Gout

Gout
Gout is a disease characterized by an abnormal metabolism of uric acid, resulting in an excess of uric acid in the tissues and blood.
People with gout either produce too much uric acid (10%), or more commonly or have problem in removing it (90%).

acute and chronic goutyarthritis, kidney stones, and local deposits of uric acid (tophi) in the skin and other tissues.
Gout may occur alone (primary gout) or may be associated with other medical conditions or medications (secondary gout).
Gouty arthritis characterised by sudden onset of a painful, hot, red, swollen joint, particularly in the foot at the big toe. Commonest inflammatory arthritis in men over the age of 40.
Diagnosed by detecting uric acid (monosodium urate) crystals in Joint aspiration which is negative birefringence.
uric acid level should be done but cannot be rule out by normal uric acid!
joint radiograph to see joint destruction.

Genetics (our inherited genes), gender, and nutrition(alcoholism, obesity) play key roles in the development of gout.
20% development of gout if parents got gout

Diets rich in red meats, internal organs, yeast, and oily fish increase the risk for gout.

Attacks of gouty arthritis can be precipitated when there is a sudden change in uric acid levels, which may be caused by
• overindulgence in alcohol and red meats,

• trauma,

• starvation and dehydration,

• IV contrast dyes,

• chemotherapy,

• medications,

o diuretics and some other anti-hypertensive medications,

o aspirin (Bayer, Ecotrin),

o nicotinic acid (B-3-50, B3-500-Gr, Niacin SR, Niacor, Niaspan ER, Slo-Niacin),

o cyclosporin A,

o allopurinol (Zyloprim) and probenecid (Benemid),

o others.

Kidney stones are more frequent in people with gout.
Uric acid crystals can form outside joints.- tophi, can be found in the earlobe, elbow, and Achilles tendon (back of the ankle), or in other tissues.
tophi are not painful but can be a valuable clue for the diagnosis as the crystals that form them can be removed with a small needle for microscopic examination.\

treatment
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
o Examples include indomethacin(Indocin), ibuprofen (Advil), andnaproxen (Aleve). Newer drugs such ascelecoxib (Celebrex) can also be used.Aspirin should not be used
o High doses of anti-inflammatory medications are needed to control the inflammation and can be tapered off within a couple of weeks.



o The primary complications of these medications include upset stomach, bleeding ulcers, and decreased kidney function.

• Colchicine (Colcrys)

o This medication is given in two different ways, either to treat the acute attack of arthritis or to prevent recurring attacks.

o To treat the hot, swollen joint, colchicine is given rapidly (generally, two tablets at once followed by another tablet an hour later).

o To help prevent an attack from coming back, colchicine can be given once or twice a day. While the chronic use of colchicine can reduce the attacks of gout, it does not prevent the accumulation of uric acid that can lead to joint damage even without attacks of hot, swollen joints.

o caution for pt with kidney or liver function.

• Corticosteroids

o Corticosteroids such as prednisone (Meticorten, Sterapred, Sterapred DS) are generally given when your doctor feels this is a safer approach than using NSAIDs.

o When given by mouth, high-dose corticosteroids are used initially and tapered off within a couple of weeks. It is important to take these medications as prescribed to avoid problems.

o Some complications with the short-term use of corticosteroids include altered mood, elevated blood pressure, and problems with control of glucose in patients with diabetes.

o Corticosteroids can also be injected into the swollen joint. Resting the joint temporarily, after it is injected with steroids, can be helpful.


• Probenecid (Benemid)

o This medication helps the body eliminate excess uric acid through the kidneys and into the urine.

drink at least 2 liters of fluid a day while taking this medication (to help prevent uric acid kidney stones from forming).




• Allopurinol

o This medication decreases the formation of uric acid by the body and is a very reliable way to lower the blood uric acid level. Allopurinol is currently the gold standard of maintenance therapy.

o Allopurinol can be still used, but the dose may need to be adjusted for kidney problem pt.

o Common side effects include stomach pain, headache, diarrhea, and rash.





• Febuxostat (Uloric)

o Febuxostat is first new medication developed specifically for the control of gout in over 40 years.

o Febuxostat decreases the formation of uric acid by the body and is a very reliable way to lower the blood uric acid level.

o Febuxostat can be used in patients with mild to moderate kidney impairment.

o Febuxostat should not be taken with 6-mercaptopurine (6-MP), or azathioprine.
It is important to understand that these maintenance medications are used to lower the uric acid well below normal to prevent recurrent gouty arthritis attacks. Generally, doctors want the blood uric acid level to be below 6.0 mg/dL. This level of uric acid is referred to as the "target level" or "goal" of therapy.
IT is not available in Malaysia.

Malaysian candidates only got to uses allopurinol.
for acute attack only can used steroid, colchicine and NSAID!

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