Overview of drug treatments of gout

Question 1

Is gout treatment different for acute and chronic gout attacks?

Answer 1

Yes

Question 2

What molecules build up and cause gout, and how does this affect joints

Answer 2

Build up of monosodium urate crystals, which exert pressure around joints

Question 3

What is gouty tophi/tophaceous gout?

Answer 3

Masses of monosodium urate crystals form in soft tissue and around joints

Question 4

Give 3 reasons for monosodium urate build up in gout?

Answer 4

Urid acid overproduction

Kidney doesn’t filter out excess uric acid

Influence of drugs eg. thiazide diuretics

Question 5

Why does uric acid build up in the body, and what enzyme is involved in this?

Answer 5

Xanthine oxidase catalyses breakdown of purines into uric acid

Question 6

What is the target of treatment for an acute flare up of gout?

Answer 6

Relieve pain and swelling

Question 7

What 3 treatments can be used to treat acute gout attacks?

Answer 7

NSAIDs, colchicine, corticosteroids

Question 8

How efficacious are NSAIDs for acute gout attacks?

Answer 8

Moderate to good efficacy

Question 9

Are NSAIDs suitable for both short and long term use for acute gout attacks?

Answer 9

Suitable for short-term use and in low dose

Not suitable for long-term use and in high dose

Question 10

What are 4 side effects of long-term use/high dosage of NSAIDs in acute gout attacks?

Answer 10

Side effects of peptic ulcers, GI bleeds, renal failure, heart failure

Question 11

Which patients are suitable to take NSAIDs for acute gout attacks?

Answer 11

Don’t have past/current/susceptibility to GI, heart diseases such as hypertension or congestive heart failure, asthma as NSAIDs can cause bronchospasms, CKD

Question 12

Give 2 reasons why NSAIDs are convenient to take for acute gout attacks?

Answer 12

They can be taken orally and are inexpensive

Question 13

Are NSAIDs started at high or low dosage for acute gout attacks?

Answer 13

NSAID often started at high dose

Question 14

What is the usual duration of NSAID treatment for acute gout attacks?

Answer 14

Taken for few weeks until flare up settles

Question 15

What is the dosage of ibuprofen (NSAID) for acute gout attacks?

Answer 15

400-800 mg ibuprofen tds (three times daily)

Question 16

What is the dosage of naproxen (NSAID) for acute gout attacks?

Answer 16

First dose is 750 mg naproxen, then 250 mg tds for 7 days

Question 17

What is colchicine and where is it derived from?

Answer 17

General anti-inflammatory drug derived from a plant alkaloid, used to treat acute gout attacks

Question 18

What is the mechanism of action of colchicine in acute gout attacks?

Answer 18

Affects microtubule depolarisation, which changes the expression of genes associated to granulocyte migration, growth, adhesion, inhibiting acute inflammation

Question 19

What is the efficacy of colchicine in acute gout attacks, and what drug is it similar to?

Answer 19

Very good efficacy, is similar to naproxen

Question 20

What are the short-term and long-term side effects of colchicine use for acute gout attacks?

Answer 20

Short-term effects include common diarrhoea and nausea

Long-term effects include renal failure, bone marrow suppression

Question 21

Which patients are suitable to take colchicine for acute gout attacks?

Answer 21

Patients who can’t take NSAIDs, as colchicine is similar to naproxen

Question 22

What are the 2 differences between colchicine and naproxen in terms of side effects, when used for treating acute gout attacks?

Answer 22

Diarrhoea twice as common from colchicine use than naproxen use

Less risk of heart failure from colchicine use than naproxen use

Question 23

What is the dosage of colchicine for acute gout attacks?

Answer 23

0.5 mg daily for few weeks

Question 24

Why is the duration of colchicine treatment for acute gout attacks a few weeks?

Answer 24

Prevents recurrent flares

Question 25

Over the duration of one course of colchicine for acute gout attacks, what is the maximum total administered amount?

Answer 25

6 mg

Question 26

How and where are corticosteroids administered in acute gout attacks?

Answer 26

Locally injected into single large painful joint

Question 27

In severe acute gout flare ups, what corticosteroid is administered?

Answer 27

Oral prednisolone

Question 28

What is the efficacy of corticosteroids for acute gout attacks?

Answer 28

Good efficacy

Question 29

Are corticosteroids safe for short and long term use, when treating acute gout attacks?

Answer 29

Safe for short-term use, but long-term use has side effects of weight gain, fluid retention, high blood pressure, diabetes and osteoporosis

Question 30

Which patients are suitable to take corticosteroids for acute gout attacks?

Answer 30

Patients who have other comorbidities Patients who can't take NSAIDs or colchicine

Question 31

What is canakinumab, and what is its mechanism of action in treating acute gout attacks?

Answer 31

Human monoclonal antibody that selectively inhibits IL-1 receptor

Question 32

How is canakinumab administered for acute gout attack treatment, and how long is the duration of one dose?

Answer 32

Subcutaneous injection that lasts up to 12 weeks

Question 33

Which patients are suitable for canakinumab use to treat acute gout attacks?

Answer 33

Patients with frequent, severe acute gout attacks that isn't treated by other drugs

Question 34

When is treatment started to prevent gout attacks from recurring?

Answer 34

Treatment started 1-2 weeks after acute flare up settles, so that flare up won't be triggered again

Question 35

Give 3 reasons why patients can have regular treatment to lower uric acid levels?

Answer 35

They had more that 2 gout attacks in a year They have renal damage Other complications

Question 36

Give 3 examples of lifestyle advice used to prevent recurrent gout attacks?

Answer 36

Low-purine diet Avoid dehydration Avoid certain drugs

Question 37

What is the first-line drug for preventing recurrent gout attacks?

Answer 37

Allopurinol

Question 38

What is the mechanism of action of allopurinol in prevention of recurrent gout attacks?

Answer 38

Inhibits xanthine oxidase, so purines can't be broken down to form uric acid in the purine metabolic pathway

Question 39

How efficacious is allopurinol for treatment of preventing recurrent gout attacks?

Answer 39

Very good efficacy

Question 40

Is allopurinol safe for short and long term use?

Answer 40

Yes, can even be used as a life-long treatment

Question 41

Why is allopurinol safe for very long-term use?

Answer 41

Rarely causes serious allergies

Question 42

What is the dosage of allopurinol in prevention of recurrent gout attacks?

Answer 42

100-600 mg , usually start dose is 100mg then up titrated

Question 43

Does use of allopurinol need to be monitored?

Answer 43

Yes, needs to be monitored few weeks after administering each dose to check uric acid serum levels and renal function

Question 44

What 2 drugs does allopurinol have drug interactions with?

Answer 44

Purine analogs Theophylline

Question 45

What is febuxostat?

Answer 45

Non-purine xanthine oxidase inhibitor, second-line drug to allopurinol for prevention of recurrent gout attacks

Question 46

What is the second-line drug for prevention of recurrent gout attacks?

Answer 46

Febuxostat

Question 47

Give 1 reason why febuxostat is inconvenient, in terms of its price?

Answer 47

It is very expensive, as it is the newest drug on the market

Question 48

Which patients are suitable for febuxostat?

Answer 48

Patients who couldn't take allopurinol due to medical conditions Patients who has such serious side effects to allopurinol that they couldn't take recommended dose used cautiously in patients with past/current/susceptibility to heart conditions

Question 49

What is the side effect of febuxostat?

Answer 49

Increased risk of cardiovascular problems