NSAIDs such as naproxen and indomethacin are used to treat acute gouty attacks.
Glucocorticoid administration has been found to be just as effective as NSAIDs in acute gout attacks. This class of drug can be used if NSAIDs are contraindicated, and they are effective when given orally, but also lead to improvement when injected into the joint.
Colchicine is a helpful medication for acute gouty attacks. It can be used in patients when NSAIDs are not well tolerated. This drug has use acutely and prophylactically. Colchicine can cause GI upset.
Colchicine works to inhibit microtubule polymerization by binding to tubulin. As tubulin is important for mitotic function, it works as a "mitotic poison." This inhibits cytoskeletal recruitment, impairing leukocyte chemotaxis and degranulation.
In chronic treatment and prevention of gout, uric acid levels must be controlled. Inhibition of xanthine oxidase decreases the conversion of xanthine to uric acid. Drugs which have activity against xanthine oxidase include allopurinol and febuxostat.
Allopurinol is a drug that decreases uric acid formation from xanthine and hypoxanthine by inhibiting xanthine oxidase. It is used in chronic gout and hyperuricemia.
Febuxostat is a drug that decreases uric acid formation from xanthine and hypoxanthine by inhibiting xanthine oxidase. It is used in chronic gout and hyperuricemia.
Uricosurics, such as Probenecid, are a class of drug which increase the excretion of uric acid in the urine, reducing blood plasma uric acid levels. This works by inhibiting uric acid reabsorption in the proximal tubule of the kidney.
Probenecid works by interfering with the kidney's organic anion transporter, which reclaims uric acid from the urine and returns it to the plasma. When probenecid is present, the organic anion transporter binds preferentially to it (instead of to uric acid), preventing reabsorption of the uric acid. Hence, the urine retains more uric acid, which lowers uric acid concentration in the plasma. It is used in chronic gout and hyperuricemia.
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