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KMID : 0882420110800030269
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Korean Journal of Medicine
2011 Volume.80 No. 3 p.269 ~ p.272
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Management of Complicated Gout
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Jung Young-Ok
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Abstract
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Chronic tophaceous gout results from long-term uncontrolled hyperuricemia with accumulation of urate crystals in joints, soft tissues, tendon sheaths and bony prominence. Urate-lowering agents should be administered to reduce serum uric acid level to less than 5 mg/dL for tophi reabsorption. Surgical indications include restoration of joint and tendon dysfunction, nerve decompression, debridement of septic joints, pain relief and cosmesis. Gout patients are at greater risk of forming uric acid stones. The renal tubular abnormality related to gout and metabolic syndrome leads to excretion of acidic urine, which favors formation of the relatively insoluble uric acid than more soluble urate. The corner stone of treatment of uric acid stone is urine alkalinization. Lowering serum uric acid with allopurinol and increasing urine volume are also important. Allopurinol is poorly tolerated and ineffective or contraindicated in some patients. Benzbromarone, a uricosuric agent is a useful alternative but possible hepatotoxicity should be monitored. Desensitization of allopurinol can be attempted to patients with mild cutaneous hypersensitivity. For gout patients with chronic renal failure, allopurinol dose need to be adjusted and nonsteroidal anti-inflammatory drugs and colchicine may be contraindicated. (Korean J Med 2011;80:269-272)Chronic tophaceous gout results from long-term uncontrolled hyperuricemia with accumulation of urate crystals in joints, soft tissues, tendon sheaths and bony prominence. Urate-lowering agents should be administered to reduce serum uric acid level to less than 5 mg/dL for tophi reabsorption. Surgical indications include restoration of joint and tendon dysfunction, nerve decompression, debridement of septic joints, pain relief and cosmesis. Gout patients are at greater risk of forming uric acid stones. The renal tubular abnormality related to gout and metabolic syndrome leads to excretion of acidic urine, which favors formation of the relatively insoluble uric acid than more soluble urate. The corner stone of treatment of uric acid stone is urine alkalinization. Lowering serum uric acid with allopurinol and increasing urine volume are also important. Allopurinol is poorly tolerated and ineffective or contraindicated in some patients. Benzbromarone, a uricosuric agent is a useful alternative but possible hepatotoxicity should be monitored. Desensitization of allopurinol can be attempted to patients with mild cutaneous hypersensitivity. For gout patients with chronic renal failure, allopurinol dose need to be adjusted and nonsteroidal anti-inflammatory drugs and colchicine may be contraindicated.
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KEYWORD
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Gout, Tophaceous gout, Uric acid stone, Allopurinol, Chronic renal failure
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