Pyrazinamide gout with

Pyrazinamide interferes with the renal excretion of urate, resulting in hyperuricemia. Acute episodes of gout or arthralgia have occurred. Arthralgia responds better to NSAIDs than to uricosuric drugs (997). 

Blood urate concentrations can be increased because of reduced excretion of uric acid in patients taking ethambutol (390). This is probably enhanced by combined treatment with isoniazid and pyridoxine. Special attention should be paid when tuberculostatic drug combinations include pyrazinamide. However, severe untoward clinical effects are rare, except in patients with gout or renal insufficiency (391,392). 

ALLOPURINOL PYRAZINAMIDE i efficacy of antigout drugs Pyrazinamide can induce hyperuricaemia Pyrazinamide should not be used in patients with gout... 

Adverse effects include hyperuricaemia and arthralgia, which is relatively frequent with daily but less so with intermittent dosing and, unlike gout, affects both large and small joints. Pyrazinoic acid, the principal metabolite of pyrazinamide, inhibits renal tubular secretion of urate. Symptomatic treatment with an NSAID is usually sufficient and it is rarely necessary to discontinue pyrazinamide because of arthralgia. Hepatitis, which was particularly associated with high doses, is not a problem with modern short-course schedules. Sideroblastic anaemia and urticaria also occur. 

Pyrazinamide should be used with extreme caution in patients with a history of gout, especially in elderly people, in whom urinary urate stones can cause renal insufficiency. 

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