94 Etiology and Pathogenesis of Hyperuricemia and Gout Robert T. Keenan, Johannes Nowatzky, Michael H. Pillinger Key Points Uric acid is the biologically active end product of human purine metabolism. 9. Other forms of TB included are cervical lymphadenopathy, granulomatous ascending colon TB, TB meningitis, miliary Koch's, cutaneous TB, abdominal Koch's and pleural effusion, which were in the percentage of 20.52%, 2.56%, 5.13%, 7.69%, 2.56%, 12.56% and 12.82% respectively.The issue of patient's tolerance of anti-tuberculosis drugs is extremely important for the treatment outcomes and as a consequence for tuberculosis control in general [Despite the development of potent regimen, the treatment for tuberculosis continues to be a problem in patients who do not tolerate these drugs. Majority of the patients, 74.37% of patients belonged to the age group of 15-45 years and remaining 25.63% belonged to the age group of 46-75 years. • insulin resistance may be associated with gout, by enhancing renal urate reabsorption. uric acid is converted by uricase into allontion and hydrogen peroxide, which in presence of peroxidase, oxidizes the chromogen (4-aminophenazone/3-hydroxy, 2,4,6-tribromo benzoic acid) to a red colored compound Quinoneimine.

9. 48.72% patients showed 25-50% increase in the uric acid level. Informed consent was taken from the patients.Prospective observational single patient group study where all patients are treated with the same drug through the study period• All in-patients diagnosed with TB admitted to medicine department, and started on intensive phase anti-tubercular treatment as St. Martha's Hospital, Bangalore.• Patients with hepatic or renal dysfunction and gouty arthritis• Patients who is not willing to give informed consent.• Patients who were diagnosed with TB (both pulmonary as well as extra pulmonary) and who were prescribed pyrazinamide in their regimen were selected for the study.• Informed consent was obtained and detailed history was taken for all the patients enrolled in the study.• Blood was withdrawn to check the uric acid levels at week '0', along with SGOT, SGPT and Liver enzymes.• Blood was withdrawn for determining uric acid levels at week 2, after introduction and at week 8, during completion of pyrazinamide therapy, respectively.• Patients were observed and asked for any symptoms of arthralgia with the help of questionnaire [Abnormal serum uric acid level was estimated by enzymatic colorimetric method.
Out of total TB patients, 66.66% were male and 33.33% were female patients.

Cyclosporine. 2. Cytotoxic drugs. Introduction. Applies to: GoutThe use of pyrazinamide is contraindicated in patients with acute gout. Hyperuricemia during therapy with pyrazinamide is due to inhibition of uric acid excretion by pyrazinoic acid, the main metabolite of pyrazinamide [Hyperuricemia is a side effect associated with or without arthralgia, articular pain and swelling [Ethical committee clearance was obtained from Institutional Ethical Review Board, St. Martha's hospital.Data was obtained from prospective series of patients who were started with anti-tubercular treatment after adequate diagnosis of TB at St. Martha's Hospital. pyrazinamide, hyperuricemia, patient compliance, tuberculosis, group study. Pyrazinamide inhibits the renal excretion of uric acid, which may frequently result in precipitation or exacerbation of gout. A small percentage of overproducers have enzymatic defects that account for their hyperuricemia. Tuberculosis is a major health problem in developing countries. 6, 9 Furthermore, gouty attacks have been associated with patients taking pyrazinamide. This is due to a decrease in urate clearance as retained organic acids compete for secretion in the …

• Hyperuricemia does NOT always lead to gout, and many patients with hyperuricemia remain ... Pyrazinamide. As per DOTS therapy the standard regimen for TB patient is 6-9 months therapy, which is divided into intensive phase and continuation phase, intensive phase involves the use of Rifampin, Isoniazid, Ethambutol and Pyrazinamide, for two months and continuation phase involves use of Isoniazid and Rifampin for 4 months [One of the main adverse effects of pyrazinamide is hyperuricemia with or without arthralgia. In chronic renal failure, the uric acid level does not generally become elevated until the creatinine clearance falls below 20 mL/min, unless other contributing factors exist. Applies to: Liver DiseasePyrazinamide is primarily metabolized by the liver. Dosage adjustments may be necessary.Moderate Potential Hazard, Moderate plausibility. Despite an increase in serum uric acid levels beyond the normal range, arthralgia was not seen in TB patients who were on DOTS.

The objective was to study the effect of pyrazinamide on serum uric acid levels in patients with tuberculosis on intensive phase of DOTS therapy and to document any symptoms of hyperuricemia like arthralgia or gout. Serum uric acid levels should be monitored regularly, and appropriate measures (e.g., administration of uricosuric agents) taken to prevent the development of gout. Applies to: Renal DysfunctionThe half-life of pyrazinamide may be prolonged in patients with renal impairment.

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