Gout Treatment

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Gout

  • Acute gout is treated with
    • nonsalicylate NSAIDs – Indomethacin
    • colchicine.
  • Chronic gout is treated with the
    • uricosuric agent – which increases the elimination of uric acid
      • probenecid
      • sulfinpyrazone
    • drug that inhibits uric acid production.
      • Allopurinol
      • Febuxostat
  • Colchicine
    • alkaloid with anti-inflammatory properties
    • used for relief of inflammation and pain in acute gouty arthritis.
    • Onset of action within  12–24 hours after oral administration.
    • prevents polymerization of tubu- lin into microtubules
    • inhibits leukocyte migration and phagocytosis
    • inhibits cell mitosis.
    • Adverse effects after oral administration
      • occur in 80% of patients
      • nausea, vomiting, abdominal pain
      • particularly diarrhea (MCQ)
    • IV administration
      • reduces the risk of GI disturbances
      • provides faster relief (6–12 h)
      • increases the risk of sloughing skin and subcutaneous tissue.
      • Higher doses may (rarely) result in liver damage and blood dyscrasias.
  • NSAIDs
    • indomethacin has been the NSAID most often used to treat acute gout attacks; the use of naproxen and sulindac is increasing.
    • NSAIDs are preferred to the more disease-specific colchicine because of the diarrhea associated with the use of colchicine. (MCQ)
  • Uricosuric agents
    • Probenecid
      • organic acid that reduces urate levels
      • act at the anionic transport site in the renal tubule to prevent reabsorption of uric acid. (MCQ)
      • Used for chronic gout,often in combination with colchicine.
    • Uricosuric agent undergo rapid oral absorption.
    • inhibit the excretion of other drugs that are actively secreted by renal tubules
      • penicillin, NSAIDs, cephalosporins, and methotrexate (MCQ)
      • Dose reduction of these drugs may be warranted.
    • Increased urinary concentration of uric acid may result in the formation of urate stones (urolithiasis). (MCQ)
    • This risk is decreased with the
      • ingestion of large volumes of fluid
      • alkalinization of urine with potassium citrate.
    • Low doses of uricosuric agents and salicylates inhibit uric acid secretion
    • Aspirin is contraindicated in gout. (MCQ)
    • Common adverse effects
      • GI disturbances
      • Dermatitis
      • blood dyscrasias.
  • Allopurinol
    • used to treat chronic, tophaceous gout
    • because it reduces the size of the established tophi (MCQ)
    • colchicine is administered concomitantly during the first week of therapy to prevent gouty arthritis.
    • inhibits the synthesis of uric acid by inhibiting xanthine oxidase (MCQ)
      • xanthine oxidase converts hypoxanthine to xanthine and xanthine to uric acid.
      • Allopurinol is metabolized by xanthine oxidase to alloxanthine, which also inhibits xanthine oxidase.
    • Allopurinol also inhibits de novo purine synthesis.
    • Adverse effects
      • Commonly produces GI disturbances and dermatitis.
      • Rarely causes hypersensitivity, including fever, hepatic dysfunction, and blood dyscrasias.
      • Allopurinol should be used with caution in patients with liver disease or bone marrow depression. (MCQ)
  • Febuxostat
    • a new xanthine oxidase inhibitor. (MCQ)
    • Although it is structurally unrelated to allopurinol, it has the same indications as those of allopurinol. (MCQ)
    • The same drug interactions with 6-mercaptopurine, azathioprine, and theophylline apply
    • Its adverse effect profile is similar to that of allopurinol.

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