GOUT

Definition (gout) (arthritis) monosodium urate (hyperuricemia) (tophi)

1.

metabolism purine

purine Enzyme

uric acid

phosphoribosyl pyrophosphate(PRPP) purine

Enzyme Hypoxanthine-guaninephoribosyl transferase(HPGRT) guanine hypoxanthine guanylic isosinic acid guanine hypoxanthine 2. \ Drug : Diuretics : Tubular section Salicylates(< 2 g/day) low dose High dose Pyrazinamide Ethambutol Disease : renal clearance tuberlar recretion reaption uric acid 1. reabsorption 2. uric acid 2 3

enzyme Enzyme HPGRT

uric acid

(Acute gouty arthritis) MSU (

) > urate , urate , Tophaceous gout , urate Tophi( >

1.

(Non-pharmacological treatment)

purine 2. (Pharmacological treatment)

1. Acute attack of gout : NSAIDs, Colchicine, Corticosteroid 1.1 NSAIDs Enzyme cyclooxygenase (COX) PG half life onset Indomethacin, Naproxen, Diclofenac, Ibuprofen Aspirin low dose (< 2 g/day) uric acid NSAIDs NSAIDs NSIADs Indomethacin Naproxen Piroxicam Ibuprofen 100-200 mg/day 750 mg 20 mg 2 1600-2400 mg/day Recommended dosage 3-4 375-500 mg 2 20-40 mg 100 mg/day

1.2 Cox-2 inhibitors gout Etoricoxib (Arcoxia) 120 mg OD

S/E

NSAIDs & Coxib drug GI : irritation, bleeding, N/V Liver: hepatotoxicity, hepatitis Renal: glomerrulopathy, decrease renal plasma flow CNS: headache, confusion, hallucination Hemato: decrease platelet aggregation**, anemia **Coxib platelet function GI SE *** 1.3 Colchicine analgesic 1 N/V NDAIDs (0.6 mg) 1-2 . max dose( 6 mg) blood count monitoring GI

loperamide(2) 2

stat

6 . (max 16 mg/day)

1.4 Corticosteroids NSAIDs colchicine Oral: prednisolone 20-30 mg/day 3-5 colchicine 1-2

Parenteral : (Intra-articular) dexamethasone, triamcinolone acetonide SE , , cushing syndrome, hypertension, Osteoporosis, glaucoma, cataract, , ,

2. Long term control : uric acid Tophi 2.1 Allopurinol

hyperuricemia

organ damage acute attack of gout

uric acid xanthine oxidase 100 mg/day 300 mg/day gout attack uric acid , Tophaceous gout, , hyperuricemia chemotherapy acute 3 wks 2.2 Uricosuric agent urine uric acid < 1000 mg/day Probenecid : 1-2 g/day bid ** Aspirin** Sulfinpyrazone: 200-400 mg/day bid or tid S/E Benzbromarone CrCL < 20 GFR > 50 mg/min severe hyperuricemia 2 L/day urinary alkalinizer Potassium citrate, Sodium bicarb, Azetazolamide