Medical Pharmacology Topics   

Antirheumatics and Gout Treatment

In addition to the use of NSAIDs and glucocorticoids, there are a number of drugs used for the treatment of rheumatoid arthritis and osteoarthritis.

Because rheumatoid arthritis appears to be an autoimmune disease, a number of immune suppressive and/or antineoplastic drugs are used to relieve symptoms of the disease, including azathioprine, hydrochloroquine, leflunomide, methotrexate, penicillamine and anakinra.

These drugs are used only in severe rheumatoid arthritis, unresponsive to conventional therapy. They have numerous side effects, including fever, chills, anorexia, nausea, vomiting, hepatotoxicity, agranulocytosis, leukopenia, anemia, and thrombocytopenia.

Other drugs used to treat rheumatoid arthritis are the gold salts: auranofin, aurothioglucose and gold sodium thiomalate. They are used to manage progressive rheumatoid arthritis that is unresponsive to traditional therapies. They can relieve pain and stiffness, and in some patients may arrest the progression of joint degeneration. These drugs do not reverse damage that has already occurred. Side effects limit their use and include metallic taste, stomatitis, and diarrhea wit abdominal pain and cramping. Some patients develop a rash, dermatitis, thrombocytopenia, aplastic anemia, agranulocytosis and acute tubular necrosis.

Gout may be acute or chronic. Acute gout is characterized by attacks of severe pain, which may be limited to a specific joint. It is caused by formation of urate crystals in the joint. As leukocytes ingest crystals they release pain mediators.

In chronic gout, patients have increased plasma uric acid (hyperuricemia). There may be no need to lower urate levels if the condition is asymptomatic, but the uric acid may precipitate in the kidneys and form stones.

Drugs used to treat gout include allopurinol, probenecid, sulfinpyrazone and colchicine. Allopurinol reduces the formation of uric acid by inhibiting xanthine oxidase. 

Probenecid and sulfinpyrazone increase excretion of uric acid by decreasing reabsorption. Treatment with these drugs include drinking lots of water and alkalinization of urine to prevent ppt or uric acid in renal tubules.

Colchicine is used to relieve acute gout attacks and prophylactically to prevent acute attacks. It inhibits the migration of granulocytes to the inflamed area, thus decreasing the inflammatory response. Major side effects include nausea, vomiting, diarrhea and abdominal pain. Long term administration increases the incidence of blood dyscrasias.

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