GOUT Dr. K. Declerck

1. 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

2. Patient education • weight loss • diet can reduce SUA with 1 à 2 mg/dl • treatment of comorbid conditions • evaluation of concomitant medications

3. Goals of treatment • 1. terminate acute attack • 2. provide rapid, safe pain and anti- inflammatory relief • 3. prevent complications * destructive arthropathy * tophi * renal stones

4. Acute gout treatment • NSAIDs • Colchicine • Corticosteroids

5. IF ON A URATE LOWERING DRUG, DO NOT STOP OR ADJUST DOSE DO NOT START A URATE LOWERING DRUG DURING AN ACUTE ATTACK

6. 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

7. 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?

8. 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

9. Urate lowering drugs = uricosurica • 1. Probenecid • 2. Sulfinpyrazone • 3. Benzbromarone • 4. Fenofibrate • 5. Losartan • 6. Vitamine C • 7. ASA

10. Uratelowering drugs = the future • 1. Febuxastat • 2. Natural uricase • 3. Uricase with HMW poly ethylenen glycol PEG • 4. URAT 1 anion exchange targeting