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Treatment of acute gouty arthritis: One physician’s approach and where this management stands relative to developments in the field

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Abstract

An attack of acute gouty arthritis is one the most painful episodes that can be experienced by humans. Fortunately, there are three classes of agents that can effectively terminate the acute attack. These include colchicine, nonsteroidal anti-inflammatory drugs, and glucocorticoids. If therapy with any one of these is initiated promptly after the onset of symptoms, relief should occur quickly. Recent observations have increased the knowledge of crystal-induced acute inflammatory responses. These observations allow a better understanding of the mechanisms of action of these agents and provide the rationale for using them in combination in severe or refractory cases.

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References and Recommended Reading

  1. Wallace SL, Bernstein D, Diamond H: Diagnostic value of the colchicine therapeutic trial. JAMA 1967, 199:525–527.

    Article  PubMed  CAS  Google Scholar 

  2. Wallace SL, Robinson H, Masi AT, et al.: Preliminary criteria for the classification of acute arthritis of primary gout. Arthritis Rheum 1977, 20:895–900.

    Article  PubMed  CAS  Google Scholar 

  3. Logan JA, Morrison E, McGill PE: SUA in acute gout [letter]. AnnRheum Dis 1997, 56:696–697.

    Article  CAS  Google Scholar 

  4. Urano W, Yamanaka H, Tsutani I, et al.: The inflammatory process in the mechanism of decreased serum uric acid concentrations during acute gouty arthritis. J Rheumatol 2002, 29:1950–1953. Provocative article proposing a mechanism for the decreased or normal urate levels frequently encountered in gout patients at the time of an acute attack.

    PubMed  CAS  Google Scholar 

  5. Rogachefsky RA, Carneiro R, Altman RD, Burkhalter WE: Gout presenting as infectious arthritis: two case reports. J Bone Joint Surg 1994, 76:269–273.

    PubMed  CAS  Google Scholar 

  6. Yu KH, Luo SF, Liou LB, et al.: Concomitant septic and gout arthritis: an analysis of 30 cases. Rheumatology 2003, 42:1062–1066. Report observing the suprising finding that almost a third of patients with these coexistent conditions lack the usual findings that would indicate a septic arthritis.

    Article  PubMed  CAS  Google Scholar 

  7. Schlesinger N, Detry MA, Holland BK, et al.: Local ice therapy during bouts of acute gouty arthritis. J Rheumatol 2002, 29:331.

    PubMed  Google Scholar 

  8. Terkeltaub RA: Gout. N Engl J Med 2003, 349:1647–1655. Outstanding review of the current views of the clinical practice of all aspects of gout.

    Article  PubMed  CAS  Google Scholar 

  9. Lange U, Schumann C, Schmidt KL: Current aspects of colchicine therapy: classical indications and new therapeutic uses. Eur J Med Res 2001, 6:150.

    PubMed  CAS  Google Scholar 

  10. Molad Y: Update on colchicines and its mechanism of action. Curr Rheumatol Rep 2002, 4:252.

    Article  PubMed  Google Scholar 

  11. Terkeltaub R, Baird S, Sears P, et al.: The murine homolog of the interleukin-8 receptor CXCR-2 is essential for the occurrence of neutropnilic inflammation in the air pouch model of acute urate crystal-induced gouty synovitis. Arthritis Rheum 1998, 41:900–909.

    Article  PubMed  CAS  Google Scholar 

  12. Manitz MP, Horst B, Seeliger S, et al.: Loss of S100A9 (MRP14) results in reduced interleukin-8-induced CD11b surface expression, a polarized microfilament system, and diminished responsiveness to chemoattractants in vitro. Mol Cell Biol 2003, 23:1034–1043.

    Article  PubMed  CAS  Google Scholar 

  13. Nacken W, Roth J, Sorg C, Kerkoff C: S100A9/S100A8: myeloid representatives of the S100 protein family as prominent players in innate immunity. Microsc Res Tech 2003, 60:569–580.

    Article  PubMed  CAS  Google Scholar 

  14. Rychman C, McColl SR, Vandal K, et al.: Role of S100A8 and S100A9 in neutrophil recruitment in response to monosodium urate monohydrate crystals in the air-pouch model of acute gouty arthritis. Arthritis Rheum 2003, 48:2310–2320.

    Article  CAS  Google Scholar 

  15. Rychman C, Vandal K, Rouleau P, et al.: Proinflammatory activities of S100: proteins S100A8, S100A9, and S100A8/A9 induce neutrophil chemotaxis and adhesion. J Immunol 2003, 170:3233–3242.

    Google Scholar 

  16. Schumacher HR, Boice HA, Daikh DI, et al.: Randomized double blind trial of etoricoxib and indomethacin in treatment of acute gouty arthritis. BMJ 2002, 324:1488. Multicenter trial demonstrating similar efficacy between a new selective COX2 inhibitor and indomethacin for the treatment of acute gout flares.

    Article  PubMed  CAS  Google Scholar 

  17. Clive DM: Renal transplant-associated hyperuricemia and gout. J Am Soc Nephrol 2000, 11:974–979.

    PubMed  CAS  Google Scholar 

  18. Fernandez C, Moguera R, Gonzalez JA, et al.: Treatment of acute attacks of gout with a small dose of intraarticular triameenalone acetonide. J Rheumatol 1999, 26:22850.

    Google Scholar 

  19. Getting SJ, Christian HC, Flower RJ, Perretti M: Activation of melanocortin type 3 receptor as a molecular mechanism for adrenocorticotropic hormone efficacy in gouty arthritis. Arthritis Rheum 2002, 46:2765–2775.

    Article  PubMed  CAS  Google Scholar 

  20. Wallace SL, Singer JZ: Review: systemic toxicity associated with the intravenous administration of colchicines: guidelines for use. J Rheumatol 1988, 15:495.

    PubMed  CAS  Google Scholar 

  21. Evans TI, Wheeler MT, Small RE, et al.: A comprehensive investigation of inpatient colchicine use shows more education is needed. J Rheumatol 1996, 23:143.

    PubMed  CAS  Google Scholar 

  22. Wortmann RL: Effective management of gout: an analogy. Am J Med 1998, 105:513–514.

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Internal Medicine, The University of Oklahoma College of Medicine, 4502 East 41st Street, 74137, Tulsa, OK, USA

    Robert L. Wortmann MD

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  1. Robert L. Wortmann MD
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Wortmann, R.L. Treatment of acute gouty arthritis: One physician’s approach and where this management stands relative to developments in the field. Curr Rheumatol Rep 6, 235–239 (2004). https://doi.org/10.1007/s11926-004-0074-4

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  • DOI: https://doi.org/10.1007/s11926-004-0074-4

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