Gout Topic Discussion · guidelines for management of gout. Part 1: systematic nonpharmacologic and...
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Gout Topic Discussion Rachel Dietsche
Transcript of Gout Topic Discussion · guidelines for management of gout. Part 1: systematic nonpharmacologic and...
Gout Topic Discussion
Rachel Dietsche
The Disease
Historically known as the ‘rich
mans disease’
Prevalence in the US is almost 4%
Tophi-deposited MSU crystals and
inflammation
Unknowns:
Why first MTP?
Why acute attacks result from
trauma or urate lowering
therapy?
Why spontaneous resolution?
Etiology
Result of high uric acid levels
Impaired excretion of uric acid
Overproduction of uric acid
High intake of purine-rich food
Etiology
Nonmodifiable Risk Factors
Male
Older in age
Pacific Islander ethnicity
Genetic loci SNPs
Modifiable Risk Factors
Obesity
Diet
Alcohol
Fructose/sucrose beverages
HTN
Diuretics
CKD
Cyclosporine, ASA
Pathophysiology
o Monosodium urate
(MSU)crystals
o Found in synovial fluid
o First metatarsal
phalangeal joint
o Inflammation
o Neutrophils
o Monocytes
o lymphocytes
Clinical Presentation
flare
painful
red
swollen
warm
Disabling
Skin desqua-mation
WBC 10,000-100,000
Mostly neutrophils
Urate ≥ 6.8mg/dL
Dual energy computed
tomography (DECT)
Urate vs calcium
Diagnosis
Scoring System
Laboratory Analysis
Physical Findings
Treatment Guidelines and Alternatives
1st Line Urate Lowering Therapy
Allopurinol
or
Febuxostat
2nd Line Urate Lowering Therapy or
Add-Ons
Probenacid
or
Fenofibrate
or
Losartan **Colchine for treatment of flares or prophylaxis
during intiation of URL**
Drug of Choice and Monitoring
Allopurinol Initial 100mg daily
Titrate 100mg Q 2-4 Weeks
Screen for HLA-B*5801 variant
Chinese, Thai, Korean
CrCL 10-20: 200mg/d
3-10: 100mg/d
<3: 100mg/d extended intervals
Side Effects Most Common
Rash
Gout flare
Nausea/vomiting
Possible diarrhea and increased
hepatic enzymes
Rare
Bone marrow suppression
Alternative Drugs and SE/Monitoring
Anakinra
IL- 1 Antagonist
100mg SQ daily for around 3 days to treat an acute flare
CrCl <30: SQ every other day
Side Effects
Most common
Head ache
Vomiting
Infection
Injection site reaction
May increase cholesterol and hepatic enzymes
References
Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American college of rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res. 2012;64. 1431.
Qaseem A, Harris RP, Forciea MA, et al. Management of acute and recurrent gout: a clinical practice guideline from the American college of physicians. Ann Intern Med. 2017;166(1)58-68.
Becker MA, Gaffo AL. Clinical manifestations and diagnosis of gout. UpToDate. Last updated 10/09/2018. Accessed 12/05/18
Allopurinol: drug information. UpToDate. Accessed 12/06/18
Anakinra: drug information. UpToDate. Accessed 12/07/18.
