00 Gout Flashcards
What levels are considered hyperuricemia?
Serum urate levels > 6.7 mg/dL (4-6 mg/dL) –> risk factor for gout, not a diagnostic factor
What dietary things should be avoided to reduce incidence of gout?
Organ meats high in purine contents (sweetbread, liver, kidney). High fructose corn syrup containing food. Soda. EtOH overuse ( > 2/day male, > 1/day female)
How do you manage asymptomatic hyperuricemia?
Do not treat asymptomatic hyperuricemia w/ drugs. Patient education is key
What is the treatment goal of an acute gouty flare?
Relieve pain ASAP. Terminate acute painful attack by controlling crystal-induced inflammation and pain. Treatment should happen within 24 hours of onset
What are the monotherapy options for a mild/moderate gout attack (1 or few small joints, or 1-2 large joints)?
NSAIDs, Systemic corticosteroids, or PO Cholchicine
What are the combo therapy options for severe gout (severe pain, polyarticular gout, multiple large joints)?
Colchicine & NSAIDs; PO Corticosteroids & Colchicine; Intraarticular steroids
What combo therapy should be avoided for severe gout?
NSAIDs and Corticosteroids: increased GI symptoms
When is Uric Acid Lowering Therapy (a lifelong therapy) indicated?
Patient with gouty arthritis AND tophus or tophi. 2 or more gout attacks/year. CKD stage 2+. H/o urolithiasis
What is the goal of ULT?
UA < 6 mg/dL in all gout cases, < 5mg/dL if tophi exists
What are the first line pharmacologic choices for ULT?
Xanthine Oxidase Inhibitor (XOI): Allopurinol and Febuxostat
What is the alternative 1st line pharmacologic choice for ULT if XOI is contraindicated or intolerant?
Probenecid (decreases UA by blocking renal tubular urate reabsorption)
When is anti-inflammatory prophylaxis recommended?
In all cases where ULT is initiated (Colchicine 1st line option), NSAIDs (lower evidence than colchicine)
What is the duration of anti-inflammatory prophylaxis?
Continue as long as evidence of gout disease activity and/or serum urate target not achieved or continue prophylaxis for the greater of: 6 months OR 3 months after achieving target serum urate level for patient w/out tophi OR 6 months after achieving the target serum urate level if there has been resolution of tophi previously detected
What is Advanced Gout?
Complications from untreated hyperuricemia occur (Tophi - deposits of UA, protein, and inflammatory cells). Polyarticular involvement in soft tissues and connective tissues. May progress to chronic gouty arthritis
What therapy is used for Advanced Gout?
Continue gout attack prophylaxis if ongoing symptoms of gout. Combination of XOI and Probenecid. Pegloticase (indicated in patients with severe gout disease and refractory to ULT)
