Colchicine give within first 12-36 hrs for best results
PO: .6mg 2 tab x 1, then .6mg every 1hour until
symptoms resolve (max 5-7mg/d)
Corticosteroids: intraarticular injections. Systemic
steroids (prednisone 20-30mg/d) reserved for patients who are intolerant to
NSAIDs and colchicine.
ACTH – 40-80 units intramuscular twice a day for 2
days, then every day for several days
CHRONIC TREATMENT (PROPHYLAXIS):
For patients with frequent attacks, tophi or renal
damage.
Uricosuric drugs: increase renal excretion (avoid in
patients with history of nephrolithiasis, renal disease): Probenicid and
Sulfinpyrazone
Probenicid: will increase plasma levels of PCN,
cephalosphorins, sulfonimides, indomethacine
Sulfinpyrazone: has anti-platelet activity.
Allopurinol: xanthine oxidase inhibitor; decreases
production of urate. Drug of choice in Pts with renal disease,
nephrolithiasis;
Also drug of choice for prophylaxis in the treatment of malignancy.
Side effects: GI, leukopenia, Derm (Stevens Johnsons,
Toxic Epidermal Necrolysis).
DO NOT START CHRONIC TREATMENT DURING ACUTE ATTACK.
(will worsen symptoms).
