For patients with advanced disease, tophi can be resolved, joint function improved, and renal dysfunction arrested. Gout is generally more severe in patients whose initial symptoms appear before age 30. Complications include obstruction and infection, with secondary tubulointerstitial disease. Untreated progressive renal dysfunction, usually related to coexisting hypertension, diabetes mellitus, or some other cause of nephropathy, leads to further impairment in the excretion of urate, accelerating the pathologic process in the joints, and is the greatest threat to life. A preventive program should aim to avert both the disability resulting from erosion of bone and joint cartilage and the renal damage.
Specific treatment depends on the stage and severity of the disease.
Coexisting hypertension, hyperlipidemia, and obesity should be treated. The response to colchicine is usually dramatic. Joint pains generally begin to subside after 12 h of treatment and cease within 36 to 48 h. The dose of colchicine is 1 mg po q 2 h until a response is obtained or until diarrhea or vomiting occur. 48 h. Treatment often causes diarrhea.