Background
What is gout?
A form of arthritis characterized by severe pain, redness, and tenderness in joints.
What are common symptoms of gout?
Red, hot, extremely painful and swollen joints.
Can also see fever.
Serum urate level > __ mg/dL is considered hyperuricemia.
6.8 (7 is acceptable)
What non-pharm treatment can be considered?
Ice.
Educate patients to reduce alcohol consumption, reduce high purine diets, hydrate more, lose weight, smoking cessation, evaluate potential drugs, etc.
First-line ULT for all patients?
Allopurinol (Zyloprim)
Start low and titrate up.
2nd line is Febuxostat (Uloric)
Alternative: Probenecid, pegloticase
The term for elevated serum urate concentration?
Hyperuricemia.
What part of the body is most commonly associated with gout?
Big toe (hallux).
Uric acid level goal?
<6 mg/dL
What are the first-line options for acute gout flare?
NSAIDS, Coricosteroids, and Colchicine.
Indomethacin, ibuprofen, and naproxen are commonly used NSAIDS for acute goat flares.
Combo therpay may be considered if multiple joints are affected or pain is severe.
True or False. Patients who present to their provider with an acute gout flare need to wait until it resolves to start ULT.
False. ULT may be started during an acute gout flare.
Usually continued indefinitely.
What is most common in patients? Overproduction or Underexcretion of uric acid.
Underexcretion of uric acid is most common in patients ~80%.
Chunks of uric acid (monosodium urate) crystals that accumulate in and around joints and other parts of the body as the result of advanced gout is called what?
Tophus/i.
True.
Is low dose or high dose colchicine preferred and why?
Low dose due to similar efficacy and dose-dependent ADR (GI, neutropenia, myopathy).
Should be used within 24 hours.
Indication for starting ULT?
-1 or more tophi
-Radiographic damage due to gout
-Frequent gout flares (>/= 2 flares/yr)
Name 2 risk factors of developing gout.
Increasing age, male gender, genetic predisposition, high purine diet, or obesity.
Name at least 2 other parts of the body that can be affected by gout.
Ankle, knee, elbow, wrist, hands, or fingers.
What is required for a definitive diagnosis of gout?
It requires aspiration of synovial fluid from affected joint and identification of intracellular monosodium urate crystals.
What options are available for NPO patients?
IV, IM, intra-articular corticosteroids is recommended.
Which ULT has a BBW and what is it?
Febuxostat (Uloric).
Increased risk of heart-related death and death from all causes with Uloric.
Uric acid is the end product of ____ degradation.
Purine.
What organ can be affected by gout and what can happen?
Renal impairment as well as kidney stones.
The name of the classification criteria for gout and what score classifies gout?
2015 ACR/EULAR gout classification criteria.
A score of >/= 8 you can classify as gout.
(max score is 23)
American College of Rheumatology (ACR)
European League Against Rheumatism (EULAR)
True or False. Patient on established ULT should stop their therapy during an acute gout flare.
False. Patient should continue on therapy.
What should be tested prior to starting allopurinol and for which patient population?
HLA-B*5801 due to risk of AHS.
Among Southeast Asian descent (e.g., Han Chinese, Korean, Thai) and for African American patients.