Symptoms and treatments for Gout

1. Symptoms and treatments for Gout Beverly Hardy

2. What is Gout? • A condition where there is a vast accumulation of uric acid onto the joints • Leads to the formation of monosodium urate in various tissues in the body • The amount of uric acid needed to cause Gout is above 360mmol/L

3. Symptoms • The main symptoms of Gout are • Pain in joints areas • Swelling of joint areas

4. Cause of symptoms • When monosodium crystals gets into joints, this illicit a reaction from the body’s immune system • The body macrophages and neutrophils attack the monosodium urate crystals causing inflammation of the joint.

5. Treatments • There are many treatments for gout • Some are used for treating the symptoms of gout, while others are used to stop gout symptoms from appearing. • Because Gout is a metabolic condition, there is no cure for it.

6. NSAIDS • Acute treatment for gout is using NSAIDs • Used to alleviate the pain caused by inflammation • Side-effects • Nausea • Vomiting • In extreme cases, kidney failure

7. Colchicine or (N-​[(7S)-​1,​2,​3,​10-​tetramethoxy-​9-​oxo-​5,​6,​7,​9-​tetrahydrobenzo​[a]​heptalen-​7-​yl]​acetamide) • Oldest drug used for gout flares • Alkaloid • Prophalytic • Dosage: 0.5g 3 times daily

8. Colchicine (cont’d) • Acts on tubulin • Interferes with microtubule formation in neutrophils • Causes low amount of neutrophils to be made, decreasing inflammation.

9. Allopurinol or 1,5-dihydro-4H-pyrazolo[3,4-d]pyrimidin-4-one • Used as along term treatment for gout • Lowers uric acid levels • Isomer of hypoxanthine • Is a xanthine oxidase inhibitor • Dosage:100mg per day

10. Allopurinol (cont’d) • Xanthine oxidase catalyzes the final reaction of the purine catabolic pathway that makes uric acid. • Allopurinol bind to xanthine oxidase and limits its activity.

11. Benzbromarone • Xanthine oxidase inhibitor • Benzofuranderivative • Sometimes used in conjunction with Allopurinol • Side effects • Nausae • Very hepatotoxic

12. Possible treatments • Febuxostat • Xanthine oxidase inhibitor • Can work in people with renal failure • Higher cost • Recombinant uratoxidase • Degrade urate into allantion • Not in use yet for Gout

13. Possible treatments • If all else fails • Surgery may be need to remove uric acid build up

14. Questions?

15. Literature Cited • Nuki, G., and Simkin, P. A. (2006) A concise history of gout and hyperuricemia and their treatment, Arthritis Res Ther8 Suppl 1, S1. • WebMD. (2010) Arthritis and Gout. • Busso, N., and So, A. (2010) Mechanisms of inflammation in gout, Arthritis Res Ther12, 206. • Chia, E. W., Grainger, R., and Harper, J. L. (2008) Colchicine suppresses neutrophil superoxide production in a murine model of gouty arthritis: a rationale for use of low-dose colchicine, Br J Pharmacol153, 1288-1295. • Conaghan, P. G., and Day, R. O. (1994) Risks and benefits of drugs used in the management and prevention of gout, Drug Saf11, 252-258. • Voet, D., Voet, J. G., and Pratt, C. W. (2008) Fundamentals of biochemistry : life at the molecular level, 3rd ed., Wiley, Hoboken, NJ. • Pacher, P., Nivorozhkin, A., and Szabo, C. (2006) Therapeutic effects of xanthine oxidase inhibitors: renaissance half a century after the discovery of allopurinol, Pharmacol Rev58, 87-114. • Tausche, Anne-Kathrin, Tim L. Janse, Hans-Egbert Schröder, Stefan R. Bornstein, Martin Aringer, and Ulf Müller-Ladner. "Gout—Current Diagnosis and Treatment." DtschArzteblInt 106 (2009): 549-55. PMC. NCBI, 24 Aug. 2009. Web. 16 Nov. 2012. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754667/ • Heel, RC, RN Brogden, TN Speigth, and GS Avery. "Benzbromarone: A Review of Its Pharmacological Properties and Therapeutic Use in Gout and Hyperuricaemia." Drugs14.5 (1977): 329-66. PubMed. NCBI. Web. 16 Nov. 2012. <http://www.ncbi.nlm.nih.gov/pubmed/338280>.