Inpharma 1221 - 22 Jan 2000

Options for the treatment of goutThe rheumatic disease gout is ‘an underdiagnosed

condition that presents diagnostic and treatmentchallenges’, says Professor RD Sturrock from the RoyalInfirmary, Glasgow, UK.

Professor Sturrock says that the first line of therapy foracute gout are NSAIDs, which should be given at fulldoses unless patients have a history of peptic ulcer,renal impairment and hypertension, or heart failure. Analternative is oral or IV colchicine, but ProfessorSturrock notes that colchicine is not well tolerated byelderly patients. For older patients with renalimpairment, intra-articular and systemic corticosteroidsare useful.

For long-term prophylaxis, Professor Sturrock saysthat allopurinol should be used, cautioning thatallopurinol therapy should not be initiated until 1 monthafter an acute episode. A low allopurinol dosage shouldbe used in older patients, increasing to a maximum of100–300 mg/day. Benzbromarone is an alternativeprophylactic therapy in urate undersecretors who havenormal renal function and no history of urate stones,says Professor Sturrock, adding that the target uratelevel should be 40–70 mg/L.Sturrock RD. Gout: easy to misdiagnose. BMJ 320: 132-133, 15 Jan2000 800801554

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Inpharma 22 Jan 2000 No. 12211173-8324/10/1221-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved