ANTIGOUTY MEANS — the pharmaceuticals applied to the treatment of gout and giperurikemichesky states developing at other diseases (e.g., leukoses, psoriasis) or arising owing to accumulation in an organism uric to - you under the influence of a number of pharmaceuticals (e.g., Pyrazinamidum, diuretics, some antineoplastic means, etc.) and radiation therapy.
By the pharmakoterapevtichesky principle P. of page divide into two groups: the means applied to stopping of bad attacks of gout (see) and the means used for treatment hron, gouts.
For stopping of bad attacks of gout use colchicine, and also steroid and non-steroidal anti-inflammatory drugs. From group of steroid anti-inflammatory drugs for this purpose apply Prednisolonum (see) and other drugs of glucocorticoids. Among non-steroidal anti-inflammatory drugs have the greatest efficiency at bad attacks of gout indometacin (see), Butadionum (see), Naproxenum, sulindak. Are less effective acetylsalicylic acid (see) and other salicylates.
The general property of all listed drugs is ability to suppress gouts of manifestation of the acute synovitis, characteristic of attacks, arising under the influence of crystals uric to - you. On contents uric to - you in P.'s organism of page this group of significant effect is no, and only separate drugs (e.g., Butadionum, salicylates) at prolonged use lower its level in blood.
Mechanisms of action of these P. of page concerning an acute gouty synovitis are not identical. So, colchicine has cytostatic properties and has karioklastichesky effect on quickly proliferating cells, i.e. division into stages of metaphase detains them. He stops manifestations of an acute synovitis at attacks of gout due to disturbance of phagocytal activity of neutrophils that results from damage by colchicine of the microtubular device of neutrophils. Suppression of phagocytosis of crystals uric to - you at effect of colchicine lead to reduction of allocation from neutrophils of lizosomalny enzymes which promote development of an acute synovitis at attacks of gout. Effect of colchicine concerning an acute gouty synovitis is very selective. At synovites of other etiology colchicine is inefficient. This feature of its action can matter for differential diagnosis of gout. Other substances close to colchicine on chemical structure and action, napr, Colchaminum (see), dezatsetilkolkhamin and trimetilkolkhitsinovy to - that, did not receive broad practical application as P. of page since on activity at gout they considerably concede to colchicine.
Steroid and non-steroidal anti-inflammatory drugs stop bad attacks of gout due to the oppressing influence on development of an inflammation that is caused by hl. about river their ability to break formation of some mediators of an inflammation (e.g., prostaglandins) and to reduce intensity of processes (hypostasis, a hyperemia, migration of neutrophils, etc.). proceeding in the centers of an inflammation. Unlike colchicine these means work not selectively and weaken manifestations of acute synovites of various genesis. Ability of separate drugs of this group (Butadionum, salicylates) to lower contents uric to - you in an organism in the mechanism of their action at bad attacks of gout, obviously, has no essential value since other substances which more actively are reducing contents uric to - you, but not having antiinflammatory properties, do not stop bad attacks of gout.
For stopping of bad attacks of gout colchicine and anti-inflammatory drugs are appointed inside. In certain cases (e.g., at acute gouty arthritises of a knee joint with a plentiful exudate) resort to punctures of joints and suction of exudate with the subsequent introduction of glucocorticoids (a hydrocortisone, Prednisolonum) to a joint cavity.
For treatment hron. gouts use P. of pages which unlike the drugs stopping bad attacks of this disease reduce contents in an organism uric to - you. On the mechanism of action among P. the page of this group can be allocated: inhibitors of synthesis uric to - you; uricosuric means, i.e. the drugs increasing its allocation with urine; drugs of the mixed type of action.
From among inhibitors of synthesis uric to - you in practice apply hl. about river allopurino l. This drug and the active metabolite which is formed of it in an organism — oksipurinol (uroxin) — suppress activity of enzyme of a xanthineoxidase, edges participates in transformation of hypoxanthine into xanthine, and xanthine — in uric to - that. Oppression by Allopyrinolum of synthesis uric to - you are followed by decrease in its content in blood and reduction of allocation with urine. Along with it allocation with urine of hypoxanthine and xanthine increases. Decrease in contents uric to - you in blood at use of Allopyrinolum promotes its mobilization from gouty tofus and other fabric depots that in an initiation of treatment this drug can lead to development of a bad attack of gout.
Inhibitors of synthesis uric to - you treat also orotovy acid (see), edges, however, concedes to Allopyrinolum by efficiency and in this regard rather seldom is uses for treatment hron, gouts.
As uricosuric means at hron, gout most widely apply anturan, Aethamidum and probenetsid which reduce contents uric to - you in blood, strengthening its removal by kidneys that is caused by hl. obr. ability of these drugs to oppress a reabsorption of urates in renal tubules. At disturbance of secretory function of kidneys efficiency of uricosuric means decreases. Reduction of level uric to - you in blood under the influence of uricosuric means lead to mobilization of urates from gouty tofus in this connection during the use of these means, as well as in case of use of Allopyrinolum, development of bad attacks of gout is possible.
Allocation uric to - you raise also combined drug Urodanum (see). However on a number of properties it significantly differs from uricosuric means. So, Urodanum promotes allocation uric to - you through kidneys, apparently, because the phosphate and a lity which are its part of piperazin benzoate form with uric to - that easily soluble salts. Besides, Urodanum can increase solubility of urates, causing changes of pH of urine. By efficiency Urodanum considerably cedes to other P. the village and therefore in modern practice it is rare * it is used for therapy hron, gouts.
Perspective P. of page of the mixed type of action are some derivatives of coumarone. From this group of connections as means for treatment hron, gouts are offered benziodaron (a synonym of Algocor, Cardivix, etc.) and benzobromaron which inhibit synthesis uric to - you and along with it have uricosuric effect. By efficiency at hron, gout these drugs do not concede to Allopyrinolum and favourably differ from uricosuric means in the fact that their activity practically does not change at disturbances of secretory function of kidneys.
Kliniko-pharmakol. the main P.' characteristic of the page applied in the USSR is provided in the table.
Bibliography: Nasonova V. A., etc. Pharmacotherapy in rheumatology, page 179, M., 1976; Pi x E. G. Podagr's varnish, M., 1970, bibliogr.; Boss G. R. a. Seegmiller J. E. Hyperuricemia and gout, New Engl. J. Med., v. 300, p. 1459, 1979, bibliogr.; Craig G. L. a. Buchanan W. W. Antirheumatic drugs, Drugs, v. 20, p. 453, 1980, bibliogr.; Goldfinger S. E. Treatment of gout, New Engl. J. Med., v. 285, p. 1303, 1971; Scott J. T. Choice of treatment in gout, Practitioner, v. 219, p. 469, 1977.
V. K. Muratov.