Gout LOs

• What meds are anti-inflammatory therapy

  Colchicine, NSAIDs (Indomethacin), Corticosteroids
• What meds are urate lowering therapy

  Allopurinol, Probenecid
• Why can urate lowering meds precipitate an acute gout attack if not paired together with an anti-inflammtory agent

  Due to rapid changes in urate concentrations
• Appropiate meds for acute gout attack with mild-moderate pain

  Colchicine (low dose preferred), NSAIDs, Corticosteroids (oral or intra-articular)
• Appropriate meds for acute gout attack with severe pain and/or multiple joint involvement

  • Colchicine plus an NSAID
  • Oral corticosteroids plus colchicine
  • Intra-artciular steroids with any other tx
• What patients are candidates for pharmacotherpy for gout tx

  • Pt w/ 1 or more subcutaneous tophi
  • Pt w/ radiographic damage (any modality) attributed to gout
  • Pt w/ frequent gout flare (>/= 2 per year)
  • Pt experiencing their first flare AND they have either CKD stage >3, serum urate >9, or urolithiasis
• Treatment of chronic gout and prevention of recurrent gout attacks

  • First line: Allopurinol (preferred), Febuxostat
  • Second line: Probenecid, Lesinurad (adjunct to XOI only), Pegloticase (only in pt w/ severe refractory gout or cannot tolerate max dose of conventional oral ULT)
• What is minimum duration of time that anti-inflammatory are initiated tgether with ULT

  At least 3-6 months