DOCTORS & MEDICAL STUDENTS VERSION
Hyperuricemia and gout frequently emerge among transplant recipients due to their compromised kidney function and the administration of medications that impede the elimination of uric acid, particularly drugs like cyclosporine and diuretics. The management of acute gout in these cases poses a notable challenge. In instances of monoarticular gout, provided that infection is ruled out, a preferred strategy often involves the injection of corticosteroids directly into the affected joint. Alternatively, in cases of polyarticular gout, escalating the dosage of systemic corticosteroids might be the sole recourse. Given that transplant patients frequently experience recurring gout attacks, sustaining long-term relief mandates the reduction of serum uric acid levels through the utilization of allopurinol or febuxostat. However, it's worth noting that the renal dysfunction frequently observed in transplant patients renders uricosuric agents ineffective. Notably, both allopurinol and febuxostat interfere with the metabolism of azathioprine and should be avoided by patients prescribed this medication.
Patient's Prognosis
In the absence of intervention, the duration of an acute gout attack can extend from a few days to multiple weeks. The gaps between such acute episodes exhibit a range spanning years; however, as the condition advances, the periods of asymptomatic relief tend to diminish. The emergence of chronic gouty arthritis arises subsequent to recurrent instances of acute gout, particularly when treatment has been insufficient. Notably, a younger age of disease onset correlates with an elevated likelihood of disease progression. In individuals whose first gout attack occurs beyond the age of 50, occurrences of incapacitating joint pathology are rare.
