Prophylactic Treatment for Flares
Anti-inflammatory/analgesic therapy may be used for prophylaxis during the time between flares (the intercritical periods). However, these do not cure gout or take the place of other medications that lower the amount of uric acid in the body. They deter or relieve the pain of gout attacks.
Prophylactic treatment is recommended as a transition to long-term urate-lowering therapy. A 2004 study reported good results with use of prophylaxis for 6 months during the initiation of urate-lowering therapy. The long-term use of prophylactic treatment may prevent the inflammation and/or pain associated with acute flares but will not affect serum urate levels or prevent the formation and deposition of crystals. Thus, such treatment does not work against the underlying cause of gout and the source of its destructive aspects.
As the disease progresses, the interval of the intercritical period decreases. During the intercritical period, crystals may be found in those asymptomatic joints and may potentially contribute to further joint damage. In fact, some clinical evidence suggests that acute gout is an effect superimposed on joints in which urate crystals and low-grade chronic inflammation have previously developed, perhaps without clinical manifestation.
The image below shows a subject with a previous diagnosis of gout who presented complaining of progressively limited mobility in the knee joint. Gout was not the suspected etiology until this MRI revealed tophi, and resultant joint damage.
The highlighted lesions are identified as tophi and the case serves as an example of how hidden damage or hidden deposition can continue to occur silently in hyperuricemic patients.