Gout drugs are medicines that prevent or relieve the symptoms of gout, a disease that affects the joints and kidneys.
Gout is a disease in which uric acid, a waste product that normally passes out of the body in urine, collects and forms crystals in the joints and the kidneys. When uric acid crystals build up in the joints, the tissue around the joint becomes inflamed, and nerve endings in the area become irritated, causing extreme pain. Uric acid crystals in the kidneys can lead to kidney stones and eventually to kidney failure.
The symptoms of gout-severe pain, usually in the hand or foot (often at the base of the big toe), but sometimes in the elbow or knee-should be reported to a health care professional. If not treated, gout can lead to high blood presssure, deformed joints, and even death from kidney failure. Fortunately, the condition is easily treated. For patients who have just had their first attack, physicians may prescribe only medicine to reduce the pain and inflammatin, such as nonsteroidal anti-inflammatory drugs, corticosteroids, or colchicine. Patients may also be advised to change their eating and drinking habits, avoiding organ meats and other protein-rich foods, cutting out alcoholic beverages, and drinking more water. Some people never have another gout attack after the first. For those who do, physicians may prescribe additional drugs that either help the body get rid of uric acid or reduce the amount of uric acid the body produces. These drugs will not relieve gout attacks that already have started, but will help prevent attacks when taken regularly.
Three main types of drugs are used in treating gout. Colchicine helps relieve the symptoms of gout by reducing inflammation. Allopurinol (Lopurin, Zyloprim) reduces the amount of uric acid produced in the body. Probenecid (Benemid, Probalan) and sulfinpyrazone (Anturane) help the body get rid of excess uric acid. Physicians may recommend that patients take more than one type of gout drug at the same time. Some of these medicines may also be prescribed for other medical conditions that are caused by too much uric acid in the body.
The recommended dosage depends on the type of gout drug. Check with the physician who prescribed the drug or the pharmacist who filled the prescription for the correct dosage.
Always take gout drugs exactly as directed. Never take larger or more frequent doses than recommended. Patients who are told to take more than one gout drug should carefully follow the physician's directions for taking all medicines.
Gout drugs such as allopurinol, probenecid, and sulfinpyrazone must be taken regularly to prevent gout attacks. The medicine may take some time to begin working, so gout attacks may continuee for awhile after starting to take the drug. Continuing to take the drug is important, even if it does not seem to be working t first.
Colchicine may be taken regularly in low doses to help prevent gout attacks or in high doses for only a few hours at a time to relieve an attack. The chance of serious side effects is greater when this medicine is taken in high doses for short periods.
Seeing a physician regularly while taking gout drugs is important. The physician will check to make sure the medicine is working as it should and will watch for unwanted side effects. Blood tests may be ordered to help the physician monitor how well the drug is working.
Drinking alcohol, including beer and wine, may increase the amount of uric acid in the body and may interfere with the effects of gout medicine. People with gout (or other conditions that result from excess uric acid) may need to limit the amount of alcohol they drink or stop drinking alcohol altogether.
Some people feel drowsy or less alert when taking gout drugs. Anyone who takes this type of medicine should not drive, use machines or do anything else that might be dangerous until they have found out how the drugs affect them.
Some gout drugs may change the results of certain medical tests. Before having medical tests, anyone taking this medicine should alert the health care professional in charge.
Older people may be especially sensitive to the effects of colchicine. The drug may also stay in their bodies longer than it does in younger people. Both the increased sensitivity to the drug and the longer time for the drug to leave the body may increase the chance of side effects.
People who have certain medical conditions or who are taking certain other medicines can have problems if they take gout drugs. Before taking these drugs, be sure to let the physician know about any of these conditions:
ALLERGIES. Anyone who has ever had unusual reactions to gout drugs or to medicines used to relieve pain or inflammation should let his or her physician know before taking gout drugs. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.
DIABETES. Some gout drugs may cause false results on certain urine sugar tests, but not on others. Diabetic patients who take gout drugs should check with their physicians to find out if their medicine will affect the results of their urine sugar tests.
PREGNANCY. The effects of taking gout drugs during pregnancy are not fully understood. Women who are pregnant or who may become pregnant should check with their physicians before using gout drugs.
BREASTFEEDING. Gout drugs may pass into breast milk. Women who are taking this medicine and want to breastfeed their babies should check with their physicians.
OTHER MEDICAL CONDITIONS. Gout drugs may cause problems for people with certain medical conditions. For example, the risk of severe allergic reactions or other serious side effects is greater when people with these medical conditions take certain gout drugs:
- congestive heart disease
- high blood pressure
- blood disease
- kidney disease or kidney stones
- cancer being treated with drugs or radiation
- stomach or intestinal problems, including stomach ulcer (now or in the past)
Before using gout drugs, people with any of medical problems listed above should make sure their physicians are aware of their conditions.
USE OF CERTAIN MEDICINES. Taking gout drugs with certain other drugs may affect the way the drugs work or may increase the chance of side effects.
A skin rash that develops during treatment with gout drugs may be a sign of a serious and possibly life-threatening reaction. If any of these symptoms occur, stop taking the medicine and check with a physician immediately:
- skin rash, itching, or hives
- scaly or peeling skin
- chills, fever, sore throat, nausea and vomiting, yellow skin or eyes, joint pain, muscle aches or pains—especially if these symptoms occur at the same time or shortly after a skin rash
Patients taking colchicine should stop taking it immediately if they have diarrhea, stomach pain, nausea, or vomiting. If these symptoms continue for 3 hours or more after the medicine is stopped, check with a physician.
Other side effects of may also need medical attention. If any of the following symptoms occur while taking gout drugs, check with the physician who prescribed the medicine as soon as possible:
- pain in the side or lower back
- painful urination
- blood in the urine
Less serious side effects, such as headache, loss of appetite, and joint pain and inflammation usually go away as the body adjusts to the drug and do not need medical treatment.
Other side effects may occur. Anyone who has unusual symptoms while taking gout difficult to interpret. Even so, each individual cell in the body carries thousands of genes coding for proteins, with some estimates as high as 150,000 genes. For gene therapy to advance to its full potential, scientists must discover the biological role of each of these individual genes and where the base pairs that make them up are located on DNA.
To address this issue, the National Institutes of Health initiated the Human Genome Project in 1990. Led by James D. Watson (one of the co-discoverers of the chemical makeup of DNA) the project's 15-year goal is to map the entire human genome (a combination of the words gene and chromosomes). A genome map would clearly identify the location of all genes as well as the more than three billion base pairs that make them up. With a precise knowledge of gene locations and functions, scientists may one day be able to conquer or control diseases that have plagued humanity for centuries.
Scientists participating in the Human Genome Project have identified an average of one new gene a day, but many expect this rate of discovery to increase. By the year 2005, their goal is to determine the exact location of all the genes on human DNA and the exact sequence of the base pairs that make them up. Some of the genes identified through this project include a gene that predisposes people to obesity, one associated with programmed cell death (apoptosis), a gene that guides HIV viral reproduction, and the genes of inherited disorders like Huntington's disease, Lou Gehrig's disease, and some colon and breast cancers. In February of 2001, scientists published a rought draft of the complete human genome. With fewer than the anticipated number of genes found, between 30,000-40,000, the consequences of this announcement are enormous. Scientists caution however, that the initial publication is only a draft of the human genome and much more work is still ahead for the completion of the project. As the human genome is completed, there will be more information available for gene therapy research and implementation.
The future of gene therapy
Gene therapy seems elegantly simple in its concept: supply the human body with a gene that can correct a biological malfunction that causes a disease. However, there are many obstacles and some distinct questions concerning the viability of gene therapy. For example, viral vectors must be carefully controlled lest they infect the patient with a viral disease. Some vectors, like retroviruses, can also enter cells functioning properly and interfere with the natural biological processes, possibly leading to other diseases. Other viral vectors, like the adenoviruses, are often recognized and destroyed by the immune system so their therapeutic effects are short-lived. Maintaining gene expression so it performs its role properly after vector delivery is difficult. As a result, some therapies need to be repeated often to provide long-lasting benefits.
One of the most pressing issues, however, is gene regulation. Genes work in concert to regulate their functioning. In other words, several genes may play a part in turning other genes on and off. For example, certain genes work together to stimulate cell division and growth, but if these are not