Full Answer
When is prophylaxis indicated in the treatment of acute gout?
Prophylaxis of acute gout with NSAIDs, colchicine, or corticosteroids is universally recommended when initiating any urate-lowering therapy in order to prevent acute gouty arthritis for a period of at least 6 months.
Why is gout treatment so complicated?
Use of these modalities can be complicated because of comorbidity and concomitant medication use that is prevalent among patients with gout.
Which medications are used in the treatment of acute gout?
Acute gouty arthritis should be treated with nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, or corticosteroids, or a combination of two agents. Xanthine oxidase inhibitor therapy remains the consensus first-line treatment option for the prevention of recurrent gout.
What is the goal of treatment during an acute gout attack?
The goal of treatment during an acute gout attack is suppression of inflammation and control of pain. It is important to note, that if a patient is not on uric acid lowering therapy at the time of an acute attack – then this is not the time to initiate such therapy. However, if a patient is on uric acid lowering therapy at the time ...
Which drug is contraindicated in acute gout?
Nonsteroidal anti-inflammatory drugs are contraindicated with the concomitant use of angiotensin-converting enzyme (ACE) inhibitors and/or diuretics. Prostaglandin production is decreased while using NSAIDs, resulting in increased constriction of afferent renal arterioles and decreased glomerular filtration pressure.
Why uricosuric drugs are not given in acute gout?
Uricosuric agents lower uric acid levels by inhibiting renal tubular reabsorption of uric acid, thereby increasing net renal excretion of uric acid. These agents increase the risk of renal stones, with about a 9-10% risk for probenecid. They should not be started during an attack of acute gouty arthritis.
Why is allopurinol not used for acute gout?
Allopurinol should not be stopped during acute flares of gout. Stopping allopurinol during an acute flare means therapeutic effect is lost and the urate level will rise. In addition, there is a real risk of the allopurinol not being recommenced as well as precipitating another flare when it is recommenced.
Which drug should be avoided in gout?
In addition to diet, exercise, and weight loss, avoid these medications that can trigger gout, if you can: Diuretics (used to treat high blood pressure or heart disease) Salicylate-containing drugs (such as aspirin) Niacin (vitamin B3 and nicotinic acid)
Which uricosuric drugs is not used in acute gout?
Uricosuric agents lower uric acid levels by inhibiting renal tubular reabsorption of uric acid, thereby increasing net renal excretion of uric acid. These agents increase the risk of renal stones, with about a 9-10% risk for probenecid. They should not be started during an attack of acute gouty arthritis.
Why do diuretics cause gout?
Diuretics can increase your risk of developing gout, a type of arthritis caused by the buildup of uric acid crystals in a joint. This may happen because diuretics increase urination, which reduces the amount of fluid in your body.
What is the best treatment for acute gout?
Oral corticosteroids, intravenous corticosteroids, NSAIDs, and colchicine are equally effective in treating acute flares of gout. NSAIDs are the first-line treatment. Indomethacin (Indocin) has historically been the preferred choice; however, there is no evidence it is more effective than any other NSAID.
What are the contraindications of allopurinol?
Contraindications / PrecautionsGeneral Information. ... Serious rash. ... Renal disease, renal failure, renal impairment. ... Hepatic disease, hepatotoxicity. ... Anticoagulant therapy, bone marrow suppression. ... Driving or operating machinery. ... Pregnancy. ... Breast-feeding.More items...
Which of the following is not a first-line option for the pharmacologic treatment of acute gout?
Which of the following is NOT a first-line option for the pharmacologic treatment of acute gout? Please click below for answer and next question. The correct answer is D. Aspirin.
What medications trigger gout?
Medications that can trigger goutchlorothiazide.chlorthalidone.hydrochlorothiazide.indapamide.metolazone.spironolactone.
Which of the following drugs is used in acute gout?
Colchicine. Your doctor may recommend colchicine (Colcrys, Gloperba, Mitigare), an anti-inflammatory drug that effectively reduces gout pain. The drug's effectiveness may be offset, however, by side effects such as nausea, vomiting and diarrhea. Corticosteroids.
What is the best treatment for gout?
Acute gouty arthritis should be treated with nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, or corticosteroids, or a combination of two agents. Xanthine oxidase inhibitor therapy remains the consensus first-line treatment option for the prevention of recurrent gout.
How long does gout last?
Prophylaxis of acute gout with NSAIDs, colchicine, or corticosteroids is universally recommended when initiating any urate-lowering therapy in order to prevent acute gouty arthritis for a period of at least 6 months.
Is gout a comorbidity?
The prevalence of gout is rising and is likely attributed to several factors including increased incidence of comorbidities , lifestyle factors, and increased use of causative medications.
Is gout a rheumatic disease?
The clinical burden of gouty arthritis has historically been well recognized; however, gout is often misdiagnosed and mismanaged. The prevalence of gout is rising and is likely attributed to several factors including increased incidence o …. Gouty arthritis is one of the most common rheumatic diseases. The clinical burden of gouty arthritis has ...
What is the goal of treatment for gout?
Acute Gout Attack. The goal of treatment during an acute gout attack is suppression of inflammation and control of pain. It is important to note, that if a patient is not on uric acid lowering therapy at the time of an acute attack – then this is not the time to initiate such therapy. However, if a patient is on uric acid lowering therapy at ...
What is the FDA approved drug for gout?
Febuxostat. In 2009, the FDA approved the use of a new xanthine oxidase inhibitor, febuxostat, for the treatment of hyperuricemia in gout. It has demonstrated a dose-dependent decreasee in serum uric acid (daily doses 80mg or 120mg). Its efficacy has been demonstrated in patients with mild or moderate renal impairment and gout.
What is uricase in humans?
Uricase is an enzyme that converts poorly soluable urate (uric acid) to the more soluable allantoin (excreted in the urine). Uricase is present in most mammals, and these mammals with uricase do not develop gout. However, humans and some primates lack uricase (because of evoluationary gene inactivation) and lack the ability to make uric acid more soluable and hence, have gout. Pegloticase is a porcine uricase which was approved by the FDA in September 2010 for the treatment of gout in patients who have failed conventional therapy.
What percentage of uric acid is derived from purines?
About 20% of uric acid is derived from purines ingested in food. Causes of hyperuricemia can be divided into two major categories: decreased clearance of uric acid from the kidney and increased synthesis of uric acid.
What is the uric acid level in renal stones?
renal stones. Prior to chemotherapy as prophylaxis of tumor lysis syndrome. Extremely high levels of serum uric acid (>12 mg/dl) Uric acid is the end product of purine (nucleic acid component of DNA) metabolism and is produced normally by the body during tissue remodeling and breakdown.
What is the best treatment for pain and inflammation?
Treatment of pain and inflammation can be achieved with NSAIDs, colchicine, or corticosteroids (systemic or intra-articular). The choice of which treatment is the right one for a particular patient should be made on the basis of the patient’s co-morbid medical conditions, other medications, and side effect profile.
What are the toxic effects of allopurinol?
Liver tests, blood counts, and renal function and should be monitored while on therapy. Toxicites include rash, hepatoxicity, bone marrow suppression and severe hypersensitivity reactions. Medication interactions can occur with allopurinol, warfarin, and theophylline and levels should be monitored.
How long does it take for gout to subside?
Usual Adult Dose for Acute Gout. -Relief of pain has been observed within 2 to 4 hours; tenderness and heat usually subside within 24 to 36 hours ; swelling gradually disappears in 3 to 5 days. -Extended release capsules are not recommended for the treatment of acute gouty arthritis.
Is advanced renal disease recommended?
Advanced Renal Disease: Not recommended; if treatment is necessary, close monitoring of renal function is advised.#N#Neonates:#N#-Contraindicated in significant renal impairment.#N#-If anuria or marked oliguria (urinary output less than 0.6 mL/kg/hr) occurs after a dose of IV therapy, no additional doses should be given until renal function returns to normal.
Treatment
- The goal of treatment during an acute gout attack is suppression of inflammation and control of pain. It is important to note, that if a patient is not on uric acid lowering therapy at the time of an acute attack then this is not the time to initiate such therapy. However, if a patient is on uric acid lowering therapy at the time of an acute attack, it should not be discontinued. Treatment of pain …
Causes
- Uric acid is the end product of purine (nucleic acid component of DNA) metabolism and is produced normally by the body during tissue remodeling and breakdown. About 20% of uric acid is derived from purines ingested in food. Causes of hyperuricemia can be divided into two major categories: decreased clearance of uric acid from the kidney and increased synthesis of uric acid.
Contraindications
- Probenecid may be given to patients with decreased clearance of uric acid by the kidney and normal renal function. In general its use should be limited to patients under the age of 60. Probenecid acts by inhibiting reabsorption of uric acid in the proximal tubules of the kidney. Starting dose is at 500 mg to 1000 mg daily and increased to 1500 mg t...
Medical uses
- Allopurinol is a well tolerated, inexpensive, and commonly used uric acid lowering agent. Allopurinol can be started at doses as low as 100 mg daily (100 mg qod if creatinine clearance < 10 cc/min) and titrated by 100 mg every 10-14 days to achieve a serum uric acid level of 4-5 mg/dl. Liver tests, blood counts, and renal function and should be monitored while on therapy. T…
Interactions
- In 2009, the FDA approved the use of a new xanthine oxidase inhibitor, febuxostat, for the treatment of hyperuricemia in gout. It has demonstrated a dose-dependent decreasee in serum uric acid (daily doses 80mg or 120mg). Its efficacy has been demonstrated in patients with mild or moderate renal impairment and gout. However, it can cause abnormalities in liver function tes…
Overview
- Uricase is an enzyme that converts poorly soluable urate (uric acid) to the more soluable allantoin (excreted in the urine). Uricase is present in most mammals, and these mammals with uricase do not develop gout. However, humans and some primates lack uricase (because of evoluationary gene inactivation) and lack the ability to make uric acid more soluable and hence, have gout. Pe…
Administration
- Pegloticase is administered by intravenous infusion every 2 weeks. Patients should be treated prophylactically for allergic reations to the infusion with steroids and anti-histamines and monitored closely for the development of an infusion reaction. Caution should be used in prescribing this treatment in patients with a known cardiac history.
Prevention
- Avoidance of purine rich foods and alcohol may help lower uric acid levels and prevent significant fluctuations in serum uric acid that may precipitate acute attacks. Obesity and increased fat distribution are risk factors for gout. Eating a healthy balanced diet of low-fat proteins, low-fat dairy and vegetables will help maintain a healthy weight which is beneficial for the prevention of …