GOUTDefinition(gout) (hyperuricemia) (arthritis) monosodium
urate (tophi) 1. metabolism purine uric acid purine phosphoribosyl
pyrophosphate(PRPP) Enzyme purine Enzyme
Hypoxanthine-guaninephoribosyl transferase(HPGRT) enzyme guanine
hypoxanthine guanylic isosinic acid Enzyme HPGRT guanine
hypoxanthine 2. uric acid 2 3 uric acid \ Drug : uric acid
Diuretics : 1. reabsorption 2.Tubular sectionSalicylates(< 2
g/day) low dose tuberlar recretion High dose reaptionPyrazinamide
Ethambutol renal clearance
Disease : (Acute gouty arthritis) MSU ( ) >> urate ,
Tophi(,, urate urate Tophaceous gout1. (Non-pharmacological
treatment) purine 2. (Pharmacological treatment)1. Acute attack of
gout : NSAIDs, Colchicine, Corticosteroid1.1 NSAIDs Enzyme
cyclooxygenase (COX) PG half life onset Indomethacin, Naproxen,
Diclofenac, Ibuprofen Aspirin low dose (< 2 g/day) uric acid
NSAIDs
NSAIDs NSIADsRecommended dosage
Indomethacin100-200 mg/day 3-4 100 mg/day
Naproxen750 mg 375-500 mg 2
Piroxicam20 mg 2 20-40 mg
Ibuprofen1600-2400 mg/day
1.2 Cox-2 inhibitors gout Etoricoxib (Arcoxia) 120 mg OD S/E
NSAIDs & Coxib drug GI : irritation, bleeding, N/V Liver:
hepatotoxicity, hepatitis Renal: glomerrulopathy, decrease renal
plasma flow CNS: headache, confusion, hallucination Hemato:
decrease platelet aggregation**, anemia **Coxib platelet function
GI SE ***1.3 Colchicine analgesic NDAIDs 1 (0.6 mg) 1-2 . GI N/V
max dose( 6 mg) blood count monitoring loperamide(2) 2 stat 1 6 .
(max 16 mg/day) 1.4 Corticosteroids NSAIDs colchicine Oral:
prednisolone 20-30 mg/day 3-5 colchicine 1-2 Parenteral :
(Intra-articular) dexamethasone, triamcinolone acetonide SE , ,
cushing syndrome, hypertension, Osteoporosis, glaucoma, cataract, ,
, , 2. Long term control : organ damage uric acid hyperuricemia
acute attack of gout Tophi2.1 Allopurinol uric acid xanthine
oxidase 100 mg/day 300 mg/day gout attack uric acid , Tophaceous
gout, , hyperuricemia chemotherapy acute 3 wks 2.2 Uricosulic agent
urine uric acid < 1000 mg/day Probenecid : 1-2 g/day bid
**Aspirin** Sulfinpyrazone: 200-400 mg/day bid or tid S/E
Benzbromarone CrCL < 20 GFR > 50 mg/min severe hyperuricemia
2 L/day urinary alkalinizer Potassium citrate, Sodium bicarb,
Azetazolamide
