3. Crystal arthropathies – gout - definition, prevalence, localization, etiology, pathogenesis, clinical presentation/clinical forms, disease course, diagnosis, differential diagnosis, management. Pseudogout · Internal Diseases – Part 1 (Rheumatology, Pulmonology, Phthisiatrics, Cardiology, Haematology) · MU Plovdiv

Treatment:

There are four goals:

To terminate the acute attack;
To prevent from future attacks;
To lower serum urate levels thus resolving the existing tophi and preventing from future urate tissue deposits;
Coexisting hypertension, hyperlipidemia, metabolic syndrome, renal failure should be treated promptly

There are four goals:

To terminate the acute attack;
To prevent from future attacks;
To lower serum urate levels thus resolving the existing tophi and preventing from future urate tissue deposits;
Coexisting hypertension, hyperlipidemia, metabolic syndrome, renal failure should be treated promptly

Acute attack. These are treated with as early as possible administration of maximal doses of NSAIDS and starting of treatment with colchicum. This should be continued for 2-3 days after resolution of the attack. Alternatively, or if the patients has contraindications for NSAIDS, colchicum, corticosteroids could be administrated im or ia. Usually as a small dose of 40 mg of methylprednisolon im is sufficient. This also should be repeated for several days. Additionally RICE should be prescribed for couple of days.
Prevention of recurrent attacks. This is usually not necessary after the first or second attacks, as often gout is a self limiting disease. However if attacks repeat colchicum one or two tablets per day should be given for months. Alternatively low dose daily NSAID should be prescribed
Lowering of serum urate levels. Urate lowering drugs prevent or even reversed joint damage done by monosodium urate crystals and tophi. Tophecious deposits are resorbed by lowering serum urate bellow the level of saturation, which is 0,41 mmol/l at core body temperature and ph, and 0,26 mmol/ l at normal peripheral temperature (31 C).
Allopurinol is started at 100 mg per day and gradually increase up to 600 mg per day (aver dose is 300 mg per day). Uricosuric drugs benzbromaron, probenicid ans sulfinpyrazone should be prescribed in younger patients, with normal renal functions and no nephrolithiasis. Febuxostat usual dose is 80 mg per day.