How Can I Talk to My Doctor About Gout?

medical care for gout

Gout, a form of inflammatory arthritis, affects more than eight million Americans.1 The disease is caused by excess uric acid in the bloodstream, a medical condition known as hyperuricemia.1 Adults with gout may experience sudden and severely painful episodes called flares.1 Getting the appropriate medical treatment for gout, including regular checkups and good communication with your doctor, goes a long way toward helping you manage the disease and preventing future flares.

 

Recognizing a progressive disease

Over time, adults with gout may progress through the stages of the disease, which are2:

  1. Asymptomatic Hyperuricemia—Excess uric acid is building up in the bloodstream, but there are no symptoms yet. Tiny urate crystals are beginning to form in the joints.
  2. Acute Gout—A severely painful episode of joint inflammation, also known as a flare, occurs without warning. This episode may be triggered by diet, stress, certain medications or another cause.
  3. Intercritical Gout—The uneventful periods between gout flares.
  4. Chronic Tophaceous Gout—After months and years with the disease, flares now occur on a regular basis. Inflammation causes stiffness and soreness. Hard, chalky lumps called tophi may form under the skin, which can eventually destroy bone and cause deformities. Chronic arthritis can then develop.

 

Seeking medical care for gout

The first time you had a gout attack, you may not have understood what was happening. Perhaps you visited your hospital emergency department. Or maybe you called your doctor asking to be seen that same day. Either way, your uric acid level was most likely tested, and you may have been instructed to start a urate-lowering therapy (ULT) such as allopurinol.3 You may also have been prescribed a medicine that can prevent gout flares in adults, such as Mitigare® (colchicine) 0.6 mg capsules.4 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. The most commonly reported adverse reactions with colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting, and abdominal pain.

A ULT is a kind of medicine that helps to reduce the amount of uric acid in your bloodstream. If your doctor prescribed a ULT, you were probably asked to come back to the office every few weeks to have your uric acid level tested as part of your medical treatment for gout. Once your uric acid level stabilized, however, your doctor may have told you that you could return to your regular checkup schedule.

 

Routine checkups

It is up to you and your doctor to decide how often you need to be seen in the office. The frequency of your visits may depend on a number of factors, including:

  • How severe your gout is
  • Which gout medicines you’re taking
  • Other medical conditions you have

Your doctor will probably order a blood test every six months or so to ensure that your uric acid level remains healthy. Your doctor most likely will also closely monitor any other conditions you have, especially those believed to be gout-related.

 

Making the most of your appointments

Before you see your doctor each time, take a few minutes to prepare. It is very important that you share as much information as you can about your gout. You’ll also want to take the opportunity to ask any questions you have. Consider downloading and completing the Gout Flare Questionnaire (from the Resources for Patients section of this website) before your appointment. Things to think about include:

  • Any symptoms you’re having, including when and how they occur
  • Any recent changes or stressors happening in your life, such as a move, a new job and/or other situation
  • Any medicines or supplements you are taking
  • Any questions you have about gout or your treatment

Be sure to mention any other medical conditions you have, especially if you are visiting a specialist (such as a rheumatologist) instead of the doctor you normally see. You may also want to consider bringing a family member or close friend with you to your appointment. You can ask them to take notes or simply be there to support you.

 

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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. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011;63(10):3136–3141.
  2. Gout and Uric Acid Education Society website. Symptoms & Stages/Clinical Presentation of Gout. Available at: http://gouteducation.org/medical-professionals/diagnosing-gout/gout-symptoms-stages/. Accessed August 31, 2018.
  3. Allopurinol Tablets, USP [prescribing information]. Memphis, TN: Northstar Healthcare Holdings; 2016.
  4. Mitigare® (colchicine) capsules [prescribing information]. Columbus, OH: West-Ward Columbus, Inc.; 2018.

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. 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.