Fransiska MC

Bag FKK-UJ
 Gout is a disorder caused by the tissue accumulation
of excessive amounts of uric acid, an end product of
purine metabolism.
Gout results from deposition of uric acid crystals in
joint spaces, leading to an inflammatory reaction that
causes intense pain, erythema, and joint swelling.
Hyperuricemia An elevated level of uric acid

Gout = Hyperuricemia ??
 Podagra Severe pain, swelling, erythematosus & warmth
in the affected joint
Monoarticular (esp. in metatarsophalangeal & knee joints)
Mild fever may be present
hyperuricemia
 Signs & symptomps
Laboratory test
Serum uric acid
WBC count (neutrophils)
Monosodium urate crystals in synovial fluid
Radiograph
Achieving rapid and effective pain relief

Maintaining joint function

Preventing disease complications

Avoiding treatment related adverse effects

Improving quality of life

 Lifestyle modification
Low-purine diet
Avoid drugs that may cause or aggravate hyperuricemia
 HYPERURICEMIA in GOUT
Xanthine
NSAID oxidase inhibitor
GOUT attack

Corticosteroid Uricosuric drugs

Colchicine Pegloticase

IL-1 inhibitor Miscellanneous

agents
 First line therapy for acute attacks of goutty arthritis
excellent efficacy & minimal toxicity (short-term use)
Therapy is initiated within 24 hours of acute attack onset &
continued until complete resolution (5-8 days)
Caution for renal insufficiency or peptic ulcer risk..!!
 Equivalent to NSAIDs in the treatment of acute gout flare
Preparation:
Oral prednison/prednisolone, methylprednisolone dose pack
Systemic triamcinolone acetonide i.m, methylprednisolone
Local triamcinolone acetonite i.a (monoarticular)
 ACR guideline only if started within 36 hours of attack onset
Dose: 0,6 mg once or twice daily following the initial 1,2 mg
dose until the acute attack resolved
Caution in patients with hepatic or renal impairment dose
adjustment
Drug interaction: CYP3A4 inhibitor (e.g. clarithromicin,
ketoconazole, ritonavir, etc.)
 Acute gout attack prouction of IL-1 >>
E.g :
Anakinra 100 mg s.c daily for 3 days
Canakinumab 150 mg s.c single dose
 Indications:
2/more gout attacks per years
1/more tophus or joint destruction
CKD (stage 2/worse)
History of urolithiasis/nefrolithiasis
E.g:
Xanthin oxidase inhibitors
Uricosuric drugs
Pegloticase
Misscellaneous agent
 Effective for prophylaxis in both underexcreters and
overproducers of uric acid
Long term prevention of reccurent acute attacks
E.g:
Allupurinol 100 mg then titrate (every 2-5 weeks) ad max 800mg/day
dose adjusment in CKD stage 4 (no greater than 50 mg)
Feboxostat 40-80 mg/day
 Mechanism:
Increase renal clearance by inhibiting postsecretory renal
proximal tubular reabsorption of uric acid
Warning..!!
May cause uricosuria & urolithiasis
maintenance of adequate urine flow & alkalinization of
the urine
Dose: probenecid 250 mg b.i.d for 1-2 weeks then 500 mg
b.i.d for 2 weeks.
KI: impaired renal function (Cr Cl < 50 mL/min), overproducers
of uric acid
 Recombinant uricase
Dose: biweekly iv
infusion no less than 2
hours
FENOFIBRATE
Increasing clearance of
hypoxanthine & xanthine

LOSARTAN
Inhibit renal tubular
reabsorption of uric acid
increase excretion