Chapter 36 Treatment of gout and hyperuricemia

There are two aspects to the management of gout: treatment of episodes of acute gouty arthritis and sustained correction of hyperuricemia. Acute gout is most commonly treated with non-steroidal anti-inflammatory drugs or oral colchicine. Other modalities, including intravenous colchicine, intra-articular corticosteroid injection, ACTH, and systemic corticosteroids may be used in special circumstances. Correction of hyperuricemia is the only definitive means to reduce the incidence of acute gout and to prevent the development of tophaceous gout, a chronic, potentially debilitating form of gouty arthritis. Urate-lowering drugs are indicated when the patient has recurrent episodes of acute gouty arthritis, tophaceous deposits, or nephrolithiasis. Two types of urate-lowering drugs are available, uricosuric agents which increase the renal excretion of uric acid and a xanthine oxidase inhibitor, allopurinol, which blocks the formation of uric acid. Allopurinol is the preferred drug in patients with tophaceous gout, nephrolithiasis, significant renal impairment, and overproduction of uric acid.