New insights in treatment of hyperuricemia and gout

In introductory part discusses author problems of early and accurate diagnosis of gouty arthritis. The definitive diagnosis is confirmed by findings of natrium – urate crystals in polarized microscopy in synovial effusion. If material for crystal analysis is not available, diagnosis could be done by combination of clinical criteria. Recently published EULAR recommendations for diagnosis of gouty arthritis can be applicated with advantage. The main aim of the therapy of acute gouty arthritis is the termination of the acute attack, elimination of natrium urate crystals deposits, prevention of future attacks, prevention or reversal of complications and associated features of gout. The treatment of acute gouty arthritis we start with application of local ice and immediataly start with antiinflammatory therapy (time more important than choice of drug) and we applicate either nonsteroidal antiinflammatory drug (NSAIDs), colchicin or corticosteroids. NSAIDs are effective also when used with some delay after start of the attack, but their efficacy has no diagnostic value. We use higher initial doses of NSAIDs with later reduction, but we introduce concomitantly effective gastroprotective princip (PPI inhibitors + nonselective NSAIDs or coxibs) for patients with higher risk for NSAIDs induced gastropathy. From coxibs of 2nd generation, has etoricoxib indication of gout, after sucesfull study. Colchicine is preferred for patients in whom the diagnosis of gout is not confirmed, eventually by patients, where NSAIDs are contraindicated. It patients with mono oligoarthritis, i. a. corticosteroidals can be applicated and for patients with polyarthritis, systemic steroids with initial dose of 30–60 mg of prednison or its equivalent can be used. For the control of hyperuricemia both nonpharmacologic (regime, diet) and pharmacologic modalities should be used. Only available drug on Czech market at present time is inhibitor of xanthinoxidase allopurinol. It the phase of clinical testing of phase III is new nonpurine inhibitor of xanthinoxidase febuxostat. Another drug also in phase III of clinical studies is PEG uricase, which is very effective, but there are problems with immunogenecity, induction of gout attacks and cost.

Keywords: Key words: hyperuricemia, gout, allopurinol.