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Treatment of gout

Treatment of gout. 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. Treatment of acute gout attack. NSAIDs

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Treatment of gout

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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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