Gout

Question 1

Disease states associated with Gout:

Answer 1

Lesch-Nyhan syndrome
End stage renal disease
Cancers with cell lysis
Major organ transplant

Question 2

Drugs associated with inducing Gout:

Answer 2

Thiazides
Low dose ASA
Niacin (Vitamin B3)
Immune suppressants
Cytotoxic agents causing cell lysis

Question 3

Chronic sequaelae of gout

Answer 3

Renal:
Nephrolithiasis (kidney stones)
Interstitial nephritis
Arthritic:
Tophi
Erosion of cartilage and bone
Joint deformities and loss of function
Metabolic:
Possibly metabolic syndrome
Stroke
CV disease

Question 4

Diagnosis of Gout

Answer 4

Aspiration of synovial fluid and visualization of crystals.

Question 5

Treatment goals for Gout

Answer 5

Acute:
Resolve inflammatory process rapidly.
Intermitten/Chronic:
Limit crystal formation, tophi, and tissue damage.
How? Lower serum uric acid (especially if comorbid conditions)

Question 6

Treatment agents for Acute Flares:

Answer 6

Colchicine (diagnostic)
Steroids - First line
NSAIDs - First/Second line
IL-1 Antagonists
ACTH (?)
Opioids (?)

Question 7

Considerations before initiating chronic Gout treatments:

Answer 7

Uric acid > 7mg/dl AND
Tophi OR
Significant kidney disease OR
Incidence of kidney stones.

Question 8

Xanthine oxidase inhibitors include:

Answer 8

Allopurinol

Febuxostat

Question 9

Uricosuric agents include:

Answer 9

Probenecid

Lisinurad

Question 10

Recombinant Uricase agents include:

Answer 10

Rasburicase

Pegloticase

Question 11

Colchicine dose

Answer 11

1. 2 mg w/in 36 of onset
2. 6mg 1hr after if needed
3. 2mg /day for maintenance, if chronic

Question 12

Naproxen dose

Answer 12

100 mg/day

Question 13

Prednisolone dose

Answer 13

35 mg/day

Question 14

Allopurinol dose

Answer 14

100 mg/day to start
- Increase by 100mg /week
300 mg/day for 50% patients
800 mg/day MAX

Question 15

Febuxostat dose

Answer 15

40 mg/day to start
80 mg/day for most patients
120 mg/day MAX

Question 16

Probenecid dose

Answer 16

250 mg BID to start

Can push up to 2,000mg/day in divided doses.

Question 17

Lisinurad dose

Answer 17

200 mg/day - Pretty rigid here.

Question 18

Colchicine key point

Answer 18

GI disturbances very common

- Significant diarrhea most problematic

Question 19

Naproxen key point

Answer 19

Nothing major.

SE limiting; GI, CV

Question 20

Prednisolone key point

Answer 20

Nothing major

Question 21

IL-1 Antagonists key point

Answer 21

Very expensive

Question 22

Allopurinol key point

Answer 22

Allopurinol-Hypersensitivity-Reaction potential

Question 23

Febuxostat key point

Answer 23

Metabolism is primarily hepatic, pick over Allopurinol in renal impaired patients.

Question 24

Probenecid key point

Answer 24

Contraindicated in patients with low creatinine clearance.

Question 25

Lisinurad key point

Answer 25

Never used as monotherapy; required XO-inhibitor in conjunction.

Question 26

Recombinant Uricase key point

Answer 26

VERY expensive