Ruenruedee,MD 17 Nov.

2010

Hyperuricemia M:>7mg/dL, F:>6 mg/dL } Monosodium urate: solubility: 6.8mg/dL at 37 C } Annual incidence of gout: increases with [UA] <7 mg/dl: 0.1% 7~9mg/dl: 0.5% >9 mg/dl: 4.5%
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} Acute } Causes

or of serum[UA] of hyperuricemia

Increased UA production or intake Decreased UA excretion

>Primary hyperuricemia >Secondary hyperuricemia

Clinical Acute mono-oligoarthritis } Identity MSU crystal in synovial fluid, tophus } Radiological finding } Serum uric acid ( not for diagnosis)
}

} GOALS:
1. 2. 3.

terminate acute attack provide rapid, safe pain/anti-inflammatory relief prevent complications destructive arthropathy tophi renal stones

1. Treatment of acute attack } 2. Prevention of acute attack } 3. Hypouricemic drug } 4.Work up and treatment of co-morbid condition } 5.Treatment of complication eg. Renal complication .
}

Agents:
1. NSAIDS 2. Corticosteroids 3. Colchicine

Colchicine (at low dose)

indications: dose:

-until dose of urate lowering drug optimized -if patient cannot take a urate lowering drug -0.6 mg qd or occasional b.i.d. -0.3 mg qd or q2days if renal disease or elderly SMALLEST DAILY DOSE POSSIBLE INDIVIDUALIZE

Who to treat?
1. tophi 2. gouty athropathy 3. radiographic changes of gout 4. multiple joint involvement 5. nephrolithiasis controversy: when to treat in early disease?

Uricostatic agent Uricosuric agent

Probenecid Benzbromarone Sulfinpyrazone Rasburicase Pegloticase Allopurinol febuxostat

Uricolytic agent

}Raised serum urate and increased

risk of gout with:
- obesity - hyperlipidemia - hyperglycemia/insulin resistance - hypertension - (smoking) - diuretic use

Cold compression } Immobilization } Tapping for Release

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