- 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;
- vitamin C:
- 500 mg of vitamin C qd may reduce serum uric acid by 0.5 to 0.7 mg/dL
- ascorbic and uric acid are reabsorbed through ion-exchange in the proximal renal tubules;
- these molecules compete with each other to be reabsorbed, and uric acid loses;
- references:
- Effect of Oral Vitamin C Supplementation on Serum Uric Acid: A Meta-analysis of Randomized Controlled Trials
- What’s New With Gout?
- Vitamin C intake and the risk of gout in men: a prospective study
- The effects of vitamin C supplementation on serum concentrations of uric acid: results of a randomized controlled trial.
- Vitamin C intake and serum uric acid concentration in men
- 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;
- references:
- Systemic steroid therapy for acute gout: a clinical trial and review of the literature.
- Local ice therapy during bouts of acute gouty arthritis.
- 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;
- Uloric
- references:
- Relation between adverse events associated with allopurinol and renal function in patients with gout.
- 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
Dropping Acid
Systemic steroid therapy for acute gout: a clinical trial and review of the literature.