GOUTY ARTHRITIS

Name :- Patel, Arpan C/Y/S :- BCH 2-5

Patel, Dishant Subject :- Biochemistry - III

Guide Questions

1. How is uric acid produced in the body? Which factors promote accumulation of uric acid in the blood
and result in the development of gout?

Ans.

Reference: Ishikawa, T. Multidrug resistance: Genomics of ABC transporters. Nat. Encycl. Hum.
Genome 2003, 4, 154160.

Purines are nitrogen-containing compounds, which are made inside the cells of your body, or come from outside of
your body, from foods containing purine (exogenous). Purine breaks down into uric acid.
 Ans. (b) These are the factors and circumstances
a. Highly active PRA(5- Phosphoribosyl-1-amine) transferase
b. G6pase deficiency
c. Highly active PRPP(Phosphoribosyl pyrophosphate)
d. Increased activity of glutathione reductase

2. What are the factors and circumstances in this case that could explain the acute attack of gout?
Ans. In this case these are the factors,

Presence of rod or needle shaped crystals in synovial fluid.

Inflammation on right toe with red colour and tenderness.

3. What is the mechanism of action of allopurinol and colchicine as treatment options in gouty arthritis?
At which points of treatment are these medication advisable?

Ans. (a) Allopurinol

IMP Inosine Hypoxanthine

Xanthine Oxidase
(XO)
H2O Pi Pi Ribose-1-5

Xanthine

Uric Acid
 Allopurinol is a hypoxanthine analog that is a suicide inhibitor of Xanthine Oxidase (XO). So it blocks the
Xanthine Oxidase. So now From Hypoxanthine to xanthine will not form therefore Uric Acid will not form. When
xanthine making from Hypoxanthine at that point Allopurinol medication advisable.

Allopurinol

IMP Inosine Hypoxanthine

Xanthine Oxidase
(XO)
H2O Pi Pi Ribose-1-5

Xanthine

Uric Acid

(b) Colchicine :-
It works by reducing the number of white blood cells which travel into the inflamed areas. This helps break the cycle
of inflammation and reduces the swelling and pain of the gout attack. It can reduce the attacks of gout, it does not
prevent the accumulation of uric acid that can lead to joint damage even without attack of hot, swollen joints.
Colchicine exerts a variety of pharmacological effects, but how these occur or how they relate to its activity in gout is
not well understood.
4. What other treatment strategies are recommended for patients with gouty arthritis?
Ans.

Nonsteroidal anti-inflammatory drugs (NSAIDs). It inhibits pain & inflammation.

Uricosuric agents. It increase the excretion of uric acid

Corticosteroid medications, such as the drug prednisone, may control gout inflammation and pain.
Corticosteroids may be administered in pill form, or they can be injected into your joint. Corticosteroids
are generally reserved for people who can't take either NSAIDs or colchicine.

Febuxostat, a nonpurine selective inhibitor of xanthine oxidase, is a potential alternative to allopurinol in

patients with gout. Inhibits synthesis of uric acid by inhibiting xanthine oxidase enzyme