title: Gout and organ transplantation.
abstract: Acute and chronic gout are common complications following organ transplantation. Risk factors include those shared with the general population (eg, diuretic use) and transplant-specific risk factors (eg, cyclosporine). Clinical features of gout are similar to those seen in the general population, although tophi may be more common. A definitive diagnosis requires demonstration of monosodium urate crystals within synovial fluid or tophi. Treatment is often empiric, although a poor response should prompt joint aspiration to exclude septic arthritis. Corticosteroids are commonly used to treat acute gout due to the adverse profile and drug interactions with NSAIDs and colchicine. Sustained reduction of serum urate (≤6 mg/dL) is critical in long-term management. Allopurinol is the most commonly used agent, although vigilant monitoring is required if combined with azathioprine. Other options include febuxostat and benzbromarone. The role of newer agents such as interleukin-1 inhibitors and uricases remains to be determined. General measures should include minimizing diuretic use.
authors.affiliation: Department of Medicine, University of Otago, Christchurch, P.O. Box 4345, Christchurch, 8140, New Zealand. lisa.stamp@cdhb.govt.nz
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Stamp
authors.forename: Peter T
authors.initials: PT
authors.lastname: Chapman
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D003078:Colchicine / Q000627:therapeutic use; D006073:Gout / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006074:Gout Suppressants / Q000627:therapeutic use; D006801:Humans; D016377:Organ Transplantation / Q000009:adverse effects*
chemical_list: D000305:Adrenal Cortex Hormones; D006074:Gout Suppressants; D003078:Colchicine