Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
GOUT 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 weight loss diet can reduce SUA with 1 à 2 mg/dl treatment of comorbid conditions evaluation of concomitant medications Goals of treatment 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 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 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 ? 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 1. Probenecid 2. Sulfinpyrazone 3. Benzbromarone 4. Fenofibrate 5. Losartan 6. Vitamine C 7. ASA Urate lowering drugs = the future 1. Febuxastat 2. Natural uricase 3. Uricase with HMW poly ethylenen glycol PEG 4. URAT 1 anion exchange targeting