Gout - Block 1 Flashcards
What is the most important RF for developing gout? Other RF?
Elevated serum urate concentration
CKD, obesitry, medication, male, older, obesity, sedetary, consumption of alcohol, sugar beverages, red meat and seafood
Hyperuricemia is a good indicator for gout?
does NOT always result in development of gout, as many patients with hyperuricemia can remain asymptomatic
Drugs that induce gout?
General sx of acute gouty arthritis?
Acute inflammatory mono-arthritis, typically of the 1st metatarsophalangeal joint
S/s of gout?
- Intense pain
- Erythema
- Warmth
- Swelling
- Inflammation of affected joints
Lab tests used for gout?
Uric acid
Observations of monosodium urate crystal in the synovial fluid or a tophus
What is Tophaceous gout?
Deposits of monosodium urate crystals in soft tissues of the hands, wrists, or elbows (generally takes > 10 years to develop)
What is gouty nephropathy and how is it treated?
Associated with acute and chronic kidney disease
Tx: potassium bicarbonate/citrate 30 – 80 mEq/day
What is the definitive diagnosis of gout?
Identification of intracellular crystals of monosodium urate (MSU) monohydrate in the synovial fluid leukocytes
Crystal appearances: needle shaped
Synovial fluid appearance in patients with gout -> purulent with presence of white blood cells
How those without synovial fluid aspiration, what factors can diagnos gout?
- Monoarticular involvement of foot or ankle joint
- Previous similar episode
- Rapid onset of severe pain & swelling (peak pain intensity in less than 24 hours)
- Erythema
- Male sex
- Presence of CV disease
- Hyperuricemia
Describe the managemetn of pain and inflammation during an acute gout flare?
Pharm tx for gout?
XO inhibitors: Zyloprim (allopurinol), Uloric (febuxostat)
Uricosurics: Probalan (probenecid), Zurampic (lesinurad)
Recombinant Urate Oxidase Enzyme: Krystexxa (pegloticase)
Describe the Initiation of ULT for Preventing Recurrence of Future Gout Flares?
What is the serume urate goal after ULT?
Urate < 6 mg/dL
What are the txs for gout inflammation?
- NSAIDs
- Colchine
- CS
Continue for 3 - 6 months (longer if persistent acute gout flares continue)
Describe the dosing of colchine for imparied kidney function?
Describe the dosing of colchine for imparied liver function?
What are the strong CYP3A4 inhibitors? How is colchicine adjusted?
How is cochicine adjusted based on moderate CYP3A4 inhibnitors?
How is cochicine adjusted based on P-gp inhibnitors?
What are alt tx for imparied kid function?
Consider reduced-dose colchicine or corticosteroids for acute management of acute gout flares.
What is alt tx for GI Dx?
Consider GI protection with PPI therapy when initiating NSAID therapy
Alt tx for CHF?
Consider colchicine for treatment of an acute gout flare.
Consider colchicine for prophylaxis when initiating ULT.
Consider losartan as a therapy for CHF, due to its uricosuric properties.
Alt tx for HTN
Consider losartan as an alternative or additional antihypertensive therapy, due to its uricosuric properties.
Alt tx for polypharm
Consider losartan as ULT for patients with comorbid hypertension.
Consider fenofibrate as ULT in patients with comorbid hypertriglyceridemia
Alt tx for financial limitations?
Consider allopurinol as ULT.
Consider NSAIDs or corticosteroids for treatment of acute gout flares.
Consider NSAIDs for prophylaxis of gout when initiating ULT.
What do you do if patient is experiencing 1st acute gout flare?
Provide treatment for acute gout flare; NOT indicated for ULT
How often do you monitor someone with gout?
NSAIDs: Long-term / prophylaxis -> recheck every 6 – 12 months
Obtain serum [uric acid] when titrating ULT, but, once serum [uric acid] = WNL, monitor periodically every 6 – 12 months.
