Gout

Purine metabolism is responsible for the production of Sodium urate. When the quantity of Urate in the blood goes up than normal, it may result in gout which may show inflammation and produces more oxygen metabolites in the blood.

Therapeutic strategies:
First of all it is better to use purine free diet i.e. we must use dairy products, fruits and cereals. The sequence, in the diagram, show that most effective medicine in treating gout is that which causes reduced entry of leukocyte into the affected joint which may be achieved by colchicine.

Other ways of therapy include:

1. Disturbing uric acid synthesis with the help of allopurinol.

2. Promoting excretion of uric acid with probenecid or sulfinpyrazone.

3. Use of NSAIDs.

Types of Gout:
There are two types of gout:

1. Acute gout.

2. Chronic gout.

Acute gout:
Causes:
The main causes of acute gout are as follows:

1. Diet which is rich in purine.

2. Kidney diseases.

3. Alcohol consumption.

Treatment:
In this we can use Indomethacin in combination with Aspirin. Indomethacin slows the movement of granulocytes in the area which is affected and aspirin decreases pain and inflammation.

Chronic gout:

Causes:
The main causes of chronic gout are as follows:
1. Genetic defect.
2. Renal deficiency
3. Lesch Nyhan syndrome.
4. Excessive synthesis of uric acid associated with cancer chemotherapy.

Treatment:
In this we can use Uricosuric drugs such as probenecid and sulfinpyrazone and Allopurinol.

Uricosuric drugs (e.g. Probenecid or sulfinpyrazone) promote excretion of uric acid resulting in reduced concentration of uric acid in plasma. It is preferred for patients with normal excretion of uric acid through urine.

Allopurinol selectively inhibits some steps in the middle of the biosynthesis of uric acid. It is preferred for patients with excessive uric acid excretion (which may be due to renal insufficiency).