Gout and

Colchiciae (23) is a toxic substance occurring ia Colchicum autumnale, it coataias the aucleus of pyrogaUol trimethyl ether. Colchiciae has beea used ia the treatmeat of acute gout, and ia plant genetics research to effect doubling of chromosomes. 

Niacin is contraindicated in patients with known hypersensitivity to niacin, active peptic ulcer, hepatic dysfunction, and arterial bleeding. The drug is used cautiously in patients with renal dysfunction, high alcohol consumption, unstable angina, gout, and pregnancy (Category C). 

Curto R> Voit EO, Cascante M Analysis of abnormalities in purine metabolism leading to gout and to neurological dysfunctions in man. Biochem J 1998 3 29 477. 

Harris MD> Siegel LB, Alloway JA Gout and hyperuricemia. Am Family Physician 1999 59 925. 

Identify patients in whom maintenance therapy for gout and hyperuricemia is warranted. 

Select an appropriate drug to reduce serum uric acid levels in patients with gout, and outline a plan for monitoring efficacy and toxicity. 

Long-term consequences of gout and hyperuricemia include joint destruction, tophi, and nephrolithiasis. 

FIGURE 56-1. Synovial fluid containing extracellular and intracellular monosodium urate crystals. (From Reginato AJ. Gout and other crystal arthropathies. In Braunwald E,... 

Some drugs can cause hyperuricemia and gout, such as thiazide diuretics, niacin, pyrazinamide, cyclosporine, and occasionally, low-dose aspirin. In most cases, these drugs block uric acid secretion in the kidney. Long-term consequences of gout and hyperuricemia include joint destruction, tophi, and nephrolithiasis. 

FIGURE 56-2. Treatment algorithm for gout and hyperuricemia. Renal insufficiency is defined as an estimated creatinine clearance (CrCI) of less than 30 mL/minute. IA, Intraarticular NSAID, nonsteroidal anti-inflammatory drug. 

TABLE 56-1. Dosage Regimens for Acute Gout and Antihyperuricemic Treatment... 

Mikuls TR, Farrar JT, Bilker WB, et al. Suboptimal physician adherence to quality indicators for the management of gout and... 

Chap. 56 - Gout and Hyperuricemia Universal Program Number ... 

Colchicine (a drug used in treatment of gout) and vinblastine (a cancer chemotherapy agent) may decrease liver uptake of americium. In rats that received an intraperitoneal injection of either colchicine and vinblastine prior to an intravenous or intramuscular injection of americium citrate, liver uptake of americium was lower, relative to controls, and kidney and skeletal americium uptake were higher (Seidel 1984, 1985). The effect is thought to involve disruption of hepatic microtubule formation, which is critical to the formation and intracellular processing of lysosomes, the initial site of accumulation of americium in the liver. 

CCL3 Synovium, SF ELISA IHC Higher levels compared with OA, gout, and traumatic joint injury. Higher levels found in early arthritis (<1 y), in lining and sublining layer of synovium compared with late arthritis (>5y). 38, 135, 141, 189... 

Serum, drain fluid, SF ELISA Higher levels present in SF of RA patients compared with serum of normal donors and drain fluids from lymph node resection of mammary carcinoma. Higher levels compared with gout and OA. 139, 145, 187, 191... 

Antirheumatic. Elder flower and vinegar fomentations can be used topically for painful joints, muscle soreness and stiffness. Elderberry juice is an ancient remedy to help neuralgia, rheumatism, gout and sciatica. Parts used flowers, berries, leaves. 

Excessive lead exposure has also been implicated as a causative agent in kidney disease associated with gout and essential hypertension (Batuman et al. 1981, 1983). Gout patients with renal impairment, and hypertensive patients with renal impairment, had significantly higher lead stores (as determined by the 3-day EDTA lead mobilization test) than gout patients or hypertensive patients without renal impairment, respectively. Therefore, excessive lead absorption may be involved in the renal impairment seen in patients with gout or essential hypertension. 

In Asia, this plant is valued as a remedy for fever, rheumatism, gout, and inflammatory illnesses. In China, the roots are used as febrifuges, deobstruents, and carminatives, and are used to assuage muscle pains, thoracic and abdominal inflammations, puerperal fever, and diarrhea. 

See Chap. 96, Gout and Hyperuricemia, authored hy Michael E. Ernst, Elizabeth C. Clark, and David W. Hawkins, for a more detailed discussion of this topic. 

Potentially important laboratory abnormalities occurring with niacin therapy include elevated liver function tests, hyperuricemia, and hyperglycemia. Niacin-associated hepatitis is more common with sustained-release preparations, and their use should be restricted to patients intolerant of regular-release products. Niacin is contraindicated in patients with active liver disease, and it may exacerbate preexisting gout and diabetes. 

Colchicine (6) is used in the treatment of a broad range of diseases including acute gout and Mediterranean fever [28] and induces depolymerization of tubulin. This compound (6) distorts the tubulin/microtubule equilibrium by binding to the tubulin dimer and halting mitosis in the metaphase. The reason this approach is such a successful target in cancer therapy is that... 

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