Diagnosis And Treatment In Rheumatology

Diagnosis And Treatment In Rheumatology

Diagnosis and Treatment in Rheumatology is a clear and concise handbook of all rheumatic diseases. The book presents organized information about current diagnosis, treatment and statistics (where ...
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Gout

Pp. 171-189 (19)

Małgorzata Wisłowska

Abstract

Gout is an inflammatory disease caused by the deposition of monosodium urate (MSU) crystals in joints and other tissues. The formation of crystals is caused by hyperuricaemia, when serum uric acid (SUA) levels are >6.0 mg/dl (360 umol/L). Palpable deposits of MSU crystals are known as tophi and form around joints. The disease presents with episodes of joint inflammation. Renal lithiasis and formation of tophi in internal organs may also occur. Gout may induce disability, severe nephropathy and increases cardiovascular risk. Uric acid is the final metabolite of purine metabolism in humans due to inactive urate oxidase (uricase). Hyperuricaemia may be caused by diet (e.g. alcohol, seafood, red meat), overproduction and undersecretion of urate. Gout may be primary and secondary. Primary gout may be associated with obesity, alcohol consumption, hypertension, type 2 diabetes and hypertrigliceridaemia. Secondary gout may be due to drugs (e.g. diuretics), in patients with nephropathy and myelolimphoproliferative diseases. Gout is painful and a swollen red toe is characteristic (podagra). Attacks may be polyarticular in hand, wrist, ankle, knee. Chronic urate arthropathy is destructive arthropathy with bone erosions and tophi. The aim of the treatment of gout is to eliminate the urate crystals. The acute attacks must be treated with NSAIDs, GCS or colchicines; hyperuricaemia must be in the serum less than 6 mg/dl (0.36 mmol/L). IL-1 inhibitors may be used in patients with an inadequate response to standard drugs. For urate lowering therapy was used xanthine oxidase inhibitors (allopurinol, febuxostat), uricosuric agents (probenecid, lesinurat) and uricase agents (pegloticase) were used.

Keywords:

A swollen red toe, Allopuriniol, Bone erosions, Cardiovascular risk, Chronic urate arthropathy, Colchicines, Febuxostat, GCS, Gout, Hyperuricaemia, IL-1 inhibitors, Lesinurat, Monosodium urate (MSU) crystals, Nephropathy, NSAIDs, Pegloticase, Podagra, Probenecid, Purine metabolism, Renal lithiasis, Serum uric acid (SUA), The urate lowering therapy, Tophi, Urate oxidase (uricase), Uricase agents, Uricosuric agents, Xanthine oxidase inhibitors.

Affiliation:

Head of Rheumatology and Internal Diseases Department CSK MSWiA Warsaw Poland.