Gout is the common inflammatory arthritis in men and in older women. It is caused by the deposition of monosodium urate and monohydrate crystals in and around synovial joints.
| Crystals | Associations |
| COMMON | |
| Monosodium urate | Acute gout |
| Monohydrate | Chronic tophaceous gout |
| Calcium pyrophosphate dihydrate | Acute pseudogout |
| Basic calcium phosphate | Calcific periarthritis |
| UNCOMMON | |
| Cholesterol | Chronic effusion in rheumatic arthritis |
| Calcium oxalate | Acute arthritis in dialysis patient |
| Semi crystalline particles | Acute synovitis |
Causes of gout:
- Increase renal tubular reabsorption
- Renal failure
- Lead toxicity
- Alcohol
- Lactic acidosis
- Drugs: thiazide and loop diuretics, low dose aspirin, pyrazinamide
- Psoriasis
Clinical features:
It mainly affects metatarsophalangeal joint. Is also affected other joints like ankle, midfoot, knee and small joints of hand.
- Rapid onset of severe pain
- Extreme tenderness
- Podagra (swelling, erythema and extreme pain and tenderness in 1st metatarsophalangeal joint)
Management:
Management should be focused on 1st dealing with the acute attack when giving prophylaxis to lower attack.
Hyperuricemia/gout is associated with hypertension, renal disease and cardiovascular disease. Allopurinol is the best choice for this management.
Allopurinol, most common medicine that used for gout medication. It is a xanthine oxidase inhibitor. It is not only used for gout but also helpful in certain types of kidney disease.
Allopurinol reduces uric acid level in the patient. By reducing uric acid level in the body, it helps in prevention of chronic kidney disease, kidney stone and many other kidney diseases.
Patient with renal disease decreased uric acid excretion through urine which will give rise of gastrointestinal excretory compensation. Hyperuricemia would stimulate the renin angiotensin aldosterone system and inhibit the release of endothelial nitric oxide, that causes vasoconstriction and increase BP at the same time. It will causes inflammation.
Allopurinol is the most widely used drug that is used for lowering the urate. It prevents gout disease as well as helpful for kidney disease. As high level of uric acid is not effectively excreted by kidney this crystal causes kidney stone. If it is not treated properly, it will affect the bones, joints, other tissues and kidney.
Serum uric acid and C-Reactive protein levels are decreased if treated with allopurinol. eGFR decreased 3.3 + 1.2 ml/min per 1.73 and in the allopurinol treatment e GFR decreased 1.3 + 1.3ml/min per 1.73 after 24 months. Allopurinol treatment slowed down the progression of renal disease in respect of age, sex, diabetes, C-Reactive protein, albuminueia.
Gout is an inflammatory arthritis which is the most common. It’s characterized by high uric acid levels in the body. If it remain uncontrolled, it will associated with the lightning-fast triggering of often excruciating and debilitating joint pain.
Allopurinol first approved by the U.S. Food and Drug Administration in the year. It is prescribed as cheap and effective way to control uric acid levels and prevent such attacks from happening in the first place.
The studies found no evidence that allopurinol helps in preservation of kidney function among the kidney patients who do not have gout disease. In addition, investigations say what appeared to be a doubling of the risk for dying among kidney patients who took the medication.
But it should not use without consult with doctor. It also has some side effect. These are:
- Allergic reaction like: hives, difficult breathing, swelling in your face or throat
- Skin reaction like: fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling
- Painful urination, blood in the urine
- Little or no urination
- Easy bruising, unusual bleeding
- Numbness
- Tingling
- Burning pain
- Worsening gout symptoms
- Liver problems–loss of appetite, weight loss, stomach pain (upper right side), itching, dark urine, clay-coloured stools, jaundice (yellowing of the skin or eyes)
- An increase in gout attacks when you first starting taking allopurinol oral
- Rash
- Drowsiness
- Fever, chills
- Abnormal liver function tests
- Nausea, diarrhoea
- Joint pain
- Unusual weight loss
- Eye pain
- Vision changes.
After a long time, investigation, it shows that there was no higher death risk among those who were just starting to take allopurinol. Nor was any elevated risk seen among those who had gotten their uric acid levels to their target goal by using allopurinol. Increasing allopurinol dosage was also found safe.
“Our findings are clinically relevant in gout care, and provide reassurance that allopurinol treatment does not have an apparent detrimental effect on mortality in patients with both gout and chronic kidney disease,” Zhang said.
Howard Feinberg, a professor of rheumatology and assistant medical director at Touro University California, said this new study is one of many that have sought to weigh the pros and cons of a drug that has been a treatment mainstay for the last 55 years.
“There was fear early in its use that it would cause kidney damage,” noted Feinberg, who was not involved with the study. “Recently, testing was done to see if it could prevent kidney damage. Neither of these proved true,” he said.
During these tests some of the patients died due to their illnesses. Most tests showed that allopurinol did not change any risk of death from the illnesses suffered by these patients. In two research studies, when they looked at the patients who had died during the research, more of the patient’s taking allopurinol died. There was no proof that this occurs because of the allopurinol. The numbers were very small and could easily be a coincidence.
Allopurinol is risky based solely on those earlier findings would be “just like seeing a lot of car accidents at the same spot may make you think it is a dangerous road, when it is really due to drunk drivers from the bar down the street.”
There is so much information that shows that allopurinol is safe, and so little information showing a risk, this is not an important area for research. We can’t research everything. There are many bigger risks to test.
Before using this drug, you should tell your detail history to the doctor. This drug can make you drowsy so you should not drive or use machinery in this situation. It should be also used with precaution during pregnancy and lactational period. It can passes through breast milk to the child so without consultation with any doctor do not use it during lactation.
Allopurinol used in other cases like:
- Calcium Oxalate Calculi with Hyperuricosuria
- Gout
- Hyperuricemia Secondary to Chemotherapy
- Uric Acid Nephrolithiasis
- Gouty Nephropathy
- Lesch-Nyhan Syndrome
- Tumor Lysis Syndrome
