Antigout medications

Antigout medications, as their name implies, are medications used to treat gout, which is a form of inflammatory arthritis.

The underlying cause of gout is hyperuricemia - which is too much uric acid in the blood, resulting in the formation of monosodium urate crystals.

These sharp, needle-like crystals deposit in areas of slow blood flow, such as joint spaces, or kidney filtration tubules.

Antigout medications work by preventing the buildup of uric acid, or by reducing inflammation.

Now, uric acid is a natural waste product of purines, which are one of the building blocks of DNA and RNA.

During their metabolism, purines are first degraded to hypoxanthine, which is then oxidized twice by xanthine oxidase; first to become xanthine, and then finally, to uric acid.

Uric acid circulates in the bloodstream until it reaches the kidneys where it’s secreted into the proximal tubules, and eventually excreted in the urine.

Now, hyperuricemia occurs when levels of circulating uric acid exceed normal levels, which is around 1.5-6 mg/dL for women and 2.5-8 mg/dL for men.

Urate crystal deposition occurs when concentration of circulating uric acid exceeds its rate of solubility, which is about 6.8 mg/dL.

Now, antigout medications are subdivided into two main groups: chronic gout medications, which are used to prevent the buildup of uric acid in the blood; and acute gout medications, which are used to reduce inflammation.

Chronic gout medications include xanthine oxidase inhibitors, such as allopurinol and febuxostat; uricosuric medications, such as probenecid and sulfinpyrazone; and recombinant urate oxidases, such as rasburicase and pegloticase.

On the other hand, acute gout medications include non-steroidal anti-inflammatory drugs (or NSAIDs), glucocorticoids, and colchicine.