Gout Flashcards
Metabolic disease that is characterized by recurrent episodes of acute arthritis due to deposits of monosodium urate in joints and cartilages
Gout
T or F: Gout is a disease characterized by recurrent chronic arthritis
False, acute
Gout is a systemic disease caused by the buildup of ____ in the ____ causing inflammation, swelling, and pain
uric acid, joints
Hyperuricemia levels in men and women
Men = >8 mg/dL
Women = 7 mg/dL
Most common first symptom of gout
Pain in joints of lower extremities
Type of gout which is a result of an innate defect in purine metabolism of uric acid excretion
- uric acid overproduction
- impaired renal clearance of uric acid
- combination
Primary Gout
Type of gout which is characterized by hematologic disorders
Secondary Gout
Treatment goals for Gout
- Relieve pain and inflammation
- Reduce serum uric acid concentration
- Prevent recurrent gout attacks
Alkaloid isolated from colchicum autumnale
Colchicine
Antimitotic drug effective in relieving acute gout attack
Colchicine
When is Colchicine most effective?
When initiated within 12-36 hours of the attack
T or F: Colchicine has a high benefit-to-risk ratio
False, low –> that’s why it used less often than NSAIDs
Can Colchicine be taken with or without food?
Yes
Colchicine duration of action
12-24 hours without altering urate metabolism
Mainstay therapy for acute gouty attacks
NSAIDs
Most common adverse effects of NSAIDs are related where?
GI system (gastritis, bleeding, perforation)
Most extensively studied NSAIDs for the treatment of acute gouty attacks
Indomethacin
MOA of NSAIDs
- inhibits PG synthesis
- inhibits urate crystal phagocytosis
- reduces inflammation and pain in acute gout flare
T or F: All NSAIDs effective for treating acute gouty arthritis attacks
False, exceptions include aspirin, salicylates, tolmetin
T or F: Oxaprozin lowers serum uric acid
True
Equivalent to NSAIDs in the treatment of acute gout flares
Corticosteroids
Corticosteroids are effective when given into what routes?
Intra-articular, IV, oral
Route of Prednisone
Oral
Route of Triamcinolone acetonide or Methylprednisone
Intra-articular or IM
Decreases activation, proliferation, survival of various inflammatory cells as well as decrease mitigation of neutrophils, inhibits prostaglandins, and proinflammatory cytokines (IL-1B)
Corticosteroids
Indication of Corticosteroids
Alternative for patients contraindicated to NSAIDs or Colchicine as well as those with renal impairment or CKD
T or F: Corticosteroids can sometimes be used for severe symptomatic gout
True
What is the goal urate levels of Uric Acid Lowering Therapy?
< 6 mg/dL, preferably < 5 mg/dL
Reduction of serum urate concentration can be done by?
- Decreasing uric acid synthesis - xanthine oxidase inhibitors
- Increasing renal excretion of uric acid - uricosurics
Can xanthine oxidase inhibitors and uricosurics be used during acute gouty arthritis attacks?
No
Reduces uric acids by impairing conversion of hypoxanthine to xanthine and ultimately xanthine to uric acid
Xanthine oxidase inhibitors
T or F: XO inhibitors are effective for overproducers of uric acids only
False, effective for both over- and underproducers
Most widely prescribed agents for long-term prevention of recurrent gout attacks
XO inhibitors
Purine analog that inhibits xanthine oxidase resulting in a decreased level of plasma urate level
Allopurinol
What is the result of XO inhibition?
Build up of its substrates = more soluble xanthine and hypoxanthine
T or F: Allopurinol is the first-line agent for the treatment of acute gout attacks
False, chronic gout attacks
Potent selective non-purine XO inhibitor, reducing xanthine and uric acid levels without affecting other enzymes in purine or pyrimidine pathway
Febuxostat
Example of Uricosuric Drugs
Probenecid
Uricosuric drugs that have been discontinued in the USA
Sulfinpyrazone and Lesinurad
MOA of Uricosuric drugs
Increases renal excretion of uric acid through inhibition of post-secretory renal proximal tubular reabsorption of uric acid
T or F: Probenecid can be given as monotherapy or in combination with XO inhibitors
True
Interleukin-1 inhibitors
Canakinumab
Anakinra
Rilonacept
MOA of IL-1 inhibitors
inhibits IL-1 receptors
Main proinflammatory cytokines responsible for crystal-induced inflammation of gout
IL-1B
Are Interleukin-1 inhibitors already FDA approved?
Not yet
Route of administration for Interleukin-1 inhibitors
SubQ
