Which action of colchicine would the nurse include when teaching a patient newly diagnosed with gout

The most commonly prescribed treatment for a gout attack is an anti-inflammatory painkiller, although not everyone is able to take this kind of medicine. Colchicine is an alternative treatment for gout attacks for those people who cannot take anti-inflammatory painkillers. Colchicine works by reducing the number of white blood cells which travel into the inflamed areas. Colchicine helps break the cycle of inflammation and reduces the swelling and pain of the gout attack.

Gout causes attacks of painful inflammation in one or more of your joints. It is caused by a build-up of a naturally occurring chemical in your blood, called uric acid (urate). From time to time, the level of uric acid in your blood may become too high and tiny grit-like crystals may form, which typically collect in your joints and tendons. The crystals irritate the tissues of the joint to cause inflammation, swelling and pain.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking colchicine it is important that your doctor knows:

• If you are pregnant, trying for a baby or breastfeeding.
• If you have any problems with the way your heart or liver works, or any problems with the way your kidneys work.
• If you have any problems with your digestive system.
• If you have a blood disorder.
• If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
• If you have ever had an allergic reaction to a medicine.

• Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about colchicine and will provide you with a full list of the side-effects which you may experience from taking it.
• You must take colchicine exactly as your doctor tells you to. Most doctors will recommend that when a gout attacks starts, you should take one tablet 2-4 times a day until the pain eases. It is important that you do not take more than 12 tablets of colchicine as a course of treatment during any one gout attack. It is also important that you leave at least three days between courses of colchicine. If you find you are having frequent attacks of gout, please let your doctor know about this.
• If you have recently been prescribed a medicine to prevent gout attacks (such as allopurinol, febuxostat, or sulfinpyrazone) and you have been given colchicine to prevent a flare-up attack of gout, the usual dose for this is one tablet twice each day.
• Take colchicine tablets with a drink of water.
• If you forget to take a dose, take it as soon as you remember unless it is nearly time for your next dose, in which case leave out the missed dose. Do not take two doses together to make up for a forgotten dose. 

• Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress.
• Do not drink grapefruit juice while you are on colchicine. This is because grapefruit juice increases the risk that you will experience side-effects from the colchicine.
• Colchicine tablets are taken in short courses of treatment to relieve the pain of a gout attack. If you have frequent attacks of gout, let your doctor know as they may prescribe another medicine for you to take every day to help prevent the attacks from occurring.
• There are a number of lifestyle changes that you can make to help reduce the risk of having a gout attack. These include losing weight (if you are overweight), eating a healthy diet and not drinking much alcohol or sugar-sweetened soft drinks. Your doctor will advise you about the changes which could benefit you.
• Never take more than the prescribed dose. Taking too much colchicine can cause serious problems. If you suspect that someone has taken an overdose of colchicine or has swallowed some by accident, you must contact a doctor straightaway. Alternatively, go to the accident and emergency department of a local hospital. Do not delay. Take the container with you, even if it is empty. This is so the doctor knows what has been taken.

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with colchicine. You will find a full list in the manufacturer's information leaflet supplied with your medicine. Speak with your doctor or pharmacist if any of the following continue or become troublesome.

If you experience any other symptoms which you think may be due to the tablets, speak with your doctor or pharmacist for further advice.

• Keep all medicines out of the reach and sight of children.
• Store in a cool, dry place, away from direct heat and light.

Gout develops in some people who have high levels of uric acid from the breakdown of purines — natural chemicals found in every cell of your body and in many foods, especially red meat, organ meats, certain seafoods, sugary sodas and beer.

When uric acid builds up, either because the kidneys don’t excrete it the way they should or from consuming too many from a high-purine diet, it can form needle-like crystals that lodge in joints, causing sudden, severe pain and swelling.

Gout attacks usually peak after 12 to 24 hours, then slowly go away on their own, whether they’re treated or not. You may have only one gout attack in your lifetime or one every few years. Recurrent gout attacks that aren’t treated may involve more joints, last longer, and become increasingly severe over time. Some people eventually develop tophi, large masses of uric acid crystals that form in soft tissues or bones around joints and may appear as hard lumps.

Risk Factors

You’re more likely to develop gout if you:

• Eat lots of purine-rich foods, including red meat and some kinds of fish, especially scallops, sardines and tuna, though the health benefits of eating fish likely outweigh any gout risk.
• Consume food and drinks sweetened with high-fructose corn syrup or drink excessive amounts of alcohol, especially beer.
• Are overweight, leading your body to produce more uric acid and to have a harder time eliminating it.
• Have a family history of gout.
• Have certain chronic conditions, including diabetes, obesity and heart or kidney disease.
• Take high blood pressure drugs, such as diuretics and beta blockers.
• Have an imbalance in your microbiome, the trillions of bacteria, viruses and fungi that live in your gut and regulate the immune system. The microbiome is implicated in most inflammatory diseases, including arthritis.

Diagnosing Gout

Your medical history, a physical exam and  tests can help diagnose gout. Your doctor will also want to rule out other reasons for your joint pain and inflammation such as an infection, injury or other type of arthritis. Tests you might have include:

• Joint fluid analysis. This is best way  to diagnose gout. Your doctor withdraws fluid from the painful joint(s) and examines it under a microscope for uric acid crystals.
• Blood test to check uric acid levels. However, many people who have high blood uric acid never develop gout, and some people with gout have normal uric acid levels.
• Imaging tests, such as X-rays, ultrasound, magnetic resonance imaging and dual-energy computerized tomography, which helps visualize uric acid crystals in joints.

Treatments

The treatment plan you and your doctor choose for your gout depends on the frequency and severity of your symptoms and your personal preference.

• Lifestyle changes. For some people, weight loss, if needed, and a Mediterranean diet or DASH diet  may help prevent gout attacks. For decades, doctors told gout patients to limit red meat (beef, pork, lamb and organ meats) and alcohol, but it’s now known that an overall healthy eating plan is far more effective and has added benefits for the heart — a common concern in people with gout. One study of nearly 45,000 men found that those who ate a typical American diet — red meat, French fries, sweets and alcohol — had a 42% greater chance of developing gout than those eating a DASH diet. Eating the low-sodium DASH diet, with an emphasis on fruits, veggies, nuts, whole grains and other whole, unprocessed foods, reduced uric acid levels and gout risk significantly.
• Anti-inflammatories. When you’re in the midst of an attack, you want to stop it as fast as possible. Doctors are likely to recommend a brief course of:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil) and naproxen (Aleve), which are available over the counter or in stronger prescription versions. NSAIDs are generally prescribed for people under 65 who don’t take blood thinners or have a history of bleeding, because NSAIDs can cause ulcers and intestinal bleeding.
  • Colchicine, a prescription anti-inflammatory relieves gout pain but may have unpleasant side effects like nausea, diarrhea or vomiting. Lower doses are as effective as higher doses and produce fewer side effects.
  • Corticosteroids — also effective at bringing down inflammation quickly but with potentially serious side effects.
• Uric acid-lowering drugs. If you have several gout attacks a year, tophi or signs of joint damage on X-rays, your doctor may suggest taking drugs to lower uric acid and prevent further complications. According to the American College of Rheumatology’s (ACR) 2020 gout guidelines, allopurinol is the first choice for all patients. Febuxostat (Uloric) may be considered for some patients who cannot take allopurinol, but it carries a higher risk of heart-related death. The ACR also recommends trying a treat-to-target approach for gout, in which you and your doctor decide on a goal — usually less than 6 mg/dL blood level of uric acid — and adjust your medication and other treatments until you reach it.

Stigma and Mental Health

Gout has for centuries been associated with excess and is the butt of innumerable jokes. That stigma, along with fear of another painful flare, can increase stress and contribute to more inflammation in your body. Like other forms of arthritis, inflammation in gout is associated with a slightly increased chance of depression, especially in people who have frequent flares.

If you feel down or discouraged, don’t be embarrassed to talk about gout to your friends and family. And keep in mind that regular exercise, restorative sleep and healthy food can go a long way toward improving your mood. The better your mood and outlook, the more able you’ll be to manage gout.