Treatment of Gout Exam 2 Flashcards
Nondrug for acute gouty arthritis
- Topical ice
- Rest inflamed joint
- Diet: 8-16 cups water/d, no alcohol, meat <4-6 oz/d; get protein from low fat dairy, tofu, eggs, nut butters
Drug treatment overview for acute gouty arthritis
- Colchicine
- NSAIDs
- Corticosteroids
- IL-1 antagonist
Treatment goal for acute gouty arthritis
relieve pain and inflammation (NOT decrease uric acid)
Drug treatment for acute gouty arthritis: Colchicine
- At first sign of flare – two 0.6 mg doses, then 0.6 mg after 1 h
- Best response if first dose given within 12 h of onset of attack, not recommended if over 36 h since onset
Drug treatment for acute gouty arthritis: NSAIDs
- very effective, may take 24 h for benefits
- Indomethacin, naproxen, sulindac FDA approved for acute gouty arthritis
- Salicylates should not be used; low doses inhibit urate secretion into renal tubules, high doses also inhibit reabsorption
Drug treatment for acute gouty arthritis: Corticosteroids
- May be combined with colchicine to prevent rebound flares of gout as steroid is discontinued
- Oral prednisone, ACTH, IA injections
Drug treatment for acute gouty arthritis: IL-1 antagonist
- b/c IL-1beta involved in urate crystal-induced inflammation
- anakinra (Kineret), rilonacept (Arcalyst), & canakinumab (Ilaris)?
Colchicine MOA
inhibits neutrophil function & inflammatory response to urate crystals; persists in neutrophils as long as 10 d after single dose
Colchicine choice in therapy
- Favorable for acute attacks (Pain relief in 24-48 h)
- also useful for chronic therapy
IL-1 antagonist MOA
Reduce urate crystal-induced inflammation
Allopurinol MOA
Xanthine Oxidase Inhibitor; purine analog
Allopurinol choice in therapy
Prophylactic; urate lowering; treat to target uric acid
Febuxostat MOA
Selective Xanthine Oxidase Inhibitor; non-purine
Febuxostat choice in therapy
Prophylactic; urate lowering; use in patients with allopurinol hypersensitivity, intolerance, or treatment failure
Uricosurics MOA
Inhibit reabsorption of urate by renal tubules