[RHEUMATOLOGY] Antigout

gout

[INTRODUCTION]

In _____, there is an increase in uric acid levels in the body. Uric acid crystals deposit in the joints and are recognized as foreign, triggering inflammation and resulting in arthritis.

Acute gout

[INTRODUCTION]

This gout commonly presents as acute monoarticular arthritis, often affecting the BIG TOE, a condition known as podagra.

acute monoarticular arthritis

[INTRODUCTION]

Acute gout commonly presents as ______, often affecting the BIG TOE, a condition known as podagra.

podagra gout

[INTRODUCTION]

Acute gout commonly presents as acute monoarticular arthritis, often affecting the BIG TOE, a condition known as ______.

Acute gout

[INTRODUCTION]

Management of ______ focuses on treating pain and inflammation, rather than immediately lowering uric acid levels.

● Colchicine

● NSAIDs

● Glucocorticoids

[DRUGS FOR ACUTE GOUT]

Drugs for acute gout include:

Colchicine

[DRUGS FOR ACUTE GOUT]

This works by inhibiting tubulin polymerization, thereby preventing microtubule formation.

This action inhibits neutrophil chemotaxis and inflammatory response in the affected joint

tubulin polymerization

[DRUGS FOR ACUTE GOUT]

Colchicine is a drug used in the management of acute gout that works by inhibiting _______ , thereby preventing microtubule formation.

This action inhibits neutrophil chemotaxis and inflammatory response in the affected joint

Colchicine

[DRUGS FOR ACUTE GOUT]

This is considered a first-line agent for acute gout attacks.

● Watery and bloody diarrhea

● Peripheral neuropathy

[DRUGS FOR ACUTE GOUT]

Toxic effects of colchicine:

NSAIDs

[DRUGS FOR ACUTE GOUT]

These are commonly used in acute gout because they inhibit cyclooxygenase (COX), reducing prostaglandin-mediated inflammation.

● Aspirin

● Tolmetin

● Salicylates

[DRUGS FOR ACUTE GOUT]

NSAIDs contraindicated in gout, as they can interfere with uric acid excretion and worsen hyperuricemia.

● Indomethacin

● Ibuprofen

[DRUGS FOR ACUTE GOUT]

Commonly used NSAIDs include:

Glucocorticoids

[DRUGS FOR ACUTE GOUT]

These are used to induce IMMUNOSUPPRESSION and should be used for NOT MORE THAN 5 DAYS.

NOT MORE THAN 5 DAYS

[DRUGS FOR ACUTE GOUT]

Glucocorticoids are used to induce IMMUNOSUPPRESSION and should be used for NOT MORE THAN ____ DAYS.

● Gouty nephropathy

● Chronic tophaceous gout

[DRUGS FOR CHRONIC GOUT]

Chronic gout includes:

Gouty nephropathy

[DRUGS FOR CHRONIC GOUT]

This gout involves the presence of renal uric acid stones.

Chronic tophaceous gout

[DRUGS FOR CHRONIC GOUT]

This gout involves the presence of TOPHI (inflammatory bumps) or subcutaneous deposits of MONOSODIUM uric crystals.

1. Give colchicine (1st 2 - 3 weeks of therapy)

2. Colchicine + Hypourecemics

[DRUGS FOR CHRONIC GOUT]

Treatment step for chronic gout:

● Allopurinol

● Febuxostat

● Pegloticase

● Rasburicase

●Uricosuric agents

- Penicillamine

- Sulfinpyrazone

- Probenecid

[DRUGS FOR CHRONIC GOUT]

Hypouricemic Agents include:

Allopurinol

[DRUGS FOR CHRONIC GOUT]

This is a purine analogue that acts as a xanthine oxidase inhibitor.

purine analogue

[DRUGS FOR CHRONIC GOUT]

Allopurinol is a _____ analogue that acts as a xanthine oxidase inhibitor.

xanthine oxidase inhibitor

[DRUGS FOR CHRONIC GOUT]

Allopurinol is a purine analogue that acts as a _____ inhibitor.

Allopurinol

[DRUGS FOR CHRONIC GOUT]

This is considered the first-line agent for chronic tophaceous gout.

Febuxostat

[DRUGS FOR CHRONIC GOUT]

This is a non-purine xanthine oxidase inhibitor that reduces uric acid production.

xanthine oxidase inhibitor

[DRUGS FOR CHRONIC GOUT]

Febuxostat is a non-purine _____ inhibitor that reduces uric acid production.

● Pegloticase

● Rasburicase

[DRUGS FOR CHRONIC GOUT]

These are recombinant uricase enzymes, which are normally absent in humans and other mammals. They work by converting uric acid into allantoin.

recombinant uricase enzymes

[DRUGS FOR CHRONIC GOUT]

Pegloticase and rasburicase are _____ enzymes, which are normally ABSENT in humans and other mammals. They work by converting uric acid into allantoin.

● Penicillamine

● Sulfinpyrazone

● Probenecid

[DRUGS FOR CHRONIC GOUT]

Uricosuric agents include:

Uricosuric agents

● Penicillamine

● Sulfinpyrazone

● Probenecid

[DRUGS FOR CHRONIC GOUT]

These enhance the urine excretion of uric acid.

Uricosuric agents

● Penicillamine

● Sulfinpyrazone

● Probenecid

[DRUGS FOR CHRONIC GOUT]

These have high risk of renal uric acid stone formation. Frequent hydration is required.

Frequent hydration

[DRUGS FOR CHRONIC GOUT]

Uricosuric agents have high risk of renal uric acid stone formation. ______ is required.