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Roomies Collab Deck 5: Rheumatology, Immunology, and Dermatology > Gout > Flashcards

Gout Flashcards

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1
Q

(?) is a common form of inflammatory arthritis characterised by raised uric acid concentration in the blood and the deposition of urate crystals in joints and other tissues

A

Gout

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2
Q

Gout is a common form of inflammatory arthritis characterised by raised (?) concentration in the blood and the deposition of urate crystals in joints and other tissues

A

Uric acid

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3
Q

Gout is a common form of inflammatory arthritis characterised by raised uric acid concentration in the blood and the deposition of (?) crystals in joints and other tissues

A

Urate

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4
Q

What are the three distinct phases of gout?

A
  1. Asymptomatic hyperuricaemia
  2. A period of acute attacks followed by variable intervals (months to years) with no symptoms
  3. Chronic tophaceous gout, where people have nodules affecting joints
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5
Q

The management of gout in those under (?) years of age require specialist supervision

A

30

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6
Q

Which two drugs can you use to treat acute attacks of gout?

A

Colchicine

High doses of an NSAID (excluding aspirin)

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7
Q

If you prescribe a high dose of an NSAID to treat an acute attack of gout, what must you also prescribe?

A

A gastro-protective drug (e.g. PPI)

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8
Q

What is the limitation of colchicine in the management of acute attacks of gout?

A

Toxicity at higher doses

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9
Q

What is the advantage of colchicine in the management of acute attacks of gout? (2)

A
  1. Does not induce fluid retention (unlike NSAIDs)

2. Can be co-administered with anticoagulants

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10
Q

What should you do if acute attacks of gout has an inadequate response to monotherapy with either colchicine or high dose NSAIDs?

A

Combination therapy (colchicine + NSAIDs)

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11
Q

What procedure is an option for the management of an acute monoarticular gout attack?

A

Joint aspiration and intra-articular injection of a corticosteroid

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12
Q

In patients having an acute attack of gout who cannot tolerate NSAIDs or colchicine, and when an intra-articular injection is unsuitable, what are the two alternative treatment options?

A
  1. Short course of oral corticosteroids

2. Injection of IM corticosteroids

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13
Q

What is the definition of frequent gouty arthritis attacks?

A

At least 3 in the previous 12 months

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14
Q

What treatment option can be considered for frequent gouty arthritis attacks (at least 3 in the previous 12 months) in patients who have an inadequate response to standard treatment?

A

An interleukin-1 inhibitor (e.g. canakinumab)

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15
Q

Name two drugs used for the long-term control of gout?

A

Allopurinol
Febuxostat

Xanthine-oxidase inhibitors that reduce the formation of uric acid from purines

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16
Q

What is the mode of action of allopurinol and febuxostat?

A

Xanthine-oxidase inhibitors that reduce the formation of uric acid from purines

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17
Q

What is the first-line urate-lowering therapy for long-term control of gout?

A

Allopurinol

  • Oral: initially 100 mg daily, adjust according to plasma uric acid concentration
  • take after food
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18
Q

If allopurinol is contraindicated or not tolerated for the long-term control of gout, what is the alternative option?

A

Febuxostat

- Oral: initially 80 mg once daily, can be increased to 120 mg once daily

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19
Q

What type of drugs can be prescribed by a specialist in patients with gout who are resistant to or are intolerant of xanthine-oxidase inhibitor?

A

Uricosuric drugs

  • Sulfinopyrazne
  • Benzbromarone

Increase the excretion of uric acid in the urine

Can be combined with xanthine-oxidase inhibitors in patients who have an inadequate response to monotherapy

20
Q

How do uricosuric drugs help in the management of long-term control of gout?

A

Increase the excretion of uric acid in the urine

Specialist use only

Can be combined with xanthine-oxidase inhibitors in patients who have an inadequate response to monotherapy

21
Q

When do you start urate-lowering therapy in a patient who requires long-term control of gout?

A

After the inflammation in an acute attack has settled

22
Q

Following an acute attack of gout, how long should colchicine be continued as prophylaxis in patients who will start urate-lowering therapy for long-term control of gout?

A

Up to 6 months

Colchicine is used as prophylaxis for up to 6 months as the initiation or up-titration of urate-lowering therapy may precipitate an acute attack of gout

Alternative to colchicine as prophylaxis: low-dose NSAID + gastro-protection

23
Q

Do you stop urate-lowering therapy if an acute attack of gout occurs?

A

NO

Continue urate-lowering therapy at the same dosage, while treating the acute attack

24
Q

What should you advise to patients with gout and a history of urolithiasis?

A

Ensure adequate daily fluid intake and avoid dehydration

25
Q

(Acidization/Alkalinisation?) of the urine with potassium citrate can be considered in recurrent kidney stone formers

A

Alkalinisation

26
Q

Alkalinisation of the urine with (?) can be considered in recurrent kidney stone formers

A

potassium citrate

27
Q

Is allopurinol used during an acute attack of gout or for long-term control of gout?

A

Long-term control of gout

28
Q

What is a common side effect of allopurinol?

A

Rash

Discontinue therapy if rash occurs.
If rash was mild re-introduce cautiously but discontinue immediately if recurrence

29
Q

What do you do if a patient on allopurinol develops a rash?

A

Discontinue therapy if rash occurs.

If rash was mild re-introduce cautiously but discontinue immediately if recurrence

30
Q

Can a pregnant patient take allopurinol?

A

ONLY if no safer alternative and disease carriers risk for mother or child

Toxicity not reported

31
Q

Are dose adjustments of allopurinol required in hepatic or renal impairment?

A

Renal impairment

Max. initial dose 100 mg daily, increased only if response inadequate; in severe impairment, reduce daily dose below 100 mg, or increase dose interval; if facilities available, adjust dose to maintain plasma-oxipurinol concentration below 100 micromol/litre.

32
Q

What is the mode of action of canakinumab?

A

A recombinant human monoclonal antibody that selectively inhibits interleukin-1 beta receptor binding

33
Q

When would you consider using the interleukin-1 inhibitor, canakinumab, in the treatment of gout?

A

Acute attacks of gout in patients with frequent gouty arthritis attacks (at least 3 in the previous 12 months) in patients who have an inadequate response to standard treatment

34
Q

Is colchicine used during an acute attack of gout or for long-term control of gout?

A

Acute attack of gout

35
Q

Apart from acute gout, what is the other indication for the use of colchicine?

A

Prophylaxis of familial Mediterranean fever (recurrent polyserositis)

36
Q

The dose of colchicine needs to be (?) if concurrent use of inhibitors of CYP3A4 or P-glycoprotein inhibitors

A

reduced

37
Q

The dose of colchicine needs to be reduced if concurrent use of (?) of CYP3A4 or P-glycoprotein inhibitors

A

inhibitors

38
Q

In elderly patients, when is a prescription of colchicine potentially inappropriate (STOPP criteria)?

A
  1. If eGFR less than 10 mL/miunute/1.73 m^2 (risk of toxicity)
  2. For chronic treatment of gout where there is no contraindication to a xanthine-oxidase inhibitor
39
Q

Are dose adjustments of colchicine required in hepatic or renal impairment?

A

Renal impairment

Reduce dose or increase dosage interval if eGFR 10–50 mL/minute/1.73 m^2.

Avoid if eGFR less than 10 mL/minute/1.73 m^2.

40
Q

Can colchicine be used during pregnancy?

A

NO

Teratogenicity in animal studies

41
Q

What are the common side effects of colchicine? (4)

A

Abdominal pain
Diarrhoea
Nausea
Vomiting

42
Q

Is febuxostat used during an acute attack of gout or for long-term control of gout?

A

Long-term control of gout

43
Q

What are the common side effects of febuxostat?

A
  1. Diarrhoea
  2. Gout aggravated
  3. Headache
  4. Hepatic disorders
  5. Nausea
  6. Oedema
  7. Skin reactions
44
Q

Are dose adjustments of febuxostat required in hepatic or renal impairment?

A

Hepatic impairment

Manufacturer advises max. 80 mg daily in mild impairment; no dose information available in moderate to severe impairment.

45
Q

What needs to be monitored before and during treatment with febuxostat?

A

LFTs

Roomies Collab Deck 5: Rheumatology, Immunology, and Dermatology (27 decks)

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