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GOUT
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Dr. K. Declerck
prevalence doubled over the last 20 years
due to longevity
use of diuretics and ASA
obesity – metabolic syndrome
end stage disease – hypertension
treatment should be non pharmacologic and
pharmacologic
Patient education
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weight loss
diet can reduce SUA with 1 à 2 mg/dl
treatment of comorbid conditions
evaluation of concomitant medications
Goals of treatment
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1. terminate acute attack
2. provide rapid, safe pain and antiinflammatory relief
3. prevent complications
* destructive arthropathy
* tophi
* renal stones
Acute gout treatment
NSAIDs
 Colchicine
 Corticosteroids
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IF ON A URATE LOWERING
DRUG, DO NOT STOP OR
ADJUST DOSE
DO NOT START A URATE
LOWERING DRUG DURING
AN ACUTE ATTACK
Gout urate lowering
treatment
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1. never start a urine acid lowering agent
during an acute attack
2. hyperuricemia with an acute inflammatory
arthritis is not necessarily gout
3. asymptomatic hyperuricemia is not a
disease and is not always an indication for
treatment
4. maintain SAU level below 6 mg/dl i.e.
below the tissue saturation for MSU
Who to treat ?
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1. tophi
2. gouty arthropathy
3. radiographic changes of gout
4. multiple joint involvement
5. nephrolithiasis
> Controversy when to treat in early disease?
Urate lowering drugs =
inhibitor of xanthine oxidase
> Allopurinol
* start low dose untill average dose of 300
mg daily
* associate prophylactic colchicine
* adjust dose in renal insufficiency
* cave: adverse events
> Oxypurinol
Urate lowering drugs =
uricosurica
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1. Probenecid
2. Sulfinpyrazone
3. Benzbromarone
4. Fenofibrate
5. Losartan
6. Vitamine C
7. ASA
Urate lowering drugs =
the future
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1. Febuxastat
2. Natural uricase
3. Uricase with HMW poly ethylenen
glycol PEG
4. URAT 1 anion exchange targeting