is metabolized by the liver and then excreted through the intestines and kidneys. Compared with other uric acid-lowering drugs, uric acid-lowering is more effective and can also protect the kidneys. When the glomerular filtration rate is 15~50 ml, the initial dose is about 20 mg per day, and the maximum dose cannot exceed 40 mg.

4. Colchicine

In the case of normal renal function, low-dose colchicine should be given as early as possible during an acute attack of gout. Systemic glucocorticoids should be used if colchicine is intolerant, contraindicated, or inadequate. When an acute attack of gout involves multiple joints and large joints, systemic glucocorticoid therapy is preferred; If one drug is ineffective, two anti-inflammatory and analgesic drugs, such as low-dose colchicine combined with systemic glucocorticoids, are indicated. Colchicine is the drug of choice for acute attacks of gout and can have anti-inflammatory and analgesic effects. Patients with renal insufficiency should adjust the dose of colchicine according to the glomerular filtration rate. The glomerular filtration rate is 35~59 ml, and the daily dose is about 0.5 mg; The glomerular filtration rate is less than 10 ml per minute, and colchicine is contraindicated.

5. Glucocorticoids

Corticosteroids are effective in relieving joint movement pain and are first-line anti-inflammatory analgesics. In people who are intolerant or contraindicated to colchicine, such as chronic renal insufficiency, glucocorticoids may be given in small doses to prevent gout attacks. However, during long-term use, oral gastric mucosal protectors should be taken at the same time.

Tips

The choice of medication for patients with gout is indeed crucial, but it also needs to be based on the protection of the kidneys. During the medication, liver and kidney function and cardiovascular health should be closely monitored, and adverse reactions such as gastrointestinal tract and osteoporosis should be observed. In addition, the medication should be strictly followed by the doctor's instructions, and the medication should not be stopped or the dosage should be changed without authorization. During this period, you should stay away from high-purine foods and keep your limbs warm.