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Acute Gout Attack Precipitating factors

Acute Gout Attack Precipitating factors. Hyperuricemia and Gout. Hyperuricemia– M:>7mg/dL, F:>6 mg/dL Monosodium urate: solubility: 7mg/dL at 37℃ 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 Gout Attack Precipitating factors

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  1. Acute Gout Attack Precipitating factors

  2. Hyperuricemia and Gout • Hyperuricemia– M:>7mg/dL, F:>6 mg/dL • Monosodium urate: solubility: 7mg/dL at 37℃ • Annual incidence of gout: increases with [UA] <7 mg/dl: 0.1% 7~9mg/dl: 0.5% >9 mg/dl: 4.5%

  3. Course of hyperuricemia and gout Asymptomatic hyhperuricemia Acute gouty arthritis Asymtomatic, but 12.5~90%仍有crystal with mild leukocyhtosis in the joint Intercritical period Acute gouty arthritis about 11 years, if untreated Chronic Tophaceous gout

  4. Criteria for diagnosis of gout Triad 1.Acute monoarthritis 2. Hyperuricemia 3. Response to Colchicine

  5. How UA crystal triggers acute inflammation? • Unclear • There may be still crystals in the joints during asymptomatic intercritical period • Drug that induces acute increase or decrease of serum [UA] may induces acute gout.

  6. Precipitation of acute gout • Acute ↑or↓ of serum[UA] • Causes of hyperuricemia • Increased UA production or intake • Decreased UA excretion

  7. Causes of hyperuricemia

  8. The elimination of uric acid • 1/3 Extrarenal: saliva, gstric juice, pancreatic secretion, bowel secretion • 2/3 Renal: • Glomerular filtration • Early proximal tubular reabsorption: 90~93% • Tubular secretion • Post-secretorytubular reabsorption

  9. Causes of hyperuricemia

  10. Drugs as preipitating factors • Drugs that ↑or↓serum [UA] acutely →acute gout attack • The occurrence of gout after the initiation of antihyperuricemic therapy is well established.

  11. Drugs precipitating Gout

  12. Drugs precipitating Gout

  13. Salicylates • Low dose(<2g/day)— inhibit tubular secretion of uric acid • Higher dose– inhibit tubular absorption>secretion

  14. Alcohol • ↑ATP turnover • Dehydration • Beer: guanosine

  15. TPN as a rare precipitating factor • ↓serum[UA] 3 mg/dl • Maximum reduction occurring during the first 3 days. • ↑urinary excretion: Urate reabsorption inhibited by infusion of amino acids • ↓ production of UA: purine-free TPN • Extracellular fluid expansion : stimulation antidiuretic hormone

  16. References • Kelley's Textbook of Rheumatology, 7th ed • Hyperuricemia and gout-Some medications can ‘precipitate’ gout. C P J / R P C • J U LY / AU G U S T 2 0 0 6 • VO L 1 3 9 , N O 4 • Recent Diuretic Use and the Risk of Recurrent Gout Attacks: The Online Case-Crossover Gout Study. The Journal of Rheumatology DAVID J. HUNTER, MICHAEL YORK, CHRISTINE E. CHAISSON, RYAN WOODS, JINGBO NIU,and YUQING ZHANG • Acute Gout Precipitated by Total Parenteral Nutrition. The Journal of Rheumatology ROBERT A. MOYER and DOUGLAS ST. JOHN

  17. 謝謝大家!!

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