Aspirin gout effects

Treatment of gout In large dose, aspirin is effective in the treatment of gout. 

Gl effects Use caution in those intolerant to salicylate because of Gl irritation, and in gastric ulcers, peptic ulcer, mild diabetes, gout, erosive gastritis, or bleeding tendencies. Salsalate and choline salicylate may cause less Gl irritation than aspirin. 

All NSAIDs, including aspirin, are about equally efficacious with a few exceptions—tolmetin seems not to be effective for gout, and aspirin is less effective than other NSAIDs (eg, indomethacin) for ankylosing spondylitis. 

Although colchicine is more specific in gout than the NSAIDs, NSAIDs (eg, indomethacin and other NSAIDs [except aspirin]) have replaced it in the treatment of acute gout because of the troublesome diarrhea sometimes associated with colchicine therapy. Colchicine is now used for the prophylaxis of recurrent episodes of gouty arthritis, is effective in preventing attacks of acute Mediterranean fever, and may have a mild beneficial effect in sarcoid arthritis and in hepatic cirrhosis. Although it can be given intravenously, this route should be used cautiously because of increased bone marrow toxicity. 

Iopanoic acid is as potent a uricosuric agent as probenecid and this effect might explain some renal complications aspirin reduces the uricosuric effect but can also impair X-ray visualization because of competition at plasma protein-binding sites. Fluctuations of serum urate after oral cholecystography can interfere with diagnostic tests and even precipitate an attack of gout (578). 

The efficacy of flurbiprofen at dosages of 200-400 mg/d is comparable to that of aspirin and other NSAIDs in clinical trials for patients with rheumatoid arthritis, ankylosing spondylitis, gout, and osteoarthritis. It is also available in a topical ophthalmic formulation for inhibition of intraoperative miosis. Flurbiprofen intravenously has been found to be effective for perioperative analgesia in minor ear, neck, and nose surgery and in lozenge form for sore throat. 

All NSAIDs, including aspirin, are about equally efficacious with a few exceptions—tolmetin seems not to be effective for gout, and aspirin is less effective than other NSAIDs (eg, indomethacin) for ankylosing spondylitis. Thus, NSAIDs tend to be differentiated on the basis of toxicity and cost-effectiveness. For example, the gastrointestinal and renal side effects of ketorolac limit its use. Fries et al (1993), using a toxicity index, estimated that indomethacin, tolmetin, and meclofenamate were associated with the greatest toxicity, while salsalate, aspirin, and ibuprofen were least toxic. The selective COX-2 inhibitors were not included in this analysis. 

Correct choice = D. Acetaminophen does not antagonize the uricosuric agent probenecid and therefore may be used in patients with gout. Acetaminophen has little anti-inflammatory effect, but has analgesic and antipyretic activities equal to those of aspirin. It is the analgesic-antipyretic of choice for children with viral infections aspirin can increase the risk for Reye s syndrome in children. Acetaminophen is a suitable substitute for the analgesic and antipyretic effects of aspirin in those patients with gastric complaints. 

Aspirin in high dose reduces renal tubular reabsorption of urate (both substances are transported by the same mechanism), but other treatments for hyperuricaemia are preferred. Indeed aspirin should be avoided in gout as low doses (< 2 g/day) inhibit urate secretion, causing urate retention and on balance its effects on urate elimination are adverse. 

Acute gout is usually treated with an NSAID in full dose. Any such drug which is tolerated may be used (except aspirin which in low dose promotes urate retention, see below) indomethacin is often chosen because of its strong anti-inflammatory action and efficacy. If treatment is started early, the attack may be terminated in a few hours. Colchicine is useful if NSAIDs are contraindicated. If neither colchicine nor NSAIDs are tolerated, oral prednisolone 40 mg/d and tapered over a week is also effective. It requires only a moment s thought to appreciate that the uricosurics and allopurinol will not relieve an acute attack of gout. 

In low dosages (up to 2 g/day), aspirin reduces urate excretion and blocks the effects of probenecid and other uricosuric agents (116). However, in 11 patients with gout, aspirin 325 mg/day had no effect on the uricosuric action of probenecid (117). In higher dosages (over 5 g/day), salicylates increase urate excretion and inhibit the effects... 

Colchicine is an antimitotic agent, highly effective in the treatment of gout, but associated with considerable toxicity. Diarrhea is used as a criterion for adequate dosage. Accidental overdosage occurs relatively often and can be dangerous. For these reasons, NSAIDs (except aspirin) are often used in acute gout instead of colchicine. 

Since its introduction in I96S. it has been widely used as an anti-inflammatuiy analgesic in RA. spondylitis, and OA. and to a lcs.scr extent in gout. Although both its analgesic and anti-inflammatory activities arc well established, it appears to be no more effective than aspirin. 

The symptoms of acute gout respond to anli-innammatory drugs suchasindomelh-acin. but it should be noted that these drugs have no direct effect on the serum urate level. Low-dose aspirin should be avoided as it inhibits renal urate excretion. Treatment must also be directed at the hyperuricaemia. Drugs such as probenecid which promote urate excretion can be used prophylactically. A diet which is low in purines and alcohol may be prescribed in an effort to reduce the plasma urate concentration. Allopurinol, a specific inhibitor of the enzyme xanthine oxidase which catalyzes the oxidation... 

When tolerated, indomethacin often is more effective than aspirin in the treatment of ankylosing spondylitis and osteoarthritis. It also is very effective in the treatment of acute gout, although it is not uricosuric. 

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