Gout Diagnosis Treatment Department of nephrology R 1

Gout Diagnosis & Treatment Department of nephrology R 1. 서 대 철

Introduction v Gout is… v Risk factor v Age v Gender v Hypertension v Hyperuricemia v Obesity v Diet – Alcohol, Meat, Sea food NEJM Vol. 334 Np. 7 Feb. 15, 1996 Altered Uric Acid Levels and Disease States. JPET 324: 1 -7, 2008 Department of Nephrology 2

Diagnosis of Gout Arthrocentesis : Needle shape, birefringence American Family Physician Volume 76, Number 6 September 15, 2007 Department of Nephrology 3

Differential diagnosis American Family Physician Volume 76, Number 6 September 15, 2007 Department of Nephrology 4

Treatment of Gout v Therapy of acute gout attack v v Prompt and safe termination of pain and disability Management of hyperuricemia v v Prevention and reversal of the consequences of urate crystal deposition Indication v v v Frequent & disabling attacks of gouty arthritis Clinical or radiologic sign of chronic gout joint disease Gout with renal disease Urinary uric acid excretion >1100 mg/day Goal : Serum urate conc. <6 mg/d. L (<5 mg/d. L in patient with tophi) Prophylaxis against flares v Reduce the recurrence of acute attack during antihyperuricemic therapy Department of Nephrology 5

Treatment of Acute Gout Department of Nephrology 6

Treatment of Acute Gout American Family Physician Volume 76, Number 6 September 15, 2007 Department of Nephrology 7

Treatment of Interval Gout Department of Nephrology 8

Treatment of Interval Gout American Family Physician Volume 76, Number 6 September 15, 2007 Department of Nephrology 9

Future prospects v Febuxostat : More selective xanthine oxidase inhibitor v v v Safe in pts. with allopurinol hypersensitivity Long half-life, more consistent action Liver metabolism : serum liver enzyme ↑ Serum urate conc. < 6. 0 mg/d. L v Febuxostat : 80 mg/d (53%), 120 mg/d (62%) v Allopurinol : 300 mg/d(21%) Rapid lowering of serum urate : Risk of acute gout attack Alternative drug : Gout attack ? Department of Nephrology 10

Future prospects v Anti-cytokine therapy – Inflammasome v MSU crystal v Activate complement v Interact tissue macrophage v IL-1 b v v Initiation of gouty inflammation Anakinra v v v Soluble IL-1 b rcp antagonist Response within 24 hr Viable Tx. option Department of Nephrology 11

References v The management of gout, Vol. 334 No. 7 Feb. 15, 1996 NEJM v Bulletin of NYU Hospital for Joint Disease 2008; 66(3): 231 -9 v Gout : An update Vol. 76, No. 6 Sep. 15, 2007 American Family physician Department of Nephrology 12