gout
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| what serum urate level indicates gout | >6.8 mg/dL
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| why don't you want to try to diagnose gout using serum urate levels during a flare. when is a better time. what is a better diagnostic method and why isnt it used more | because serum uric acid is low during a flare, you should check ~2 weeks after a flare. better to do a joint aspirate during a flare but patients typically won't allow this.
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| options for monotherapy treatment of acute gout attacks | NSAIDs, colchicine, oral corticosteroids. can try intra-articular steroids or IM triamcinolone if 1 or more large joints are involved. ACTH is also an option if patient can't take oral meds
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| options for combination therapy treatment of acute gout attacks | colchicine and NSAIDS; colchicine and oral corticosteroids; intra-articular steroids and [colchicine, NSAIDS or oral corticosteroids.
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| indications for urate lowering therapy | tophi by exam or imaging, 2 or more gouty attacks per year, CKD stage 2 or greater, past urolithiasis,
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| first line for chronic urate lowering therapy | xanthine oxidase inhibitor - i.e. allopurinol or febuxastat
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| alternative agents for chronic urate lowering therapy | probenecid, losartan, fenofibrate
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| when is it not appropriate to use probenecid as an alternative to xanthine oxidase inhibtors for suppression of gout | CrCl <50 or a history of urolithiasis
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| What are risk factors for allopurinol hypersensitivity syndrome | thiazides, decreased renal function and ethnic factors
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| what should you expect to see in patients who are started on urate lowering therapy and how should you treat this | after initiation of urate lowering therapy, expect to see an increase in gout flares. use prophylaxis to deal with this. colchicine, NSAIDs + PPI, or oral corticosteroids. start within 36 hours of flare.
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| if persistent hyperuricemia occurs despite treatment with standard therapies what can you add and what precautions are necessary | pegloticase can be started but all other gout meds must be stopped. causes hypersensitivity, pretreat with antihistamine and steroids
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| what NSAIDS are approved for use in gout | naproxen, sulindac and indomethacin
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