Gout

__ is a chronic disease of monosodium urate deposition characterized by arthritis flares and disability.

Gout

What is the MOST common predisposing factor for someone developing Gout?

Genetics

Is Gout more common in men or women and why is this?

More Common in Men; Estrogen levels in women cause their bodies to be better able to clear Uric Acid

T/F: Gout is the MOST common form of inflammatory arthritis.

True

Surgery, Alcohol (Esp. Beer), Medications, Foods, Infections, and Rapid-Lowering of Serum Uric Acid are all precipitators of __ __.

Gout Attack

What is the Definitive Diagnosis that is 100% Positive for Gout?

Monosodium Urate Crystals in Aspirates Obtained from Joints or Tophi

T/F: Hyperuricemia has LOW SPECIFICITY for Gout

True

___ is defined as circulating uric acid level that exceeds the solubility threshold for monosodium urate (>6.8 mg/dL)

Hyperuricemia

Is Gout or Hyperuricemia more common?

Hyperuricemia

What is the most common risk factor seen in a majority of pts who develop Gout?

Hypertension

What is the DEFINITIVE DIAGNOSIS for Gout?

Aspiration and examination of affected joint fluid with microscopy under polarized light to see negatively birefringent uric acid crystals.

Liver Enzymes, CBC, and Electrolyte Labs should be rechecked every __ to __ months for pts on Long-Term Therapy or Prophylaxis for Gout.

6 ; 12

___ (MOA): Disrupts Cytoskeletal Functions by inhibiting Beta-Tubulin Polymerization into microtubules; preventing activation, degranulation, and migration of neutrophils associated with mediating gout Sx's.

Colchicine

What is the dose recommendation for Colchicine in the Acute Flare Treatment of Gout?

1.2mg Immediately upon Sx's and then 0.6mg one hour later

Which three NSAID's carry an FDA approval for Treating Gout Acutely?

Indomethacin, Naproxen, and Sulindac

What two comorbid conditions create complications with using Corticosteroids?

T2D and Infections

What two comorbid conditions create complications with using NSAIDs?

HTN and Diabetes

Which NSAID is the OLDEST agent and also has the most toxic potential?

Indomethacin

Chronic Therapy is indicated for pts with >/= __ flares per year; those with tophi, ; or those with evidence of joint damage.

2

What agent is First Line for Chronic Therapy of Gout?

Allopurinol

Which Gout treatment would it be necessary in order to Allele test for HLA-B*5801 prior to administrating this medication?

Allopurinol

T/F: When dosing Allopurinol, we use the TREAT-TO-TARGET approach

True

T/F: Adherence to Allopurinol use is a major concern, with <50% of pts remaining adherent.

True

When administering Allopurinol for Chronic Therapy; It is important to provide prophylactic therapy up through the final dose change of ULT and for ___ month(s) after the last flare.

one

How often should a pts dose of Allopurinol be increased?

Every 3 to 6 weeks

___ (Uloric) has a BBW for potential Cardiovascular Effects. This is controversial however because a recent trial between this agent and allopurinol showed NO difference in this same measure.

Febuxostat

What agent is LAST line in treating chronic migraines and works by converting uric acid to allantoin?

Pegloticase (Krystexxa)

Anaphylaxis occurs in roughly 5% of pts taking Pegloticase and requires pretreatment with what to prevent this?

Antihistamine and Corticosteroids

___ is contraindicated in G6PD Deficinecy

Pegloticase

Which medication is administered as an 8mg IV every 2 weeks (Over 2 Hours)

Pegloticase

___ (MOA): Converts Uric Acid to Allantoin (A water soluble compund that is easily excretable)

Pegloticase

Nephrolithiasis occurs in approximately __ % of patients with Gout.

15

What is the target urine volume per day?

2 to 3 Liters

Avoidance of __ rich foods is an appropriate non-pharm recommendation for pts with Gout.

Purine

T/F: Counseling pts with Gout to AVOID Sodium Salts is an appropriate recommendation.

True

Pts with Uric Acid Nephrolithiasis should be treated to a target of < __ mg/dL serum uric acid.

5

T/F: It is unclear whether hyperuricemia has a harmful effect on the kidneys.

True; While it is a fact that renal failure happens in a high percentage of gouty patients, the causation has NOT been established.

Where is the MOST common site of tophaceous deposits?

Base of the fingers

Pts with Tophaceous Gout should be Treat-to-Target of <__ mg/dL

5

Diuretics, BB, ACEIs, ARBs (Besides Losartan), Salicylates, Nicotinic Acid, Ethanol, Levodopa, Cyclosporine, Cytotoxic Dtugs, Pyrazinamide, and Ethambutol are drugs that ___ serum urate.

Increase

Losartan, DHPs, Fenofibrate, SGLT2Is, and Metformin are all drugs that __ serum urate.

Decrease

What two diets would be the best to recommend to a patient with GOUT?

DASH or Mediterranean

T/F: Patient adherence to ULT is notoriously poor.

True

What is the dose limiting effect of Colchicine?

GI Effects, specifically Diarrhea

T/F: What impact on BP does NSAIDs have?

Increases BP

What is the max dose of Febuxostat in pts with severe renal failure?

40mg

What two agents are the best option for pts with financial limitations?

Allopurinol and Colchicine

Should pts with asymptomatic hyperuricemia receive treatment with ULT?

No; there is no evidence that this is necessary

Which ARB is known to lower serum urate levels?

Losartan

Which transporter is responsible for urate reabsorption?

URAT1

When are intra-articular steroids preferred?

One or two affected joints

Minimum duration of prophylaxis with ULT?

3–6 months (and ≥1 month after last flare)

When is probenecid appropriate?

_ _ is the final breakdown product of purines. Purines come from:

• Normal cell turnover

• DNA/RNA breakdown

• Some foods (red meat, seafood)

Uric acid

What enzyme converts hypoxanthine → xanthine → uric acid?

A: Xanthine oxidase

Where is the primary defect in under-excretion?

Proximal renal tubule

Which conditions increase urate reabsorption?

A: CKD, dehydration, insulin resistance, diuretics