Gout Flashcards
What causes gout?
Abnormally high uric acid levels, which deposits urate crystals in joints, soft tissue and urinary tract
How can one obtain high levels of uric acid (hyperuricaemia)?
Overproduction of uric acid
Renal under excretion of uric acid
Both of the above
Overtaking high amounts of food rich in purines
Which 2 drugs should NEVER be given with a condition like gout?
Aspirin - can cause uric acid retention
Thiazide-like diuretic - makes you return uric acid/glucose
Which disease goes hand in hand with gout?
CVD
What are some examples of foods/liquids that have high purine content?
All alcohol
Fish/seafood/shellfish
Organ meats
Turkey, bacon, other meats
What are the symptoms of an acute attack of gout?
Pain
Redness/hotness of toe joints
Can cause fever
Night/early hour waking
What is tophaceous gout?
Crystals of uric acid accumulating in the joints, forming yellow bumps/raises
What must you avoid while treating an acute attack of gout?
Fluctuating uric acid levels, as this can prolong the attack or trigger future ones.
What are the 4 treatment options for an acute attack of gout?
NSAIDs
Colchicine
Steroids
Monoclonal antibodies
Which NSAID is the safest to use for an acute attack of gout, and why?
Naproxen because it has the best CV safety profile
Can also use: ketoprofen, indometacin, diclofenac
How is ibuprofen give for an acute attack of gout?
Off-licensed, so try to avoid.
How long are NSAIDs usually required for, for an acute attack of gout?
7-14 days until the attack goes away
Why is colchicine less effective than NSAIDs?
Because it has a slow onset of action, more side effects, and its efficacy is reduced over time
What is the dosing of colchicine for an acute attack of gout?
Start ASAP due to reduced efficacy
1g, then 500mcg every 4h for 3 days
What is the max dose of colchicine per day?
6mg
If renal insufficiency is present, which class of drug is given for an acute attack of gout?
Steroids
How are corticosteroids given for an acute gout attack, & why is this way preferred?
Given via injection into the affected joint to minimise side effects which can arise if taken orally
Which corticosteroid is given for an acute gout attack?
Methyl prednisolone
Which monoclonal antibody can be used for acute attacks if all treatment has not worked?
Canakinumab
What lifestyle modifications can be done to help prevent future gout attacks?
Weight loss
Decrease alcohol
Reduce dietary purine intake
Increase water intake - to flush out the uric acid
Give basic drug e.g. Na+ bicarbonate which can ionise the uric acid
What determines after an acute gout attack whether the patient should start reducing their uric acid levels?
If they have had >3 attacks + raised urate levels
Evidence of joint damage
Tophaceous deposits visible
Evidence of renal failure
Family history present
Normal rate levels cannot be achieved through lifestyle changes
What is given as prophylaxis along with the long term drugs for gout, & for how long?
NSAIDs/colchicine for 3 months (at low doses), until uric acid levels are stable
What type of drug is allopurinol, & what is its mechanism of action?
It is a xanthine oxidase inhibitor preventing uric acid formation from purines
When can you not start allopurinol? When should you start it?
It should never be started during an acute attack.
Must start 1-2 weeks after acute attack has subsided
What is the dosing for allopurinol?
100mg OD
Max 900mg
Why should plenty of water be taken while using allopurinol?
To flush out its metabolites from the kidneys
Why can allopurinol be given to renally impaired patients?
Because allopurinol itself does not work on the kidneys
What should you do if a patient taking allopurinol develops a rash?
Discontinue allopurinol and refer
This is a sign of a severe skin condition
What type of drug is febuxostat?
It is a xanthine oxidase inhibitor
Why is allopurinol used over febuxostat?
Because febuxostat has increased risk of CVD and GI side effects.
Why should plenty of water be taken while using febuxostat?
To remove/flush out the accumulation of uric acid crystals in the kidneys
Can you give febuxostat to renally impaired patients?
No
Why is febuxostat preferred to be taken with milk?
Because milk is alkaline which can remove accumulated uric acid crystals
What is the dosing of febuxostat?
80mg OD
What type of drug is sulfinpyrazone, and how does it work?
It is a uricosuric which increases urine excretion by blocking tubular reabsorption of urate
In which patients is sulfinpyrazone contraindicated in?
Renally impaired patients
Those with a history of uric acid stones in their kidneys
When should you start sulfinpyrazones after an acute gout attack?
Given 3 weeks after an acute attack
Why is drinking plenty of fluids essential when taking sulfinpyrazone?
Because the risk of urate crystal formation is high in renal tubes, so they need to be flushed out.
What is the dosing of sulfinpyrazone?
Titrated up to 600mg, then reduced to maintenance dose of 200mg when uric acid levels stabilise
