Treatment of gout with colchicine and allopurinol. Gout: treatment with modern drugs

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Treatment of gout provides a differential strategy depending on the stage of the disease (acute attack or interictal period, chronic form).

Gout therapy.

Gout therapy consists of relieving an attack of arthritis and measures in the interictal period (prevention of repeated exacerbations of articular syndrome, treatment of extra-articular manifestations of gout - gouty tendinitis, myositis, gouty nephropathy, etc.). There are 3 main tasks in the treatment of this disease:

1. stop an acute attack of gout as quickly as possible;
2. prevent its relapse;
3. prevent or reduce the manifestations of chronic gout (primarily the formation of tophi and kidney stones).

Successful treatment of gout is possible only with the joint efforts of the doctor and the patient. One of the important components of success is the patient’s adherence to the diet.

Therapeutic nutrition for gout.

For gout it is prescribed therapeutic nutrition within table No. 6. This diet involves excluding foods containing large amounts of purines (200 mcg), limiting the intake of salt (5-8 g), fats (fats have a hyperuricemic effect); the total protein content is normal, but with a reduced quota of animal proteins (the ratio between plant and animal proteins approaches 1:15); sufficient amount of vitamins.

The diet includes alkaline mineral waters and citrus fruits to enhance the removal of urates from the body. Food is given to the patient in uncut form, steamed or boiled in water. Vegetables and fruits are consumed raw, boiled or baked.

The total amount of free fluid increases to 2.5 l, if there are no contraindications from of cardio-vascular system. It is recommended to take liquid in the form of tea, cranberry juice, juices, alkaline mineral waters.

The diet is split, 5-6 times a day in small portions, drinking in between meals.

• Bread and flour products: wheat, rye bread, limited to puff pastry and pastry products.
• Meat and poultry: low-fat varieties, no more than 1-2 times a week, boiled. Boiling meat and poultry leads to the transfer of up to 50% of the purines contained in the products into the broth.
• Fish: low-fat varieties, 1-2 times a week, boiled.
• Dairy products: milk, kefir, yogurt, cottage cheese, sour cream, mild cheese.
• Fats: butter, vegetable oil.
• Cereals: any in moderation.
• Vegetables: in any culinary processing, salted and pickled vegetables are limited.
• Fruits and sweet dishes: any fruits and berries, fresh and in any culinary preparation; creams, jelly, marmalade, marshmallows.
• Drinks: weak tea, juices, fruit drinks, kvass, rose hip decoction, alkaline mineral waters.

Prohibited: liver, kidneys, brains, tongue, smoked meats, canned food, fatty, salted, smoked fish, canned fish, meat, fish, chicken, mushroom broths, beef, pork and cooking fat, legumes, sorrel, spinach, figs, chocolate , cocoa, strong tea, coffee.

When gout is combined with obesity, hypocaloric table No. 6e is prescribed (the amount of baked goods, cereals, easily absorbed carbohydrates, and fats in the diet is reduced).

Medication relief of gout attack.

To relieve an acute attack of gouty polyarthritis, it is used colchicine- a colchicum preparation, which is a powerful phosphatase inhibitor and inhibits the processes of cell division. It is recommended to strictly adhere to the following rules when using colchicine (Wallace S., Singer J., 1984):

• a single dose should not exceed 2 mg, and the total dose should not exceed 4 mg (first, 1 mg of colchicine dissolved in 20 ml of isotonic sodium chloride solution is administered over at least 10 minutes);
• if the patient received colchicine orally the day before, this drug should not be used intravenously; after intravenous administration of a full dose, colchicine should not be used in any form for at least 7 days;
• in the presence of kidney and liver disease, the dose of colchicine should be reduced (by 50% if creatinine clearance is below 50 ml/min). If this indicator is below 10 ml/min, colchicine is not used. In elderly patients, it is advisable to study creatinine clearance before intravenous colchicine use;
• Precautions should be taken to avoid the risk of colchicine getting into nearby tissues. The onset of action of intravenously administered colchicine is observed within 6-12 hours.

There are several regimens for using colchicine:

1) orally, 0.5 mg every hour until relief of arthritis or until the maximum permissible dose is reached - 6 mg;

2) 1.0 mg orally every 3 hours until the maximum permissible dose is reached - 10 mg;

3) safer scheme:

Day 1 - colchicine orally 1 mg 3 times a day after meals;

Day 2 - 1 mg in the morning and evening, then 1 mg per day.

Improvement usually occurs within 12 hours from the start of treatment. The effect of colchicine is extremely specific for gout (in no other arthritis does the drug have such a relieving effect as in gout). The drug is effective in 90% of patients. Most often, the lack of therapeutic effect is due to late use of the drug.

Colchicine causes side effects from the gastrointestinal tract (diarrhea, nausea, and less often vomiting), as a result of which it is necessary to reduce the dose or even discontinue the drug. Diarrhea can be persistent and painful, and to prevent it, bismuth preparations are prescribed simultaneously with colchicine.

An absolute contraindication for the use of colchicine is a combination of renal and hepatic failure, a marked decrease in glomerular filtration rate and extrahepatic biliary obstruction.

With long-term treatment of gout with colchicine, anemia and leukopenia may develop..

The toxicity and frequency of side effects of NSAIDs, which are also used to treat gout attacks, are significantly lower. Preparations of the pyrazolone (butadione, reopirin, ketazol, phenylbutazone) and indole (indomethacin, methindole) series have found widespread use in clinical practice.

To relieve acute gouty arthritis, NSAIDs are used in large doses, but even with this use they are better tolerated than colchicine. Moreover, in case of development side effects or intolerance to one of these drugs, it can be replaced with others, and a more pronounced therapeutic effect is often achieved.

Voltaren is widely used to relieve gout attacks, which is prescribed on the first day at 200 mg, and then at 150 mg/day. The advantage of the drug is its good tolerability and increasing clinical effect as the dose increases. Voltaren can also be administered intramuscularly, 3 ml 1-2 times a day, which is especially important for concomitant diseases gastrointestinal tract. The use of prolonged forms of drugs is very effective: voltaren-retard, methindol-retard, etc.

In terms of safety, taking into account the development of side effects, especially from the gastrointestinal tract, preference is given to selective COX-2 inhibitors (nimesulide, meloxicam).

Good effect The use of GCS during an acute attack has been known for a long time; this method is considered safe and is indicated when it is impossible to use NSAIDs or colchicine due to intolerance to these drugs, the presence of renal failure, and ulcerative lesions of the gastrointestinal tract. Their parenteral administration is most effective. D. Werlen (1993) showed that the effect of their administration is rapid and persistent, even when using single intramuscular doses (7 mg of betamethasone). The drugs are well tolerated, frequency adverse reactions small, isolated cases of transient hyperglycemia are possible.

GCS can be used in the following options:

1. prednisolone 40-60 mg on the first day (tablet form), followed by a dose reduction of 5 mg every other day;
2. triamcinolone IM 60 mg, repeat administration after 24 hours if necessary;
3. methylprednisolone IV 50-150 mg, and also in severe cases in the form of small pulse therapy: once 250-500 mg;
4. periarticular or intra-articular (with the mandatory exclusion of septic arthritis) administration of GCS (diprospan, hydrocortisone).

Treatment of chronic gouty arthritis.

In long-term therapy of gout, to prevent repeated attacks of polyarthritis, it is necessary to achieve a decrease in plasma uric acid levels. Anti-gout (long-term, basic) therapy is carried out in patients with frequent (3-4 times a year) attacks of arthritis and especially with chronic tophus gout and nephrolithiasis. Important indications for starting therapy for gout are also persistent hyperuricemia, even with a history of one attack of arthritis, or a reduction in the intervals between attacks.

There are currently two groups in use medicinal substances: uricosuric drugs that increase the excretion of uric acid by the kidneys, and uricodepressive drugs that reduce its synthesis.

Allopurinol(hydroxypyrazolopyrimidine, milurite) inhibits the enzyme xanthine oxidase, as a result of which the conversion of hypoxanthine into xanthine and then into uric acid is disrupted. Its content in the blood decreases, and uricosuria decreases at the same time, so there is no risk of the formation of urate stones in the urinary tract. The drug can also be used in the presence of renal pathology (but without severe renal failure). The allopurinol metabolite oxypurinol also inhibits xanthine oxidase.

Indications for the use of allopurinol are:

• reliable diagnosis of chronic gouty arthritis;
• hyperexcretion of uric acid (more than 800 mg/day - without diet and more than 600 mg - on a low-purine diet);
• kidney damage with a decrease in creatinine clearance below 80 ml/min:
• formation of tophi in soft tissues and subchondral bone;
• nephrolithiasis;
• a persistent increase in uric acid levels of more than 13 mg% in men and more than 10 mg% in women;
• contraindications to the use of uricosuric drugs;
• carrying out cytotoxic therapy or radiotherapy for lymphoproliferative diseases;
• gout not controlled by uricosuric agents and colchicine, manifested by prolonged attacks or uncontrolled hyperuricemia;
• identifying signs of gouty nephropathy.

Allopurinol is available in tablets of 0.1 and 0.3 g.

It is necessary to adhere to the following basic principles when treating gout with allopurinol:

1. It is not recommended to start therapy with allopurinol in the presence of an acute articular attack; it is necessary to stop the articular syndrome. If an attack develops during allopurinol therapy, then you can reduce the dose and not completely stop the drug.
2. To prevent acute attacks of arthritis, which sometimes occur at the beginning of taking the drug, and the occurrence of allergic and severe adverse reactions, it is recommended to start therapy with a small dose (usually 100 mg per day). A reflection of the correct selection of the dose of the drug is the rate of decrease in the level of hyperuricemia no more than 0.6-0.8 mg% or 0.1-0.6 mg/dl, or 10% of the initial figures within 1 month. therapy.
3. To prevent an acute attack of gout, when starting to take allopurinol, it is possible to use low doses colchicine or NSAIDs.
4. When allopurinol is discontinued, uric acid levels increase rapidly (within 3-4 days).
5. It should be remembered that during an attack of arthritis, the level of uric acid is usually lower than in the inter-attack period, so repeated studies of its level are required after the arthritis has stopped.

The initial dose of the drug is 50-100 mg/day, then daily the daily dose is increased by 100 mg and adjusted to 200-300 mg for mild forms of the disease and to 400-500 mg for moderate and severe forms.

The level of uric acid in the blood begins to decrease on the 2-3rd day and reaches normal levels on the 7-10th day. As uricemia decreases, the dosage of allopurinol is reduced; stable and complete normalization of uricemia usually occurs after 4-6 months, after which a maintenance dose of allopurinol is prescribed - 100 mg/day.

The reduction and decrease in the intensity of attacks, softening and resorption of tophi is observed after 6-12 months. continuous treatment with allopurinol. After long-term treatment, chronic joint manifestations may completely disappear. Treatment with allopurinol continues for many years, almost continuously.

The drug does not have a noticeable effect on gouty nephropathy. In case of insufficiency of renal function, the dose of allopurinol is determined in accordance with the clearance value of creatine: for clearance values ​​​​of more than 60 ml/min, 200 mg/day is sufficient, for clearance values ​​less than 40 ml/min daily dose should not exceed 100 mg. When creatinine clearance decreases below 10 ml/min, allopurinol intake is limited to 100 mg for 3 days. The use of higher doses may worsen chronic renal failure. This is due to the fact that allopurinol blocks purine breakdown to xanthine, the level of the latter in the blood and urine increases many times, and xanthinemia and xanthinuria can have a harmful effect on the kidneys.

Allopurinol is well tolerated; in rare cases, side effects are possible:

• allergic reactions (itching, skin rashes, allergic edema Quincke, vasculitis);
• dyspeptic phenomena;
• increased body temperature;
• acute renal failure;
• agranulocytosis;
• Steven-Johnson syndrome.

During treatment of gout with allopurinol, it is necessary to ensure diuresis within 2 liters and a slightly alkaline urine reaction to avoid the formation of xanthine stones (when urine is alkalinized, hypoxanthine and xanthine remain dissolved).

Contraindications to the use of allopurinol:

• pronounced violations liver functions,
• hemochromatosis,
• pregnancy,
• childhood(except for malignant diseases with hyperuricemia).

Clinically significant drug interactions allopurinol with other drugs:

• when combined with cyclophosphamide, bone marrow suppression is aggravated;
• with simultaneous administration of azathioprine - potentiation of immunosuppressive and cytolytic effects;
• when taken in combination with ampicillin, the frequency of skin rashes increases.

Thiopurinol- allopurinol derivative in tablets of 0.1 g.

The drug inhibits the synthesis of uric acid, inhibits glutamine phosphoribosyltransferase, is as active as allopurinol, but is much better tolerated by patients. Used in a daily dose of 300-400 mg.

Uricosurige drugs have the property of reducing tubular reabsorption of urate, resulting in increased excretion of uric acid by the kidneys.

Indications for use:

• renal (hypoexcretory) type of gout in the absence of severe gouty nephropathy;
• mixed type of gout with daily excretion of uric acid less than 2.7 mmol (less than 450 mg).

When treating gout with uricosuric drugs, the following must be taken into account. The main way to increase the excretion of urate by the kidneys is to increase diuresis. With high diuresis, the concentration of urates in the urine decreases and their tendency to crystallize decreases. Minute diuresis also increases, which contributes to an increase in urate clearance. In addition, to enhance the excretion of urates, it is necessary to alkalize the urine (for example, by taking 1 teaspoon of sodium bicarbonate daily in the morning).

Thus, to enhance the removal of urates from the body, it is necessary to take a sufficient amount of fluid (at least 2-2.5 liters per day) and alkalize urine using sodium bicarbonate and alkaline mineral waters.

Probenecid(benemide) is a derivative of benzoic acid, an analogue of phenylbutazone. Initially, it is prescribed at a dose of 0.5 g 2 times a day; later, depending on the magnitude of hyperuricemia, the dose can be increased, but not more than 2 g/day. The most commonly used daily dose is 1-2 g. A daily dose of 1 g increases the excretion of uric acid in the urine by an average of 50% and reduces uricemia. The drug should be used long-term, for a number of years.

Benemide is well tolerated, but in some cases, dyspeptic symptoms and allergic reactions (skin reactions, itching, fever) are possible.

Long-term treatment of gout with benemide is not recommended for moderate and transient hyperuricemia, reduced glomerular filtration (less than 30 ml per minute), and frequently recurring articular crises.

Benemide is contraindicated in chronic renal failure, pregnancy, hyperuricosuria (800-1000 mg per day).

Anturan(sulfinpyrazone) - available in tablets of OD g, administered orally in a daily dose of 0.3-0.4 g (in 2-4 doses) after meals, preferably washed down with milk. The uricosuric effect lasts about 8 hours. Salicylates weaken the effect of anturan. The drug is well tolerated, but exacerbation is possible chronic diseases stomach and duodenum.

Anturan also has an antiaggregation effect.

When treating gout with anturan, you must take at least 2-2.5 liters of alkaline liquid per day.

Contraindications to the use of Anturan:

• peptic ulcer stomach and duodenum,
• hypersensitivity to pyrazolone derivatives,
• severe damage to the liver and kidneys.

Benzobromarone(desuric) has a strong uricosuric effect due to inhibition of the absorption of uric acid in the proximal renal tubules. In addition, the drug inhibits enzymes involved in the synthesis of purines. Under the influence of benzobromarone, the secretion of uric acid through the intestines also increases.

The drug is available in tablets of 0.1 g, prescribed with meals, starting from 0.05 g (1/2 tablet) 1 time per day, if the urate level in the blood is not sufficiently reduced - 1 tablet per day.

Benzobromarone is well tolerated; in some cases, dyspeptic symptoms, allergic skin reactions, and diarrhea are possible. In the first days of treatment, joint pain may intensify; in these cases, NSAIDs should be taken.

When treating gout with benzobromarone, you must drink at least 2 liters of alkaline liquid per day to prevent the deposition of stones in the urinary tract.

Contraindications to the use of benzobromarone are severe liver and kidney damage.

Hipurik- micronized benzobromarone in tablets of 0.8 g. Treatment is carried out in the same way as benzobromarone.

Losartan- angiotensin II antagonist. IN last years ACE inhibitors have been shown to increase uric acid excretion. M. Nakashima (1992) found that the uricosuric effect of losartan is dose-dependent and reduces serum uric acid levels.

Using a test system, it was found that losartan acts on the urate/lactate and urate/chloride exchange systems. The IC50 of losartan for these two metabolic systems is much lower than that of probenecid, indicating that losartan has a much stronger affinity for these urate metabolic systems than probenecid and is a potent inhibitor of urate reabsorption.

On average, the expected reduction in serum uric acid levels during treatment with losartan is 1 mg/dL (60 µmol/L), i.e. 10-15% at a dose of losartan 50 mg per day (Wurzner G., 2001).

Allomaron- combination drug, containing 100 mg allopurinol and 20 mg benzobromarone; inhibits the synthesis of uric acid and increases its excretion in the urine. The combination of two drugs in allomaron - a uricodepressant and a uricoeliminator - reduces the risk side effects allopurinol and eliminate the risk of kidney stones.

Allomaron effectively reduces the synthesis of uric acid, due to which its excretion remains within normal limits (despite the use of benzobromarone in the drug). In this regard, it is not necessary to observe the precautions (drinking plenty of fluids, alkalinizing urine) necessary when carrying out therapy with uricosuric drugs to prevent the formation of stones.

With severe uricemia, the dose is increased to 2-3 tablets per day. Patients with nephrolithiasis should be advised to drink plenty of fluids and alkalinize their urine during the first 10-14 days of treatment with allomaron.

The use of allomaron allows for a greater reduction in uric acid levels than monotherapy with allopurinol (100 mg/day) or benzobromarone (20 mg/day). Allomaron at a dose of 1-3 tablets per day ensures normalization of uricemia within 3-4 weeks. in most patients with gout and hyperuricemia. Treatment lasts 3-6 months. and longer.

Allomaron is used for gout, hyperuricemia of any origin and to prevent relapses of arthritis, as well as for kidney damage and the formation of tophi.

Contraindications to the use of allomaron:

• pregnancy and lactation;
• hypersensitivity to the drug;
• age up to 14 years;

Allomaron is well tolerated. In rare cases, it causes allergic reactions, dyspeptic disorders, and a decrease in the number of leukocytes and platelets in the blood.

Local use of drugs for gout.

It is advisable to use local (on the joints) applications of anti-inflammatory ointments (Dicloran, Fastum, Dollit, Voltaren, etc.). To relieve a gouty attack, compresses with a 50% dimexide solution are used, which has a pronounced analgesic and anti-inflammatory effect (applications consist of 1 tablespoon of a 50% dimexide solution, 1 tablespoon of water and an ampule of analgin or novocaine; applied as a compress for 30-40 minutes ). The course consists of 10-20 procedures.

Physiotherapeutic treatment in the acute period of gout is limited.

Ultraviolet irradiation of the joint in an erythemal dose, started at the maximum early dates, before the appearance of swelling and redness of the joint, sometimes allows you to interrupt the beginning attack.

Use phonophoresis with calcium, diphenhydramine; iontophoresis with lithium; reflexology, acupressure, transcranial stimulation of opioid structures.

Physiotherapeutic treatment in the inter-attack period of gout includes diathermy, mud and paraffin applications. Phonophoresis with hydrocortisone has a pronounced anti-inflammatory effect. Hydrocortisone received through the procedure, due to its immunosuppressive effect, helps to weaken the inflammatory process, enhance local blood and lymph circulation, and accelerate the removal of urate crystals from the affected tissues. Phonophoresis with hydrocortisone also helps improve kidney function, remove urate from the body and reduce its level in the blood. The course of treatment is 6-8 procedures.

Thermal therapy (applications of mud, paraffin, ozokerite, combination of mud applications with inductothermy) contributes to a significant improvement in joint function, reduces pain and inflammatory processes in the periarticular tissues, and reduces the urate content in them.

Thermal treatment of gout is especially effective when chronic gouty polyarthritis is combined with osteoarthritis, and with joint deformities. The course of treatment is 6-8 procedures.

In complex treatment, it is advisable to carry out balneotherapy, use radon, hydrogen sulfide, iodine-bromine sodium chloride baths.

Balneotherapy for patients with gout is carried out in the inter-attack period. Balneotherapy helps improve the microcirculation system, have a uricosuric effect, improve trophism of tissues and synovial membranes, and improve blood supply to the tissues of affected joints. This in turn helps remove uric acid salts from the synovial membranes and tissue depots. Under the influence of balneotherapy they decrease inflammatory phenomena in the joints, the activity of lysosomal enzymes decreases, the functionality of the liver and kidneys increases, and the indicators of purine and lipid metabolism improve.

Radon baths for gout.

The main active factor in taking radon baths is a-radiation. Radon enters the body through the skin and lungs, which causes internal irradiation of the body. The decay products of radon are deposited on the patient’s skin, and an active plaque is formed, causing external irradiation of the skin. Radon baths normalize uric acid metabolism, improve liver function, have a beneficial effect on lipid metabolism, normalize blood pressure, and improve blood circulation in the tissues of affected joints. Radon baths have an analgesic, sedative, and anti-inflammatory effect. Radon baths are prescribed with a radon concentration of 1.5 kBq/l, a temperature of 36-37 ° C, lasting 10-15 minutes for two days in a row followed by a break day or three days in a row, 4 or 5 baths per week; course of treatment - 12-14 baths.

Hydrogen sulfide baths for gout.

The specific effect of these baths is due to hydrogen sulfide, which enters mainly through the skin. Hydrogen sulfide has a positive effect on the liver, which affects the state of purine and other types of metabolism. Hydrogen sulfide baths enhance microcirculation, trophic processes in joint tissues, improve cartilage nutrition, reduce the level of uric acid in the blood, and have a uricosuric effect. Hydrogen sulfide baths are prescribed with a concentration of 50-100 mg/l, temperature 36-37 ° C, duration 10-15 minutes, two days in a row followed by a day off; course of treatment - 10-12 procedures.

Contraindications to hydrogen sulfide baths for gout are:

• acute attack of gout;
• phase of incomplete remission;
• dysfunction of the kidneys, liver;
• chronic hepatitis;
• cholelithiasis and urolithiasis.

Iodine-bromine sodium chloride baths for gout have an effect on the body through skin receptors. The microelements iodine and bromine, forming a depot in the skin, partially penetrate into the humoral environment of the body. Being part of various enzyme systems, they affect metabolic processes. Sodium chloride, which is the main mineral component of iodine-bromine chloride-sodium baths, promotes the penetration of iodine and bromine into the body. Iodine-bromine baths have a positive effect on the nervous, cardiovascular, sympathoadrenal and pituitary-adrenal systems, stabilize hepatocyte membranes, improve kidney function, increase urate excretion, reduce the level of urate in the blood, and normalize lipid metabolism. Iodine-bromine baths, having anti-inflammatory, antitoxic and bactericidal effects, promote rapid cleansing and scarring of tophi, and are well tolerated by patients. Patients' pain quickly subsides, tophi decrease, and signs of inflammation decrease.

Iodine-bromine baths are indicated for patients with gout in remission, as well as when gout is combined with stage 1-2 hypertension, obesity, urolithiasis, coronary artery disease no higher than class II without heart rhythm disturbances. Iodine-bromine baths are prescribed with a sodium chloride content of 20 g/l, iodine - 10 g/l, bromine - 25 g/l; bath temperature - 37 °C, procedure duration - 10-15 minutes, two days in a row followed by a day off. If baths are well tolerated, patients are given 5 baths per week, for a course of treatment 10-12 baths.

Iodine-bromine baths in combination with hydrocortisone phonophoresis are used to treat gout in the phase of incomplete remission; hydrocortisone phonophoresis in this case reduces the risk of exacerbation during treatment, reduces the activity of inflammation and improves the functional state of the joints.

Method of complex treatment of gout using hydrocortisone phonophoresis (on the affected joints) and iodine-bromine sodium chloride baths: hydrocortisone phonophoresis (UZT-1 device) with a frequency of 880 kHz is prescribed to the area of ​​the affected joints in a continuous mode with an intensity of 0.4-0.7 W/cm2 (labile technique) 5 minutes for each field (no more than two joints per day) daily. The course of treatment is 12 procedures.

This method of complex treatment of gout is also used for gout-related obesity, spinal osteochondrosis, and urolithiasis.

Spa treatment is prescribed to patients with gout in remission with preserved functional ability of the joints. The main therapeutic factors are balneotherapy, mud therapy, drinking alkaline mineral waters, and nutritional therapy.

Physiobalneotherapy in sanatoriums and resorts is carried out against the background of ongoing treatment with anti-gout drugs.

Efferent methods of treating gout.

Currently, in the treatment of various pathological conditions of gout, methods of extracorporeal hemocorrection are widely used, which are more effective in purifying the blood of various wastes and toxic substances. When treating gout, it is preferable to use plasma exchange with extracorporeal modified autoplasma(POEMK). This method was developed based on cryoplasmasorption technology. Plasma is obtained by performing hardware plasmapheresis. Indications for POEMK:

• development of resistance to drugs that relieve articular gout attacks;
• intolerance or poor tolerability of basic therapy drugs;
• steadily progressing course of gout;
• progressive gouty nephropathy.

Patients with gout undergo plasmapheresis - 3-4 sessions every 6 months.

When performing POEMK, it is necessary to take into account the type of dyslipidemia. Thus, the use of POEMK in isolated elevated level triglycerides and very low density lipoproteins (VLDL) is inappropriate. It should be borne in mind that in familial hyperlipidemia (type lib or IV), plasma freezing and cryoprecipitate formation may worsen due to increased triglyceride levels. This significantly reduces the efficiency of removal of cholesterol and low-density lipoproteins (LDL) during plasma exchange.

Evaluation of the effectiveness of therapy is determined by a decrease in the level of uric acid in the blood serum, a decrease in the frequency of gout attacks, resorption of tophi, the absence of progression of urolithiasis, and a decrease in the need for NSAIDs, colchicine, and corticosteroids.

Prognosis for gouty arthritis generally favorable. The following are considered unfavorable prognostic factors for gout:

• development of the disease before the age of 30 years;
• persistent hyperuricemia more than 0.6 mmol/l;
• persistent hyperuricosuria more than 1100 mg/day;
• the presence of urolithiasis in combination with infection urinary tract;
• progressive nephropathy, especially in combination with diabetes mellitus and arterial hypertension.

Urolithiasis develops in 20-50% of cases, and renal failure is the cause of death in 18-25% of cases.

Joint diseases
IN AND. Mazurov

Colchicine for gout is effective medicine to stop the exacerbation of the disease. It has a number of contraindications and side effects. The drug is unsafe and can cause complications, so you should consult your doctor before starting to take the pills.

In case of acute development of gout and the inflammatory process, it is recommended to take 1 tablet 3 times a day on the first day of therapy, the preventive course involves taking 1 tablet in the evening for 12 weeks

The release form of the gout medication Colchicine is tablets. One tablet contains 0.5 or 1 mg active substance, colchicine (Colchica splendid alkaloid). Colchicine comes in the form of small white film-coated tablets.

The composition contains the following auxiliary components:

• lactose monohydrate;
• starch;
• Aerosil;
• Castor oil;
• shell components and dyes.

The drug is available in packages of 20, 40 and 60 tablets.

Pharmacological properties

The drug belongs to the drugs that affect the metabolism of uric acid in the body. pharmachologic effect is caused by a decrease in the rate of migration of leukocytes to the site of inflammation, which makes it possible to quickly and effectively stop the inflammatory process. Along with reducing inflammation, the drug reduces the rate of sedimentation of uric acid microcrystals in the joints, thereby reducing the risk of developing new exacerbations of gouty arthritis.

A feature of the treatment of gout with colchicine is the rapid action of the drug. After taking the tablet, the maximum concentration of the active substance in the blood plasma is reached after 120 minutes. Colchicine gout tablets quickly reduce symptoms. After taking the first therapeutic dose, a noticeable improvement in well-being occurs within a maximum of 4-5 hours.

Indications for use

Indications for the use of Colchicine for gout are exacerbation of gouty arthritis and prevention of disease progression.

For gouty arthritis, taking Colchicine can quickly reduce the severity pain syndrome and stop the inflammatory process.

Taking pills for gouty arthritis improves overall health within a few hours.

Colchicine can be used not only for relapse or exacerbation of gout, but also for the prevention of gouty arthritis. In addition, the medicine can be used as part of complex therapy gout, since it does not interact negatively with Allopurinol, which is used to reduce the concentration of uric acid in gout.

Contraindications and restrictions for use

The drug should be discontinued if there is an individual intolerance to it.

The drug has quite a few contraindications. These include:

• colchicine intolerance;
• lactose intolerance;
• hemodialysis;
• dyscrasia (change in composition) of blood.

If liver and kidney function are impaired, a reduction in the recommended dosages given in the instructions for the drug is indicated. Elderly patients may also be advised to reduce the dose of the drug in the first weeks of use.

The medicine is not prescribed to pregnant women; there is insufficient data on the effect of Colchicine on the body of pregnant women. This is primarily due to the fact that gout is a men's disease that affects people over 50 years of age. In women, gout occurs very rarely, and only after menopause. For the same reason, the drug is not used in pediatric practice.

How should I take Colchicine for gout?

Treatment of gout with Colchicine should be agreed with your doctor. The medicine for gout and gouty exacerbations Colchicine is usually taken according to the instructions, however, on the recommendation of the attending physician, the dosage regimen can be changed.

In case of exacerbation of gout, you should immediately take one tablet of Colchicine at a dosage of 1 mg, and then take half a tablet every three hours, or the drug at a dosage of 0.5 mg.

The maximum daily dose for exacerbation of gout is 6 mg of the drug, for the prevention of relapses – 1.5 mg.

Treatment of exacerbation is carried out until the symptoms subside. Then a three-day break is taken and the course can be repeated if the inflammatory process does not go away. If the inflammation has been successfully stopped, treatment is continued after a few days, taking 0.5 mg of Colchicine three times a day.

If a gout attack is accompanied by sharp pain, the doctor will determine how to take Colchicine for gout. As a rule, a fairly short course of treatment with large doses of the drug is practiced. Prophylactic medication is taken for three months.

The tablet must be taken immediately after a meal with plenty of water. The medicine should not be chewed; the tablet should be swallowed whole.

Side effects and overdose

When taking the drug, the following may occur: unpleasant symptoms like stomach pain and diarrhea

The use of Colchicine for gout may have the following side effects:

• nausea and vomiting;
• stomach ache;
• diarrhea;
• muscle weakness;
• stomach bleeding;
• general weakness;
• skin rash;
• seizures;
• alopecia (baldness);
• peripheral neuritis;
• hematopoietic disorders;
• bone marrow suppression.

If you are intolerant to the medication, symptoms of an allergic reaction appear. As a rule, this is manifested by hives, swelling of the skin, and severe itching. Long-term use of large doses of the drug may adversely affect liver and kidney function.

If any alarming symptoms appear, you should consult a doctor. You should definitely call " ambulance» when acute pain in the stomach or bloody diarrhea.

In case of an overdose of the drug, convulsive seizures may occur, internal bleeding may develop, loss of consciousness and suppression of kidney function may occur. In this case, it is necessary to call emergency medical assistance as soon as possible.

The drug should be prescribed with caution to elderly patients. People whose bodies are severely weakened by recent illnesses are advised to refrain from taking the drug. The following conditions require a reduction in dosage or taking the medication under the supervision of a physician:

• heart diseases;
• impaired renal and liver function;
• respiratory failure;
• disorders of the bone marrow.

Small doses of the drug do not affect the work nervous system. During an exacerbation, large doses of Colchicine are prescribed, which can negatively affect the reaction rate, so you should refrain from driving.

Important! Colchicine is incompatible with alcohol; alcohol should be completely avoided during treatment.

Before you start taking a medication, you should carefully study drug interactions.

1. Thiazide diuretics often increase plasma uric acid levels. When taken simultaneously, the effect of Colchicine will be weak.
2. Colchicine interferes with the absorption of vitamin B12.
3. Concomitant use with Cyclosporine is not recommended, as this increases the risk of muscle damage, which can cause hypotonicity or cramps.
4. Erythromycin increases the activity of Colchicine. This is dangerous due to the development of intoxication of the body due to high concentrations of Colchicine in the blood.
5. Colchicine should be taken with caution concomitantly with non-steroidal anti-inflammatory drugs due to the risk of leukopenia.

The drug can be taken with other medicines designed to reduce uric acid levels in the body (Allopurinol). The exact dosage, dosage regimen and duration of treatment are determined by the doctor individually.

Cost and analogues

Colchicum-Dispert tablets are taken orally, dosage form washed down with water, dosage for an acute attack - 2 tablets at the beginning of therapy, then every two hours another 1-3 tablets

Colchicine has recently been difficult to find in Russian pharmacies. The average cost of the drug is 500 rubles per pack of 20 tablets. The drug is sold strictly according to a prescription, so it must be prescribed by a doctor.

Complete analogues of the drug are tablets Colchicum-Dispert, Colchimin, Colchicein. These drugs have the same composition, release form, dosage and application features. Medicines with a different composition, but similar action does not exist. If Colchicine is not suitable for the patient, it is necessary to consult with a doctor about the possibility of changing the drug. If the patient is intolerant to this substance, a special therapeutic diet and Allopurinol may be indicated.

Please note that the drug contains an alkaloid, which can cause severe allergic reaction. In addition, the tablets contain lactose monohydrate, so use is prohibited if you are lactose intolerant.

If allergy symptoms appear, you should stop taking the pills and consult your doctor about a further gout treatment regimen.

Gout is one of the diseases of the joints, accompanied by the deposition of uric acid salts in them. The main causes of pathology include: a sedentary lifestyle, alcohol abuse, hormonal changes in women after menopause. Systematic use of the gout medication Colchicine will help alleviate the patient's condition.

Colchicine tablets for gout are made from the extract of a plant belonging to the deciduous family - autumn colchicum. The medicine inhibits the activity of purine compounds and helps remove excess urea.

The drug is produced exclusively in tablets. One tablet contains 1 mg of active ingredient.

The mechanism of action of the drug on the body

Treatment of gout with Colchicine helps to eliminate pain and swelling of tissues in the affected area in a short period of time. The therapeutic effect of the drug is achieved by reducing the level of urea in the body. The drug is most effective at an early stage of the disease.

The maximum concentration of the drug in the blood is reached approximately 10 hours after taking the tablets. After the specified time, visible relief occurs.

For gout

If a patient has gout, the medicine is used to relieve and prevent attacks of the disease. There are other indications for prescribing the medication:

• the presence of Behçet's disease in the patient;
• some ;
• scleroderma;
• the patient has Mediterranean fever.

Contraindications to medication use

There are certain contraindications for use pharmaceutical drug. The product is not recommended for use in the presence of the following pathologies:

• severe kidney and liver diseases. A large amount of the active substance is concentrated in these organs;
• bone marrow pathologies;
• individual sensitivity to the components of the product;
• severe pathologies of the digestive tract;
• the presence of a purulent inflammatory process in the body.

The medicine is not recommended for women expecting a child. The drug is contraindicated during breastfeeding. Tablets should not be taken by people who are addicted to alcohol. Alcohol interacts poorly with Colchicine.

The following side effects may occur when using the medicine:

Most often, side effects occur when the recommended dose of the drug is exceeded. If any of the unwanted effects listed above occur, you should consult your doctor.

Scheme of use

If gout worsens, you should start taking Colchicine as soon as the first signs of discomfort appear. Duration therapeutic treatment, as a rule, is 4 days.

In case of an acute attack of gout, take one tablet three times a day on the first day. It is recommended to take the medicine with plenty of water. In subsequent days, it is recommended to reduce the dosage of the medication. On the second and third days you should take one tablet twice a day. The next day you need to take one tablet shortly before bed.

In the presence of sharp pain You are allowed to take one tablet of Colchicine at intervals of two hours throughout the day. This measure will eliminate pain.

To prevent a gout attack, one tablet of medication is taken once a day, at night. The duration of use of the medication in this case usually does not exceed three months.

In order to increase the effectiveness of the medicine for gout, you should adhere to strict guidelines. With gout, it is recommended to eat small portions. The amount of salt and fats of animal origin in the diet should be reduced.

Without changing taste preferences, complete recovery is usually impossible.

In the presence of gout, the basis of the diet should be the following products:

• boiled meat;
• fish baked in the oven;
• walnuts;
• eggs;
• vegetable dishes;
• dairy products;
• fruits.

• offal dishes;
• jellied fish;
• dishes prepared from fatty meats, legumes;
• alcoholic drinks;
• spicy sauces and savory spices;
• smoked meats;
• fried food;
• salted vegetables.

Reviews

Alexey Sergeevich, 67 years old: « I live in a remote village, so I'm used to being treated folk remedies. I read that onion decoction relieves pain in the joints. I took 150 ml twice a day for three weeks. But the visible effect, unfortunately, did not notice. I decided, as an exception, to visit the city hospital. The doctor discouraged me by diagnosing gout.

The specialist prescribed me the drug Colchicine. I took it exactly according to the attached instructions. As a result, my health improved markedly. It is not for nothing that in numerous reviews they warmly write about Colchicine!

Alevtina Ivanovna, 55 years old: « Previously, I took the medicine Colchicum-Dispert. It contains an extract obtained from colchicum seeds and additional ingredients. The Austrian drug is of excellent quality and works quickly. But the medicine has a significant drawback: high cost. Therefore, when taking a preventive course, I decided to independently replace it with cheaper Colchicine. Unfortunately, there is no time to visit a doctor. I hope that the analogue will be no worse than Colchicum-Dispert.”

Anna Ivanovna, 65 years old: « I am very pleased with the drug Colchicine. No side effects were found with its use. At the same time, I applied an ointment made with butter to the affected area.

The recipe for its preparation is extremely simple: you need to take the same amount of alcohol and oil. First, melt the butter in a frying pan. Then alcohol is added to the resulting mass. After it has completely evaporated, the mixture must be cooled and transferred to a separate container. I rubbed medicinal ointment into the sore spot during gout attacks twice a day.”

Mikhail Yurievich, 70 years old: « Painful sensations in the legs disappeared approximately 12 hours after the first application of Colchicine. Now I take the medicine according to a simple regimen. To prevent an attack of the disease, I take one tablet of the medication at night for a month. I haven’t experienced an exacerbation of gout in a long time! I think I owe this to Colchicine!”

Elena Ivanovna, 66 years old: « Took medicine as prescribed by the doctor. When taking the medication, there was slight nausea, which disappeared fairly soon. Pain and inflammation medicine shoots great. But I don’t recommend getting too carried away with it: kidney and liver function may worsen. The drug must be taken under the supervision of a doctor. Self-medication in this situation is unacceptable. After all, the drug can increase blood pressure and lower body temperature."

Conclusion

Colchicine is effective in acute attacks of gout. To increase the effectiveness of the product, it is recommended to reduce the consumption of easily digestible carbohydrates and foods rich in animal protein.

In contact with

And to prevent its exacerbations, especially during the first few months of treatment with allopurinol or agents that promote the removal of uric acid. In this capacity, there is still no generally accepted alternative to colchicine.

In acute gout, colchicine produces an impressive response, most likely due to the reduction in inflammation caused by urate crystals. This is achieved by running several various mechanisms, including a decrease in leukocyte mobility. It must be understood that among these mechanisms there is nothing similar to analgesia, just as there is neither a decrease in the concentration of uric acid in the serum, nor an increase in its excretion from the body. In addition, colchicine has an antimitotic effect.

In acute gout attacks, treatment with colchicine should be started as early as possible., and manifestations of its action can be detected within the first 12 hours.

UK recommended dose of colchicine for acute gout- first 1 mg orally, then 0.5 mg every 2-3 hours until pain relief or until symptoms of side effects of colchicine appear on the organs gastrointestinal tract. The total dose should not exceed 6 mg. If it is necessary to repeat the course, you must wait at least 3 days without taking colchicine.

Many British rheumatologists consider this dosage to be excessive and suggest prescribing no more than 0.5 mg of colchicine 3 (three) times a day for acute gout. Due to the surprising lack of side effects, some authors regard low-dose colchicine treatment as an alternative to previous treatments and even as the therapy of choice.

In the USA, the recommended first dose is 1.2 mg, then 0.6 mg after 1 hour. 1.8 mg is considered the maximum dose of colchicine that can be taken to relieve an acute attack of gout within one hour.

Other dosage regimens for colchicine are also offered in the United States. They range from low dose (1.2 mg + 0.6 mg once) to high dose (1.2 mg + 0.6 mg every 6 hours) and at the same time, they give approximately the same result in relation to the underlying disease (acute gout), but the low dosage regimen is accompanied by significantly fewer side effects.

When colchicine is prescribed while taking strong inhibitors of the cytochrome P450 isoenzyme CYP3A4, or such drugs are known to have been prescribed in the last 2 weeks before starting colchicine treatment, the US recommendation is to halve the colchicine dosage indicated in the previous paragraph to 0.6 mg and 0.3 mg, respectively. When taking moderately strong CYP3A4 inhibitors, it is recommended to limit yourself to one dose of colchicine 1.2 mg, and when taking P-glycoprotein inhibitors - one dose equal to 0.6 mg. You can repeat the course only after 3 (three) days.

Previously, colchicine was given intravenously slowly in an amount of 1-2 mg over 2-5 minutes; supplements, if necessary, were 0.5-1.0 mg every 6 hours, but with the condition that the total dose of colchicine did not exceed 4.0 mg in 24 hours and when this maximum dose was reached, the next administration of colchicine was allowed no earlier than 7 days later.

Although intravenous administration the drug is effective, colchicine should not be used intravenously due to the risk of serious and sometimes even fatal side effects. Currently, intravenous administration of colchicine is not recommended in many countries.

In Great Britain Colchicine is also used to prevent acute gout: 0.5 mg orally 2-3 times a day.

Colchicine for acute gout and LIVER failure:

Although in chronic liver failure the clearance of colchicine can be significantly reduced, patients with liver cirrhosis tolerate long-term oral colchicine 0.6 mg twice daily quite well.

In the United States, the treatment of acute gout does not even use a dose reduction of colchicine for people with liver failure, but close monitoring of the patient is recommended to diagnose signs of side effects of colchicine. Treatment courses of the drug for severe liver failure should not be repeated more often than after 2 weeks, or other treatment options should be considered.

Colchicine for acute gout and RENAL failure:

In the UK, a reduction in the dose of colchicine or an increase in the interval between doses is suggested if the creatinine clearance is 10-50 mL/min, and if the clearance is less than 10 mL/min, colchicine is considered contraindicated.

In the USA, it is accepted that there is no need to reduce the dose if there is a slight or moderate decrease in creatinine clearance (30-80 ml/min). With a pronounced decrease in renal function (less than 30 ml/min), the dose of colchicine is also not adjusted, but courses of treatment are carried out no more often than once every 2 weeks. In patients on dialysis, the total recommended dose of colchicine should be reduced to a single dose (0.6 mg) and should not be repeated more than every 2 weeks.

As recommended above, the amount of intravenously administered colchicine should be halved when the creatinine clearance is 10-50 mL/min, and when the clearance is up to 10 mL/min, colchicine is contraindicated. (This is just a note, since intravenous colchicine has already fallen out of use almost everywhere).

Colchicine is NOT prescribed for either hepatic or renal failure if the patient is taking P-glycoprotein inhibitors or strong inhibitors of the cytochrome P450 isoenzyme CYP3A4.