Hyperuricemia is a metabolic disorder caused by disorders of purine metabolism and is an early stage of gout. Gout is a monosodium urate deposition-induced crystal arthritis that induces local inflammatory responses and tissue destruction, directly associated with HUA due to disorders of purine metabolism. Gout and hyperuricemia are staged into asymptomatic hyperuricemia, acute onset of gout, intermittent gout, chronic gout arthritis, and gouty nephropathy.
At present, the drugs for the treatment of hyperuricemia and gout are mainly drugs that inhibit uric acid production (such as allopurinol, non-bustastat, etc.), drugs that promote uric acid excretion (such as benzbromomarone, etc.), drugs used during acute attacks of gout (non-steroidal anti-inflammatory drugs, colchicine, glucocorticoids), uric acid oxidase (labuli enzyme, prikehi, pergolotase), alkalized urine drugs (sodium bicarbonate, citrate preparations) and so on.
Colchicine, NSAIDs, and glucocorticoids can be used during acute gout attacks to rapidly control acute inflammatory responses, relieve joint symptoms and signs, and prevent further episodes and joint damage; intermittent treatment with uric acid-lowering drugs in gout can maintain blood uric acid within the normal range, prevent the onset of acute attacks and prevent the formation of gout stones, and prevent the progression of chronic gout arthritis; uric acid-lowering drugs (including drugs that inhibit uric acid production and promote uric acid excretion) and alkalizing urine drugs can be used in chronic stages of gout Gout nephropathy can be selected with uric acid-lowering drugs, alkalizing urine drugs, and it is recommended to drink more water.
So, can painkillers (mainly nonsteroidal anti-inflammatory drugs, glucocorticoids) be taken with uric acid-lowering drugs?
01 From the perspective of the acute onset of gout:
During the acute onset of gout, anti-inflammatory drugs such as nonsteroidal anti-inflammatory drugs and glucocorticoids are used as soon as possible for the purpose of controlling joint inflammation, but uric acid-lowering drugs should not be used at this stage unless uric acid-lowering drugs have been taken continuously.
Because uric acid-lowering drugs not only have no anti-inflammatory and analgesic effect in the acute stage, but also reduce uric acid crystals in the tissues and blood uric acid drop too quickly, prompting the surface of tophi in the joint to dissolve, forming insoluble crystals and aggravating the inflammatory response, causing acute attacks of gouty arthritis. It is recommended to start uric acid-lowering drug therapy 2-4 weeks after complete remission of the acute onset of gout. It can be continued for use during the remission period and the user has been in acute onset. Acute onset of gout who are taking uric acid-lowering drugs are not advised to discontinue uric acid-lowering drugs.
02 From the initial stage of uric acid-lowering therapy:
After patients with gout begin to take uric acid-lowering drugs, fluctuations in blood uric acid levels can cause tophi or urate crystals inside and outside the joint to dissolve, which may lead to recurrent attacks of gouty arthritis.
At the beginning of uric acid reduction therapy (3-6 months), the blood uric acid level can be significantly reduced, about 12-61% of patients can have repeated attacks of gout, continue treatment for 8-12 months, and the frequency of gout attacks can be significantly reduced. Small-dose NSAIDs or glucocorticoids are initial uses to prevent recurrent gout episodes of uric acid-lowering therapy (up to 3 to 6 months).
In the early stage of uric acid-lowering therapy in gout patients, for colchicine intolerance, small-dose NSAIDs are recommended as second-line drugs to prevent gout attacks, and small doses of NSAIDs during uric acid-lowering therapy can significantly reduce the frequency of gout attacks; intolerance to colchicine and nonsteroidal anti-inflammatory drugs or contraindications, such as chronic renal insufficiency, small doses of glucocorticoids (prednisone ≤ 10mg/d) are recommended to prevent gout attacks, and small doses of glucocorticoids can significantly reduce the frequency of gout attacks. Efficacy is comparable to that of nonsteroidal anti-inflammatory drugs, but slightly lower than colchicine.
In addition, it is recommended to start uric acid-lowering drugs in small doses and increase the dose slowly to avoid or reduce the risk of acute onset of gout in the initial treatment of uric acid-lowering drugs.
As can be seen from the above, painkillers (mainly nonsteroidal anti-inflammatory drugs, glucocorticoids) can be taken together with uric acid-lowering drugs.