Gout - Block 1

Question 2

What is the most important RF for developing gout? Other RF?

Answer 2

Elevated serum urate concentration

CKD, obesitry, medication, male, older, obesity, sedetary, consumption of alcohol, sugar beverages, red meat and seafood

Question 3

Hyperuricemia is a good indicator for gout?

Answer 3

does NOT always result in development of gout, as many patients with hyperuricemia can remain asymptomatic

Question 4

Drugs that induce gout?

Answer 4

Question 5

General sx of acute gouty arthritis?

Answer 5

Acute inflammatory mono-arthritis, typically of the 1st metatarsophalangeal joint

Question 6

S/s of gout?

Answer 6

1. Intense pain
2. Erythema
3. Warmth
4. Swelling
5. Inflammation of affected joints

Question 7

Lab tests used for gout?

Answer 7

Uric acid

Observations of monosodium urate crystal in the synovial fluid or a tophus

Question 8

What is Tophaceous gout?

Answer 8

Deposits of monosodium urate crystals in soft tissues of the hands, wrists, or elbows (generally takes > 10 years to develop)

Question 9

What is gouty nephropathy and how is it treated?

Answer 9

Associated with acute and chronic kidney disease

Tx: potassium bicarbonate/citrate 30 – 80 mEq/day

Question 10

What is the definitive diagnosis of gout?

Answer 10

Identification of intracellular crystals of monosodium urate (MSU) monohydrate in the synovial fluid leukocytes

Crystal appearances: needle shaped

Synovial fluid appearance in patients with gout -> purulent with presence of white blood cells

Question 11

How those without synovial fluid aspiration, what factors can diagnos gout?

Answer 11

1. Monoarticular involvement of foot or ankle joint
2. Previous similar episode
3. Rapid onset of severe pain & swelling (peak pain intensity in less than 24 hours)
4. Erythema
5. Male sex
6. Presence of CV disease
7. Hyperuricemia

Question 12

Describe the managemetn of pain and inflammation during an acute gout flare?

Answer 12

Question 13

Pharm tx for gout?

Answer 13

XO inhibitors: Zyloprim (allopurinol), Uloric (febuxostat)
Uricosurics: Probalan (probenecid), Zurampic (lesinurad)
Recombinant Urate Oxidase Enzyme: Krystexxa (pegloticase)

Question 14

Describe the Initiation of ULT for Preventing Recurrence of Future Gout Flares?

Answer 14

Question 15

What is the serume urate goal after ULT?

Answer 15

Urate < 6 mg/dL

Question 16

What are the txs for gout inflammation?

Answer 16

1. NSAIDs
2. Colchine
3. CS

Continue for 3 - 6 months (longer if persistent acute gout flares continue)

Question 17

Describe the dosing of colchine for imparied kidney function?

Answer 17

Question 18

Describe the dosing of colchine for imparied liver function?

Answer 18

Question 19

What are the strong CYP3A4 inhibitors? How is colchicine adjusted?

Answer 19

Question 20

How is cochicine adjusted based on moderate CYP3A4 inhibnitors?

Answer 20

Question 21

How is cochicine adjusted based on P-gp inhibnitors?

Answer 21

Question 22

What are alt tx for imparied kid function?

Answer 22

Consider reduced-dose colchicine or corticosteroids for acute management of acute gout flares.

Question 23

What is alt tx for GI Dx?

Answer 23

Consider GI protection with PPI therapy when initiating NSAID therapy

Question 24

Alt tx for CHF?

Answer 24

Consider colchicine for treatment of an acute gout flare.
Consider colchicine for prophylaxis when initiating ULT.

Consider losartan as a therapy for CHF, due to its uricosuric properties.

Question 25

Alt tx for HTN

Answer 25

Consider losartan as an alternative or additional antihypertensive therapy, due to its uricosuric properties.

Question 26

Alt tx for polypharm

Answer 26

Consider losartan as ULT for patients with comorbid hypertension.

Consider fenofibrate as ULT in patients with comorbid hypertriglyceridemia

Question 27

Alt tx for financial limitations?

Answer 27

Consider allopurinol as ULT.

Consider NSAIDs or corticosteroids for treatment of acute gout flares.

Consider NSAIDs for prophylaxis of gout when initiating ULT.

Question 28

What do you do if patient is experiencing 1st acute gout flare?

Answer 28

Provide treatment for acute gout flare; NOT indicated for ULT

Question 29

How often do you monitor someone with gout?

Answer 29

NSAIDs: Long-term / prophylaxis -> recheck every 6 – 12 months

Obtain serum [uric acid] when titrating ULT, but, once serum [uric acid] = WNL, monitor periodically every 6 – 12 months.