Caused by uric acid over-production or underexcretion
Factors: DKA, myeloproliferative and lymphoproliferative disease, acute EtOH, hypothyroidism, acromegaly, hypo or hyperparathyroidism, chronic hemolytic anemia, obesity
Medications:
- Decrease uric acid filtration: diuretics (thiazide and loop diuretics), nicotinic acid (Niaspan), salicylates (ASA), alcohol (EtOH), levodopa/carbidopa, ethambutol, pyrazinamide, ticagrelor
Acute treatment:
- Colchicine, NSAIDs, corticosteroids (if NSAIDS contraindicated)
Chronic treatment:
- Allopurinol or Uloric (febuxostat), colchicine and probenecid, pegloticase
- Don’t use salicylates as they increase uric acid levels
- Steroids are reserved for resistant cases or patients that are not able to take colchicine or NSAIDs
- Indomethacin is the most commonly used NSAID
- Xanthine oxidase inhibitors: allopurinol (rash in CKD, interaction with azathioprine, mercaptopurine,
- Urate oxidize enzyme: uricase, pegloticase
- Prevention: decrease red meat consumption (blood has uric acid), decrease alcohol consumption, decrease weight
Prophylaxis:
- Colchicine or choline + allopurinol. Stopping suddenly may cause an attack.
- Urosuric agents: probenacid, sulfripyrazone
- Febuxostat decreases uric acid made
- Pegloticase decreases uric acid made
- Probenacid – increase excretion