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Comprehensive Gout Treatment Guide: Drugs and Therapies

Learn about effective drugs and therapies for treating acute and chronic gout attacks, from NSAIDs and glucocorticoids to xanthine oxidase inhibitors and monoclonal antibodies. Discover key treatment options, dosages, and potential side effects.

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Comprehensive Gout Treatment Guide: Drugs and Therapies

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  1. Treatment of gout

  2. Drugs • Acute gout attack • strong anti-inflammatory action • pain-killers • inhibition of leucocyte migration to the joint • Hyperuricemia therapy / prevention of gout attack • increase of uric acid excretion • block of synthesis + diet

  3. Treatment of acute gout attack • NSAIDs • higherdoses (i.m., p.o., p.r.) • somehavepreferablyuricosuriceffect • indometacine, diclofenac, piroxicam • colchicine • alcaloidobtainedfromColchicumautumnale • p.o. every 2-4 hrs • mitoticpoison, inhibitsphagocytosis and leukocyte migration • AE: severe diarrhea – rehydratation! • glucocorticoids • localadm. (i.a.) – triamcinolone • systemic(p.o., i.m., i.v.) – prednison, methylprednisolon • canakinumab • IL-1 inhibitor, humanmonoclonalantibody • patientswho do not tolerateNSAIDs and GC • s.c. aplication

  4. Chronic treatment of gout • Uricosurics • inhibit reabsorption of uric acid in primary tubulus Lesinurad • only in combination with xantin oxidase inhibitors Probenecide • sometimes used with antibiotics or antivirotics to make them stay longer in the body • unregistered in Czech Rep.

  5. Antiuratics • inhibitsyntesisof urine acid by inhibitionxantin oxidase (XO) Allopurinol • isomer of hypoxanthin, competitive inhibition of xanthinoxidase • inhibitsde novo syntesisofpurines • not combine with cytostatics of purine structure (azathioprin, 6-mercaptopurin) – allopurinol  their toxicity! • AE: usuallywelltolerated, most common: • rash, GIT intoleration, hypersensitivereaction XO XO uric acid hypoxanthin xanthin

  6. Febuxostat • MA: non-purine inhibitor ofxantinoxidase • clinicaltrials proved higherefficacythanallopurinol • AE: goutattacts, liver functionabnormalities, diarrhoea, nausea, headache Pegloticase(recombinanturicase) • MA: transformsuric acid to alantoin withbettersolubility • AE:anaphylacticshock, reaction to infusion, goutattactsatthebeginningoftherapy • i.v. aplication (only to inpatient)

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