T/F: All individuals with hyperuricemia will at some point develop a clinical event from urate crystal deposition
Most individuals w/ hyperuricemia may never develop a clinical event from urate crystal deposition
(so don't tx hyperuricemia if no h/o gout!)
Drugs active in gout inhibit what 2 things?
1. Crystal phagocytosis
2. PMN and macrophage release of inflammatory mediators
Is it more common for a person to have overproduction or underexcretion of uric acid?
Where is 2/3 of the daily uric acid production excreted?
In the urine
2/3 of the daily uric acid production is excreted in the urine, where is the remainder eliminated?
Through the GI tract after enzymatic degradation by colonic bacteria
The following are examples of _____ rich foods:
Purine rich foods
What is the definitive dx of gout?
tapping the joint and microscopic exam of uric acid crystals
In the absence of a history of gout, does asymptomatic hyperuricemia require treatment?
What is acute gout?
Attacks of joint inflammation
Usually affecting the 1st MTP
Which toe does acute gout most commonly affect?
(how many days, area MCly affected?)
1st MTP- Podagra "foot pain"
Chronic or acute gout?
- Tophaceous Gout
What type of urate is in the soft tissues and joints in Tophaceous gout?
What is non-pharmacological treatment for acute gout?
Local ice application
(most effective as adjunctive tx)
What are the 3 acute gout first line treatments?
1. NSAIDs (Indomethacin, naproxen and Sulindac)
Within how many hours of acute gout attack onset should treatment (NSAIDs, colchicine, steroids) be taken and for how many days?
Within 24 hours
until complete resolution, ~5-8 days after initiating therapy
Mechanism of which acute gout med?
- Inhibition of microtubule assembly decreases macrophage migration and phagocytosis
- Inhibits leukotriene B4 decreasing inflammation
Acute Gout tx:
Colchicine must be used w/in ___ hrs of attack onset to be effective
What are the 3 ADEs of Colchicine?
2. Myelosuppression (rare)
3. Neuromyopathy (reversible)
Dose adjustment of Colchicine is recommended when used with what 2 groups of meds?
selected CYP3A4 and P-glycoprotein inhibitors
(so don't give w/ -azoles or -vir)
Colchicine inhibits renal tubular secretion of what med?
When is intraarticular corticosteorid (TAC-Kenalog) administration acceptable in the tx of acute gout?
What meds should it be used in combo with?
- When only 1 or 2 joints involved
- Should be used in combo w/ NSAIDs, Colchicine or oral corticosteroids
What 3 meds can be used for tx of chronic gout?
- Allopurinol, Febuxostat
Which med should be used for refractory cases of chronic gout?
What are the 2 xanthine oxidase inhibitors used to tx chronic gout?
Which chronic gout med currently only has an indication for hyperuricemia in malignancy
What is the main side effect of Colchicine and is often difficult to tolerate?
Dose dependent diarrhea
What are the 3 anti-inflammatory regimens that are needed during the initiation of urate-lowering therapy (ULT)?
2. Low dose NSAIDs w/ PPI
Anti-inflammatory regimens (Colchicine, NSAIDs w/ PPI or prednisone) are required during the initiation of urate lowering therapy.
How long should they be continued?
Continue at least 6 months
3-6 months after achieving target serum uric acid
What are Xanthine osidase inhibitors (allopurinol/febuxostat) efficacious for?
prophylaxis of recurrent gout attacks in both underexcreters and overproducers of uric acid
In what 4 for initiation of allopurinol or febuxostat?