- Anti-Gout Meds:
-
Allopurinol
-
Colchicine
-
Indomethacin
-
Probenecid
- Sulfinpyrazone
- Discussion:
- inflammatory response to MSU crystals can be interrupted w/ joint rest,
anti-inflammatory drugs,
or administration of
colchicine;
-
colchicine: for all pts w/ gout, whether it is primary or secondary, it removes factors that commonly precipitate attacks;
- Acute Treatment:
-
NSAIDS:
indomethacin
-
colchicine: prophylactic administration may reduce frequency of multiple attacks;
-
steroids may be indicated if NSAIDS and colchicine cannot be given;
- contra-indicated medications:
allopurinol and
probenecid may worsen symptoms during acute attack;
- these medications may cause precipitation of urate if given during the acute attack;
- Recurrent Attacks:
- requires reduction of miscible pool of urate;
- goal is to reducing serum urate concentrations to less than 6.0 mg /dl (360 µmol / lit);
- if trophi are present, then uric acid level needs to be lower than 5.0 mg / dl (300 µmol per liter)
- need to determine whether pt w/ recurrent gouty episodes is:
- over producer (10% of primary gout);
-
allopurinol (xanthine oxidase inhibitor) is indicated in patients with increased urate production
- uricosuric drugs (probenecid) are contraindicated in these type patients;
- underexcreter of
uric acid (90% primary gout) or ....
- treated with
probenecid, sulfinpyrazone, or
allopurinol;
- for pts w/ normal urinary urate excretion, then use
probenecid;
- blocks renal resorption of uric acid, thus increasing net excretion;
- probencid is contraindicated for pts w/ history of renal stones or elevated urinary urate excretion rates;
- alternatively, allopurinol is also effective for these patients as well;
- Chronic Gout:
-
Allopurinol
- administered on long-term basis to pts w/ gout to block purine degradation;
- inhibits xanthine oxidase which increases blood levels of xanthine and hypoxanthine which are excreted in urine;
- Management of Trophi:
-
allopurinol can dissolve these masses;
- trophi can be located in soft tissue or bone;
- in bone, they form well demarcated cysts w/o adjacent osteoporosis;
- aspirated fluid will usually demonstrate birefringent crystalloids
- surgery is usually not required,
& drainage with ATB is not required unless there is a concomitant infection;
Systemic steroid therapy for acute gout: a clinical trial and review of the literature.
