All About Gout

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All About Gout

• Samantha Stuckey
• Medicinal Chemistry
• Spring 2007

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Overview

• What it is
• Risk factors
• Symptoms
• Diagnosis
• Treatment
• Cost and other options

http//en.wikipedia.org/wiki/Gout
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What is Gout?
Uric Acid

• Metabolic arthritis
• Disorder of uric acid metabolism
• MSU crystals and tophi
• Inflammatory response

http//www.healthsystem.virginia.edu/internet/rheu
matology/gout.cfm
http//www.gout-diet-tips.com/
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http//www.jci.org
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Risk Factors

• Hyperuricemia
• Too much uric acid
• Slow removal
• Weight
• Hypertension
• Diabetes
• Diet
• Sardines, Broth, Brains, Kidneys, Sweetbread,
  etc.
• Alcohol Use
• The disease of kings

http//www.healthleader.uthouston.edu/archive/Endo
crinology/2005/gout-0418.html
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Dietary Information
http//www.jci.org
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Other Risk Factors

• Men more likely
• Certain ethnicities
• Pacific Islanders
• Maori of New Zealand
• African-Americans

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Symptoms

• Swelling at joints
• Big toe
• Stiffness
• Pain
• Redness
• Warmness

Images courtesy of Google Images
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Stages of Gout

• Asymptomatic
• Acute
• Intercritical
• Chronic
• Kidney damage, hypertension, kidney stones

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Diagnosis

• Light microscopy
• White discharge
• Urate levels
• 420µmol/L (males) 380µmol/L (females)
• Others
• Full blood count
• Electrolytes
• Erythrocyte sedimentation rate

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Types of Treatment

• No cure
• Treatment of symptoms
• NSAIDs
• Allopurinol
• Colchicine
• Uricosuric agents
• Intra-articular glucocorticoids
• Preparation-H

Images courtesy of Google Images
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Allopurinol

• U.S. usage since 1964
• Marketing
• GlaxoSmithKline Zyloprim
• Hexal Australia Allohexal
• The Wellcome Foundation Zyloric

Images courtesy of Google Images
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Allopurinol

• Lowers blood uric acid levels
• Inhibits xanthine oxidase
• Preventive
• 100mg or 300mg tablets
• Once daily with plenty of
  water

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Allopurinol

• Cost
• 100mg 13-135 for 100-600ct bottle
• 300mg 23-410 for 100-600ct bottle
• Drug interactions
• Ampicillin and amoxicillin
• Side effects
• Rash, nausea, diarrhea, upset stomach, unusual
  tastes, drowsiness, acute gout attacks

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Colchicine

• Originally from Colchicum autumnale plants
• First isolated in 1820 by P.S. Pelletier and J.
  Caventon
• Trade names
• Col-Probenecid, Colbenemid, Proben-C, Probenecid
  and Colchicine
• Low therapeutic index

Images courtesy of Google Images
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Colchicine

• Suppresses inflammation
• Binds with tubulin
• 0.5mg and 0.6mg tablets or
  intravenous administration
• Within 12-48 hours
• Every hour until 4.8mg

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Colchicine

• Cost
• 14-135 for 60-300ct bottles
• Drug interactions
• Alcohol, NSAIDs, erythromycin
• Side effects
• Dose-related
• Nausea, diarrhea, abdominal pain, vomiting, hair
  loss, weakness, nerve irritation, anemia

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Non-Pharmaceutical and Other Treatment

• Ice
• Dietary modifications
• Low purine foods
• Joe-Pye weed
• Sleep apnea treatment
• Acupuncture
• Febuxostat PEG-uricase
• Stage III trials

Images courtesy of Google Images
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The End

• Questions?
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