Gout- 2020 Treatment Guidelines for Chronic Therapy Flashcards
Do all gout patients need chronic therapy?
No, they can use nonpharm treatment options
Nonpharm therapy for chronic gout
Limiting alcohol intake, red meats, organ meat, seafood high in purines, high fructose corn syrup
Weight loss if patient is obese/exercise
Components of chronic gout therapy
UA lowering therapy and flare prophylaxis
UA-lowering therapy can do what?
Initiate flares
Prophy gout flare meds should be used with what?
UA lowering therapy
Chronic gout therapy should not be what?
Stopped during a flare
Indications for chronic gout treatment
≥1 SQ tophi, radiographic evidence of damage attributable to gout; OR frequent flares (≥2/year)
When to CONSIDER chronic gout treatment
History of >1 attack, but <2 attacks/year
Those with first gout flare with the following characteristics:
CKD Stage ≥3
UA concentration >9 mg/dl
Urolithiasis
If it’s decided that a patient needs ULT during a flare, when should it be started?
During the flare
SUA goal
<6mg/dl
What agent is recommended first line over all others?
Allopurinol
UA level monitoring
Monitor q2-5wks with increased ULT intensity until the goal is reached
How long should therapy be continued for when it meets the goal?
Indefinitely
When to switch to pegloticase in chronic gout treatment
When XOI treatment, probenecid, and other interventions failed to achieve goal UA level and patients continue to have at least 2 flares/year OR non-resolving tophi
When should gout flare prophy be started?
Prophy with anti-inflammatory meds should be initiated when ULT is initiated (AKA initiate both at the same time)
What agents do you use for gout prophy?
The same ones as you do for a flare, but at different doses
Prophy dose of colchicine
0.6mg PO QD-BID
Prophy dose of NSAIDs
Example is 250mg naproxen, add on a PPI when indicated
(any low dose NSAID will work)
Prophy dose of steroids
Low dose prednisolone or prednisone <=10mg/day
First-line options for gout prophy treatment
Colchicine and low-dose NSAIDs
When to use low dose steroids for prophy
If BOTH colchicine and low dose NSAIDs are CI’ed, not tolerated, or ineffective
How long should prophy gout treatment be continued for?
3-6 months based on resolution of symptoms and tophi absence with ongoing evaluation and continued prophy if flares continue
If a patient is on gout prophy and they have a flare in the last 3 months with palpable tophi present, what do you do?
Continue prophy treatment
If a patient is on gout prophy and there’s no signs and symptoms, what do you do?
Continue treatment for at least 6 months OR 3 months after achieving target SUA goal appropriate for the patient and no tophi on PE OR 6 months after achieving target SUA goal with one or more tophi present on PE
