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Acute Gout Attack

Precipitating factors

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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]

9 mg/dl: 4.5%

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Course of hyperuricemia and gout

Asymptomatic hyperuricemia

Acute gouty arthritis

Intercritical period Asymtomatic, but 12.5~90%

crystal with mild

leukocytosis in the joint

Acute gouty arthritis

Chronic Tophaceous gout

about 11 years,if untreated

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Criteria for diagnosis of gout

Triad

1.Acute monoarthritis

2. Hyperuricemia

3. Response to Colchicine

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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.

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Precipitation of acute gout

Acute or of serum[UA]

Causes of hyperuricemia Increased UA production or intake

Decreased UA excretion

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Causes of hyperuricemia

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The elimination of uric acid

1/3 Extrarenal: saliva, gstric juice, pancreaticsecretion, bowel secretion

2/3 Renal:

Glomerular filtration

Early proximal tubular reabsorption: 90~93%

Tubular secretion

Post-secretory tubular reabsorption

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Causes of hyperuricemia

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Drugs as preipitating factors

Drugs that orserum [UA] acutely

acute gout attack

The occurrence of gout after the initiation ofantihyperuricemic therapy is well

established.

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Drugs precipitating Gout

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Drugs precipitating Gout

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Salicylates

Low dose(secretion

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Alcohol

ATP

turnover

Dehydration Beer:

guanosine

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TPN as a rare precipitating factor

serum[UA] 3 mg/dl

Maximum reduction occurring during the first 3days.

urinary excretion:Urate reabsorption inhibited by infusion of amino acids

production of UA:

purine-free TPN

Extracellular fluid expansion :stimulation antidiuretic hormone

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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 RheumatologyDAVID 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 DOUGLASST. JOHN

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