Answers to Questions About Gout You May Be Afraid to Ask

about gout

Gout is the most common inflammatory arthritis in the US and acute gout flares are among the most painful events humans can experience.1 Yet, many people who suffer with it don’t ask questions when they see the doctor. Read on for answers to questions about gout you may be afraid to ask.

 

Why do my gout attacks happen at night?

An internet-based study of 724 people found that the risk of a flare is almost two and a half times higher between midnight and 8 am than it is during the day.1 Here are three possible reasons:

  • Lower body temperature—For most people, the body temperature is lower at night.1 This decrease in body temperature can promote the formation of urate crystals and potentially trigger a gout attack.1
  • Nighttime dehydration—Nighttime dehydration (as a result of normal breathing) is believed to contribute to the higher risk of flares during the nighttime/early morning hours.1
  • Falling cortisol levels—Cortisol, a hormone that affects many of your body’s functions, tends to fall between midnight and 4 am.1,2 This decrease can trigger a gout attack.1

 

Why are my gout flares so painful?

When there is excess uric acid in the bloodstream, urate crystals can form around a joint. When triggered, tiny bits of these crystals can become loose and irritate the joint lining.3 White blood cells perceive the urate crystal fragments as a foreign substance or invader and respond by attempting to surround and consume these fragments.3,4 All of this cellular activity contributes to the pain, swelling and redness associated with a gout flare.3,4

 

When will my gout attack be over?

For most people, the pain is the most severe within the first four to 12 hours after the start of a gout attack.5 Once the worst is over, discomfort can linger from a few days to a few weeks.5 Future attacks typically last longer and may affect multiple joints, however.5 That’s why it is so important to get the disease under control as soon as possible.5

 

Will my gout eventually just go away?

Unfortunately, gout is a progressive disease.6 It begins quietly, with the uric acid level slowly rising in the bloodstream, and can ultimately become a chronic condition.6 According to the Gout Education Society, the disease can progress through three stages6:

  1. Gout flares—The uric acid level in bloodstream is higher than normal and urate crystals begin forming in one or more of the joints.6 At some point, a gout attack, or flare, occurs.6
  2. Tophus formation and bony erosions—After five years or so of recurrent attacks, people with gout can develop hardened urate lumps under the skin and around the joints.6 Although they are not painful, these lumps (also known as tophus) can interfere with normal joint function and eventually destroy cartilage and bone.6
  3. Chronic tophaceous gout—In the earlier stages of gout, joints feel normal and function normally except during attacks.6 At this stage, however, gout attacks become even more common, and joint discomfort becomes chronic.6

Fortunately, early and effective treatment with the appropriate medications can help prevent the more advanced stages of gout.6

 

Is it my fault I have gout?

For years, gout was believed to be a “rich man’s disease”—the result of too much eating and drinking.7 However, recent research has shown that bad habits may not be entirely to blame.8,9 The results of studies conducted in Japan and Taiwan imply that, while diet can affect gout risk, heredity may have a bigger influence.8,9 That said, bear in mind that certain foods and drinks (red meat, seafood and alcoholic or sugary drinks, for example) have the potential to trigger attacks in people who have already been diagnosed with gout.5

 

What is the best way to manage my gout?

If you suffer with gout and are having frequent attacks, make an appointment to see your doctor as soon as possible. He or she can review the medications you are taking and determine if adjustments are needed. Your doctor may also recommend colchicine therapy to prevent gout flares.10 One such medicine is Mitigare® (Colchicine) 0.6 mg Capsules, which is FDA-approved to prevent flares in adults with gout.10 The safety and effectiveness of Mitigare® for acute treatment of gout flares during prophylaxis has not been studied, however.10 It is also important to keep in mind that Mitigare® is not an analgesic medication and should not be used to treat pain from other causes.10 To learn more about Mitigare and how it may be able to help you prevent gout flares10, talk with your doctor.

 

Mitigare® is a registered trademark of Hikma Pharmaceuticals USA Inc.

 

Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.

Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.

Blood dyscrasias such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia and aplastic anemia have been reported with colchicine used in therapeutic doses.

Monitor for toxicity and, if present, consider temporary interruption or discontinuation of colchicine.

Drug interaction with dual P-gp and CYP3A4 inhibitors: Co-administration of colchicine with dual P-gp and CYP3A4 inhibitors has resulted in life-threatening interactions and death.

Neuromuscular toxicity and rhabdomyolysis may occur with chronic treatment with colchicine in therapeutic doses, especially in combination with other drugs known to cause this effect. Patients with impaired renal function and elderly patients (including those with normal renal and hepatic function) are at increased risk. Consider temporary interruption or discontinuation of Mitigare®.

The most commonly reported adverse reactions with colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting and abdominal pain.

 

Please see the full Prescribing Information and Medication Guide for Mitigare® for complete product details.

 

NOTE: This article was not written by a medical professional and is not intended to substitute for the guidance of a physician. These are not Hikma’s recommendations for gout flare prevention, but rather facts and data collected from various reliable medical sources. For a full list of resources and their attributing links, see below.

References

  1. Choi HK, et al. Nocturnal risk of gout attacks. Arthritis Rheumatol. 2015;67(2):555-562.
  2. Cortisol Test. What is a cortisol test? Medline Plus website. Available at: https://medlineplus.gov/lab-tests/cortisol-test/. Accessed March 26, 2020.
  3. Gout: Joint pain and more. Harvard Health Publishing/Harvard Medical School website. Available at: https://www.health.harvard.edu/pain/gout-joint-pain-and-more. Accessed March 26, 2020.
  4. Patient education: Gout (Beyond the Basics). UpToDate® website (Wolters Kluwer). Available at: https://www.uptodate.com/contents/gout-beyond-the-basics. Accessed March 26, 2020.
  5. Gout/Symptoms & causes/Overview. Mayo Clinic website. Available at: https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897. Accessed March 26, 2020.
  6. Symptoms and Stages. Gout and Uric Acid Education Society website. Available at: http://gouteducation.org/patient/what-is-gout/gout-symptoms-stages/. Accessed February 27, 2018.
  7. Nicola Dalbeth and Keith J Petrie: It’s time to change the name of gout. The British Medical Journal Opinion/Comment and opinion from the BMJ’s international community of readers, authors, and editors. Available at: https://blogs.bmj.com/bmj/2018/02/05/nicola-dalbeth-and-keith-j-petrie-its-time-to-change-the-name-of-gout/
  8. Higashino T, Takada T, Nakaoka H, et al. Multiple common and rare variants of ABCG2 cause gout. RMD Open. 2017;3:e000464.
  9. J Chang S-J, Chen C-J, et al. ABCG2 contributes to the development of gout and hyperuricemia in a genome-wide association study. Nature/Scientific Reports. 2018;8:3137.
  10. Mitigare® (Colchicine) 0.6 mg Capsules [prescribing information]. Columbus, OH: West-ward Columbus, Inc.; 2019.

Important Safety Information for Mitigare® (colchicine) 0.6 mg capsules

  • Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.
  • Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.
  • Blood dyscrasias such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, and aplastic anemia have been reported with colchicine used in therapeutic doses.
  • Monitor for toxicity and if present consider temporary interruption or discontinuation of colchicine.
  • Drug interaction with dual P-gp and CYP3A4 inhibitors: Co-administration of colchicine with dual P-gp and CYP3A4 inhibitors has resulted in life-threatening interactions and death.
  • Neuromuscular toxicity and rhabdomyolysis may occur with chronic treatment with colchicine in therapeutic doses, especially in combination with other drugs known to cause this effect. Patients with impaired renal function and elderly patients (including those with normal renal and hepatic function) are at increased risk. Consider temporary interruption or discontinuation of Mitigare®.
  • The most commonly reported adverse reactions with colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting, and abdominal pain.

Indication

Mitigare® is indicated for prophylaxis of gout flares in adults. The safety and effectiveness of Mitigare for acute treatment of gout flares during prophylaxis has not been studied.

Mitigare® is not an analgesic medication and should not be used to treat pain from other causes.

For Full Prescribing Information please CLICK HERE and for Medication Guide CLICK HERE.

You are encouraged to report negative side effects of prescription drugs to the FDA.

Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Manufactured by: West-Ward Columbus Inc., Columbus, OH 43228

Important Safety Information for Mitigare® (colchicine) 0.6 mg capsules

  • Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4.