Treatment of gout



Drugs
1.Acute gout attack
–strong anti-inflammatory action
–pain-killers
–inhibition of leucocyte migration to the joint
2.Hyperuricemia therapy / prevention of gout attack
–increase of uric acid excretion
–block of synthesis
–+ diet
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Treatment of acute gout attack
•NSAIDs
–higher doses (i.m., p.o., p.r.)
–some have preferably uricosuric effect
–indometacine, diclofenac, piroxicam
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•colchicine
–alcaloid obtained from Colchicum autumnale
–p.o. every 2-4 hrs
–mitotic poison, inhibits phagocytosis and leukocyte migration
–AE: severe diarrhea – rehydratation!
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•glucocorticoids
–local adm. (i.a.) – triamcinolone
–systemic (p.o., i.m., i.v.) – prednison, methylprednisolon
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•canakinumab
–IL-1 inhibitor, human monoclonal antibody
–patients who do not tolerate NSAIDs and GC
–s.c. aplication
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Chronic treatment of gout
1.Uricosurics
•inhibit reabsorption of uric acid in primary tubulus
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•Lesinurad
•only in combination with xantin oxidase inhibitors
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•Probenecide
•sometimes used with antibiotics or antivirotics to make them stay longer in the body
•unregistered in Czech Rep.

2.Antiuratics
•inhibit syntesis of urine acid by inhibition xantin oxidase (XO)
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•Allopurinol
•isomer of hypoxanthin, competitive inhibition of xanthin oxidase
•inhibits de novo syntesis of purines
•not combine with cytostatics of purine structure (azathioprin, 6-mercaptopurin) – allopurinol
their toxicity!
•AE: usually well tolerated, most common:
–rash, GIT intoleration, hypersensitive reaction
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•hypoxanthin
•xanthin
•uric acid
•XO
•XO

•Febuxostat
•MA: non-purine inhibitor of xantinoxidase
•clinical trials proved higher efficacy than allopurinol
•AE: gout attacts, liver function abnormalities, diarrhoea, nausea, headache
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•Pegloticase (recombinant uricase)
•MA: transforms uric acid to alantoin with better solubility
•AE: anaphylactic shock, reaction to infusion, gout attacts at the beginning of therapy
•i.v. aplication (only to inpatient)