Question

Q1) discuss the pharmologic agents intended to treat gouty arthritis and explain how they treat it

Answer 1

A gout is a form of arthritis caused by the presence of excess uric acid in the bloodstream. The high concentration of the uric acid in the blood may be due to the failure of the action of the kidney in removing the uric acid from the body. This high concentration of uric acid started accumulation in the joints.

Hyperuricemia is the central cause of the deposition of the crystals. the crystals are made up of monosodium urate (MSU). The inflammation due to thus deposition results in Gouty arthritis.

When the deposition takes place the innate immunity started to respond which is a nonspecific response common to all the invading pathogens. The macrophages present in the joints are activated and phagocytose the MSU crystals that release IL-1β.

The cytokine binds to the synovial endothelium and releases several proinflammatory cytokines. It activates neutrophils that also releases IL-1 β and proinflammatory cytokines that again elevate the inflammation.

• During the acute attack, nonsteroidal anti-inflammatory drugs (NSAIDs = indomethacin and naproxen ) and colchicine are given as first-line treatment for relief of acute pain. Colchicine works by decreasing the swelling and lessening the formation of uric acid crystals that cause pain.
• Anakinra is a recombinant, human IL-1 receptor antagonist which is a nonglycosylated form for the patients that do not respond to first-line treatment.
• Canakinumab (ACZ885) is a fully human monoclonal antibody that neutralizes the effect of human IL-1β in inflammation by inhibition of IL-1β signaling that results in the suppression of inflammation.

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