Gout 2.0. Scott Vogelgesang, M.D. Division of Immunology: Rheumatology & Allergy
|
|
- Theresa Anthony
- 6 years ago
- Views:
Transcription
1 Gout 2.0 Scott Vogelgesang, M.D. Division of Immunology: Rheumatology & Allergy
2 Case 48 year old man presents with swollen, painful left toe that started overnight. Didn t hurt when he went to bed. No trauma, never happened before. No fever, no family history of arthritis or gout. PMH: Hypertension, Hyperlipidemia Meds: HCTZ 25 mg daily, atorvastatin 20 mg daily, aspirin 81 mg daily SH: No tobacco, ETOH 5-10/week Exam: t36.8 p95 (increases to 115 when you use the word needle ), bp148/91 Rest (except right toe) unremarkable Left toe.
3 Case (continued) CBC, Electrolytes, liver tests normal Serum Uric Acid 5.2 mg/dl X-ray of the foot shows only soft-tissue swelling. Now what? Next diagnostic step?
4 Arthrocentesis Demonstrate crystals Needled-shaped Intracellular Negatively birefringent ( parallelyellow ) Rule out septic joint
5 Alternate scenario you want to poke a needle where?!! I came to see you to make this better, not make it hurt worse! Come on, can t you tell me what this is without sticking a needle into my already sore toe? Your records indicate that when you started his statin, he had a serum uric acid of 10.2 mg/dl. Can we make a diagnosis without aspiration?
6 Presumptive Diagnosis: (Unable to demonstrate crystals) Rapid development of severe pain ( 24 hrs) Pain, erythema, swelling typical joint Hyperuricemia ~80% probability of having gout Zhang w et al. Ann Rheum Dis 2006;65:1301
7 Dual Energy Computed Tomography (DECT) Identifies urate deposits Using chemical properties of urate Yield 85-90% False negative scans: 1 st episode of gout Symptom duration < 6 weeks False positive Osteoarthritis Similar to conventional CT Radiation exposure Expense Durcan L et al. Semin Arthritis Rheum 2015,
8 Double Contour Sign Ultrasound Irregular echogenic line over the superficial layer of hyaline cartilage No radiation $ < than CT Performance Specific Not sensitive Durcan L et al. Semin Arthritis Rheum 2015,
9 Case you mean, you knew I had high levels of that gout chemical and you didn t treat it? Could you have prevented this pain in my toe? Should we treat asymptomatic hyperuricemia?
10 (Asymptomatic) Hyperuricemia Onset: Men: puberty Women: menopause Level of SUA correlates with likelihood of acute gout, renal stones BUT only 1-10% of those with hyperuricemia will develop acute gout Not treated
11 Case - Management Choices depend on severity and number of joints
12 Baseline Recommendations Education, diet & lifestyle recommendations Avoid high-purine foods, alcohol overuse Encourage low/non-fat dairy products and vegetables Weight loss Smoking cessation Increase exercise Secondary Causes Obesity Excessive alcohol Metabolic syndrome Hypertension Hyperlipidemia History of urolithiasis Chronic kidney disease Genetic/acquired cause of urate overproduction Lead intoxication
13 NSAIDs Use any short-acting NSAID- Full dose FDA: indomethacin, naproxen, sulindac No functional difference in efficacy Use at onset of symptoms Keep Rx available so no need to call office Continue until attack resolves Usually better tolerated than colchicine
14 Colchicine: Oral 1.2 mg then 0.6 mg 1 hour later 12 hours later 0.6 mg qd or BID Mechanism: Inhibits microtubule formation Decreases inflammatory response Side Effects: NVD, marrow suppression, death, hepatitis, seizures, respiratory depression, alopecia,
15 Prednisone 0.5 mg/kg x 5-10 days then stop or- 0.5 mg/kg x 2-5 days then taper over 7 days
16 Joint Injection Rule out infection before injecting steroids Not routinely done unless cultures negative for hours
17 Case Should we stop his HCTZ? The decision should be individualized, taking into consideration the degree to which the thiazide increases the serum urate level, whether this increase can be managed without overly complicating the patient s hypouricemic therapy, and, most importantly, what effect switching to another drug will have on the control of the patient s hypertension. No study has directly addressed this issue. Should we stop his aspirin? aspirin in low doses for cardioprotection (81 mg daily) also need not be stopped in patients with hyperuricemia or gout in an effort to better control the serum urate level. Low-dose aspirin increases the serum urate level by about 0.3 mg/dl. Since patients with gout have a higher risk of having cardiovascular disease, metabolic syndrome, and chronic kidney disease, many will benefit from low-dose aspirin therapy. Could we substitute losartan for HCTZ? Losartan is a weak uricosuric and can lower the serum urate level slightly, possibly making the addition of another hypouricemic agent unnecessary, while still controlling the blood pressure with a single pill. This decision must be individualized, taking into consideration the efficacy and cost of the alternative antihypertensive drug, as well as the potential but as yet unproven cardiovascular and renal benefits of lowering the serum urate with a more potent hypouricemic to a degree not likely to be attained with losartan alone. Mandel B. Cleveland Clinic Journal of Medicine February;81(2):83, 86
18 Case Same patient 10 years later Managed his attacks by taking ibuprofen 800 mg three times daily at the first twinge of toe pain for 5 days Frequency of attacks has been increasing over the past few years now he gets 4-5 attacks per year and the ibuprofen doesn t completely abate the attacks anymore. He returns to clinic for advice Exam: T37.1 p82 bp 127/78 Rest unremarkable (no tophi) CBC, Liver tests, electrolytes normal. Serum Uric Acid 10.4 mg/dl
19 Chronic/Tophaceous Gout Destructive, chronic arthritis Rate of urate deposition SUA level Can be polyarticular with systemic features
20 Urate Lowering Therapy Indications 1 gout attack & chronic kidney disease Tophi 2 attacks/year History of urolithiasis Medications Xanthine Oxidase Inhibitors (XOI) Examples: Allopurinol, Febuxostat Stop purine metabolism (inhibit xanthine oxidase) Uric acid doesn t form Uricosurics: Example: Probenecid increase renal excretion of uric acid Urate Transporter (URAT1) inhibitor Example: Lesinurad inhibits uric acid reabsorption Uricase: converts uric acid to allantoin
21 Overall Approach to Therapy Allopurinol or Febuxostat (XOI) Treat to at least 6.0 mg/dl (< 5.0 mg/dl if tophi) Increase intensity and re-evaluate If not successful, consider adding lesinurad Probenecid as alternative if XOI is contra-indicated or not tolerated Add uricosuric with both agents titrate to max appropriate dose If ineffective, consider pegloticase
22 Allopurinol Xanthine oxidase (competitive) inhibitor Consider HLA-B*5801 in Koreans with CKD 3, Chinese, Thai Dose Start 100 mg/day (50 mg/day in CKD 4) Titrate up q 2-5 weeks Max 800 mg/day Side Effects: TEN, NVD, marrow suppression, hepatitis, fever, vasculitis, alopecia Drug interactions: azathioprine Any change in SUA can precipitate acute flare of gout Beware of allopurinol hypersensitivity TEN can be fatal
23 Febuxostat Xanthine Oxidase inhibition (non-competitive) 40 mg qd (max 80 mg) Side Effects Cardiovascular (MI, CVA) Elevated LFTS Gout Flare Avoid combo with azathioprine
24 Probenecid Uricosuric monotherapy or combo with XOI Rarely used anymore Ideal candidate: XOI not tolerated < 60 years of age normal renal function (GFR > ml/min) 24 hour urine uric acid < 800 mg no history of stones > 2 attacks/year 250 mg BID (max 3g/day) Side effects: rash, NVD, marrow toxicity
25 Lesinurad Urate transporter (URAT1) inhibitor 200 mg daily Used in combination with XOI Side Effects Renal failure (stop if CrCl < 45) Headache GERD Avoid with ASA, valproic acid, OCP
26 Other Options Pegloticase (uricase): Persistent activity despite (or intolerance to) combination urate lowering therapy IL-1 antagonists
27 Prophylaxis Colchicine (or NSAIDs) to prevent an acute exacerbation while initiating hypouricemic therapy Colchicine 0.6 mg qd - BID indomethacin 25 mg qd BID Duration: Greater of 6 months or- 3 mos after target SUA (no tophi) 6 mos after target SUA (with tophi that resolved)
28 Take Home Points Diagnosis of gout: Crystal identification Presumptive Dx Criteria Dual Energy CT Ultrasound Asymptomatic Hyperuricemia not treated. Acute treatment: NSAIDs Colchicine Prednisone Allopurinol: 2 attacks/yr, stones, GFR, tophi, TLL, Enzyme deficiency
29 Questions? References Neogi T. Clinical practice: gout. New Engl J Med 2011;364: Khanna D, et al American College of Rheumatology Guidelines for Management of Gout Part 1. Arthritis Care Res 2012;64(10): Khanna D, et al American College of Rheumatology Guidelines for Management of Gout Part 2. Arthritis Care Res 2012; 64: Mandel B. Cleveland Clinic Journal of Medicine February;81(2):83, 86 Zhang w et al. Ann Rheum Dis 2006;65:1301
Gout: Develop treatment plan in William Jones, MS, RPh
Gout: Develop treatment plan in 2013 William Jones, MS, RPh (wnjones49@cox.net) Objectives Describe acute gouty arthritis Tx Describe Tx of chronic gouty arthritis. Define the target serum uric acid concentration
More informationPodcast (Video Recorded Lecture Series): Gout for the USMLE Step One Exam. Howard J. Sachs, MD
Podcast (Video Recorded Lecture Series): Gout for the USMLE Step One Exam Howard J. Sachs, MD www.12daysinmarch.com Email: Howard@12daysinmarch.com Podcast (Video Recorded Lecture Series): Gout for the
More informationOBJECTIVES GOUT GOUTY INFLAMMATION 6/10/2016 GOUT INCIDENCE AND PREVALENCE MONOSODIUM URATE CRYSTAL DEPOSITION DISEASE
GOUT Lisa Talbert, MD Family Medicine Update June 15, 2016 OBJECTIVES To be familiar with the clinical presentation and pathophysiology of gouty arthritis Be able to incorporate current guidelines when
More information1. To review the diagnosis of gout and its differential. 2. To understand the four stages of gout
Objectives 1. To review the diagnosis of gout and its differential GOUT 2. To understand the four stages of gout 3. To develop an approach for the acute treatment of gout Anthony Lim 9/13/12 Cycle 3 4.
More informationCase presentation. serum uric acid = 11.5 mg/dl 24-hour uric acid excretion = 300 mg
GOUT 55 y/o male 12 hours pain in my big toe & ankle went to bed last night feeling fine felt as if had broken toe this morning similar problems in right ankle & left wrist Case presentation lab studies
More informationLecture 8 Gout Hinch. Pathogenesis of acute attacks
Gout: disease characterized by deposition of monosodium crystals in soft tissues (cartilage, tendons, bursa) recurrent episodes of acute joint pain & inflammation Pathogenesis of acute attacks Epidemiology:
More informationGout: Update in therapeutics
Summary Gout: Update in therapeutics 29/11/14 Caroline van Durme CHU de Liège Maastricht University Medical Centre+ Why treating gout? Guidelines: ACR 12 Drugs: Colchicine Allopurinol: what about the kidney?
More informationA Patient s Guide to Gout. Foot and Ankle Center of Massachusetts, P.C.
A Patient s Guide to Gout Welcome to Foot and Ankle Center of Massachusetts, where we believe in accelerating your learning curve with educational materials that are clearly written and professionally
More informationGout Treatment Guidelines
Gout Treatment Guidelines Gout is a disorder that manifests as a spectrum of clinical and pathologic features built on a foundation of an excess body burden of uric acid, manifested in part by hyperuricemia,
More informationGout -revisited. Shrenik Shah
Gout -revisited Shrenik Shah definition Monosodium urate (MSU) crystal deposition episodic and later persistent joint inflammation and tophi All MSU crystal deposition- broader definition EULAR- European
More informationAchieving Gout Goals in Your Practice An Interview with Paul P. Doghramji, MD, FAAFP
Achieving Gout Goals in Your Practice An Interview with Paul P. Doghramji, MD, FAAFP Dr. Paul Doghramji is attending physician at the Pottstown Memorial Medical Center and medical director of Health Services
More informationUpdate on Gout for GPs
Update on Gout for GPs Dr Patrick Kiely PhD FRCP Consultant Physician and Rheumatologist St George s, London 2/3 1/3 Gut bacteria have uricase Chronic erosive arthropathy Clinical spectrum Making the diagnosis
More informationDrugs Used to Treat Gout. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia
Drugs Used to Treat Gout Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Gout is a metabolic disease characterized by recurrent episodes of acute arthritis
More informationGOUT IN THE ELDERLY. Learning Objectives. Disclosure. Geriatric Grand Rounds. Geriatric Grand Rounds
Visit web sites: Tuesday, June 2, 2009 12:00 noon Dr. Bill Black Auditorium Glenrose Rehabilitation Hospital In keeping with Glenrose Rehabilitation Hospital policy, speakers participating in this event
More informationGout- Treatment Updates. Harinder Singh, MD Rheumatology Mercy Internal Medicine Clinic Mason City, IA
Gout- Treatment Updates Harinder Singh, MD Rheumatology Mercy Internal Medicine Clinic Mason City, IA Gout Outline of purine metabolism: (1) amidophosphoribosyltransferase (2) hypoxanthine-guanine phosphoribosyltransferase
More informationEnhanced Primary Care Pathway: Gout
Enhanced Primary Care Pathway: Gout 1. Focused summary of gout relevant to primary care Significance: Gout is a chronic, progressive, inflammatory disease requiring appropriate long-term management. Gout
More informationGout Hanan Abdel Rehim
Review article 35 Gout Hanan Abdel Rehim Department of Internal Medicine, Kasr-Al Aini School of Medicine, Cairo University, Cairo, Egypt Correspondence to Hanan Abdel Rehim, MD, 11 Ismaiel Wahby Street,
More informationGout A rapid review. Jeremy Jones
Gout A rapid review Jeremy Jones The Hyperuricemia Cascade Dietary purines Tissue nucleic acids Urate Endogenous purine synthesis Overproduction Hyperuricemia Underexcretion Silent tissue deposition Gout
More informationRheumatology Cases for the Internist
Rheumatology Cases for the Internist Marc C. Hochberg, MD, MPH Professor of Medicine Head, Division of Rheumatology and Clinical Immunology Vice Chair, Department of Medicine University of Maryland School
More informationRheumatoid arthritis, seronegative spondylarthritides and gout. György Nagy
Rheumatoid arthritis, seronegative spondylarthritides and gout György Nagy Dec 4, 2017 Rheumatoid arthritis Rheumatoid arthritis Chronic, progressive, autoimmune disorder of the joints with extra-articular
More informationManaging Gout A Review of the Research for Adults
Managing Gout A Review of the Research for Adults e Is This Information Right for Me? This information is right for you if: Your health care professional* has said that you have gout. You are age 18 or
More informationGout: Let s Be Crystal Clear. Dr. Philip A. Baer Seacourses Asia CME December 2017
Gout: Let s Be Crystal Clear Dr. Philip A. Baer Seacourses Asia CME December 2017 Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or
More informationZurampic. (lesinurad) New Product Slideshow
Zurampic (lesinurad) New Product Slideshow Introduction Brand name: Zurampic Generic name: Lesinurad Pharmacological class: URAT1 inhibitor Strength and Formulation: 200mg; tablets Manufacturer: Ironwood
More information3/2/2014. Got Gout? Get a Plumber. Objectives. Disclosures
Got Gout? Get a Plumber. Heidi Garcia, PA-C Department of Rheumatology Division of Internal Medicine Mayo Clinic Arizona 2013 MFMER slide-1 Objectives Recall some of the history of Gout. Describe the pathophysiology
More informationCrystal induced arthropathies. Dr. Amitesh Aggarwal
Crystal induced arthropathies Dr. Amitesh Aggarwal 1 Crystal induced Arthropathies Gout Pseudogout Debilitating illnesses; Recurrent episodes of pain and joint inflammation; Formation and deposition of
More informationNew Drug Evaluation: lesinurad tablet, oral
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationGOUT. Dr Krishnan Baburaj West herts NHS Trust
GOUT Dr Krishnan Baburaj West herts NHS Trust podagra Gout A disease of kings, the king of diseases History Louis XIV Emperor Augustus Henry VIII Introduction Gout an inflammatory arthritic condition that
More informationPennsylvania Academy of Family Physicians Foundation & UPMC 43rd Refresher Course in Family Medicine CME Conference March 10-13, 2016
Pennsylvania Academy of Family Physicians Foundation & UPMC 43rd Refresher Course in Family Medicine CME Conference March 10-13, 2016 Disclosures: Gout and Pseudogout Wayne Blount MD Speaker has no disclosures
More informationuric acid Non electrolytes of the plasma
73 uric acid Non electrolytes of the plasma 1 Purines and uric acid Fig 2 JFI Uric acid is the major product of catabolism of the purine nucleosides adenosine and guanosine, Uric acid is sparingly soluble
More informationAn update on the management of gout
An update on the management of gout 8 The management of gout involves treatment of an acute attack, lifestyle modification and urate lowering treatment to achieve a target serum urate level. Recent evidence
More informationGout basics. Update on Gout. Production of uric acid. Gout basics. Crystal induced inflammation. Gout calculator. The important role of ultrasound
Update on Gout The important role of ultrasound Cheung C Yue, M.D. Gout basics Hyperuricemia gout Over 5 years, 22% >9 mg/dl develop gout Man 3-4 times more than women Risks: thiazide, cyclosporin, low
More informationGOUT disease spectrum including
GOUT disease spectrum including *hyperuricemia, *recurrent attacks of acute arthritis associated with monosodium urate crystals in leukocytes found in synovial fluid, *deposits of monosodium urate crystals
More informationDrugs for Gout, osteoarthritis and osteoporosis
MMS Pharmacology Lecture 3 Drugs for Gout, osteoarthritis and osteoporosis Dr Sura Al Zoubi Revision Gout The term gout describes a disease spectrum including hyperuricemia, recurrent attacks of acute
More information4/1/2011. New Developments in Gout. Conflict of Interest Declaration. Objectives
New Developments in Gout Tatum N. Mead, Pharm.D. Clinical Assistant Professor UMKC SOP meadt@umkc.edu April 16, 2011 1 Conflict of Interest Declaration I have no actual or potential conflict of interest
More informationLECTURE 5: DRUGS IN GOUT
Red : important Black : in male / female slides Pink : in female s slides only Blue : in male s slides only Green : Dr s notes Grey: Extra information, explanation Editing File LECTURE 5: DRUGS IN GOUT
More informationMono-articular Joint Complaints
Mono-articular Joint Complaints Derrick J. Todd, M.D., Ph.D. Associate Physician Department of Rheumatology, Immunology, and Allergy Brigham and Women s Hospital Instructor of Medicine Harvard Medical
More informationGOUT & PSEUDOGOUT OPSC 2018 HOWARD L. FEINBERG, D.O., F.A.C.O.I.., F.A.C.R.
GOUT & PSEUDOGOUT OPSC 2018 HOWARD L. FEINBERG, D.O., F.A.C.O.I.., F.A.C.R. Everything in excess is opposed by nature Eunuchs do not take the gout, nor become bald. GOUT Hyperuricemia is not gout Gout
More informationDose of celecoxib in gout attack attack
Dose of celecoxib in gout attack Gout is a disease characterized by an abnormal metabolism of uric acid, resulting in an excess of uric acid in the tissues and blood. People with gout either produce too
More informationRheumatology Updates for the Primary Care Provider
Rheumatology Updates for the Primary Care Provider Jean Tayar, MD, RhMSUS Associate Professor Section of Rheumatology and Clinical Immunology Department of General Internal Medicine UT MD Anderson Cancer
More informationLesinurad in Combination With a Xanthine Oxidase Inhibitor for Treatment of Hyperuricemia Associated With Gout
Lesinurad in Combination With a Xanthine Oxidase Inhibitor for Treatment of Hyperuricemia Associated With Gout Briefing Document for the Arthritis Advisory Committee Meeting Date: 23 October 215 Ardea
More informationZurampic, Duzallo (lesinurad Products)
Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Krystexxa) Reference Number: CP.PHAR.115 Effective Date: 06.01.13 Last Review Date: 02.19 Line of Business: Commercial, Medicaid Coding Implications Revision Log See Important Reminder
More informationACP Rheumatology Pearls. Adam Q Carlson MD Assistant Professor UVA Rheumatology
ACP Rheumatology Pearls Adam Q Carlson MD Assistant Professor UVA Rheumatology Disclosures I have no personal or professional disclosures Case #1 27 yo woman with a history of systemic lupus complicated
More informationCOPYRIGHT. Update in Internal Medicine December 4, 2016
Update in Internal Medicine December 4, 2016 Fadi Badlissi, MD, MSc Director of the Musculoskeletal Medicine Unit The Orthopedic Department & Rheumatology Division Beth Israel Deaconess Medical Center
More informationNew Drugs for the Primary Care Provider: What You Need to Know
4:00 4:35 pm New Drugs for the Primary Care Provider: What You Need to Know SPEAKER Gerald W. Smetana, MD Presenter Disclosure Information The following relationships exist related to this presentation:
More informationUrate Lowering Efficacy of Febuxostat Versus Allopurinol in Hyperuricemic Patients with Gout
Philippine Journal of Internal Medicine Meta-Analysis Urate Lowering Efficacy of Febuxostat Versus Allopurinol in Hyperuricemic Patients with Gout Erika Bianca S. Villazor-Isidro, M.D.*; John Carlo G.
More informationWhat will happen in the future? How will gout be diagnosed? How is gout treated? prevent
Rheumatology Day Unit Dr J Hamilton 0191 4458359 0191 4455240 (9-5 Mon-Fri) Dr C Heycock 0191 4452198 Answer phone on 24hours Dr C Kelly 0191 4452193 Dr V Saravanan 0191 4456055 Dr M Rynne 0191 4458359
More informationLimitations of Use: (1) Duzallo is not recommended for the treatment of asymptomatic hyperuricemia.
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.63 Subject: Duzallo Page: 1 of 5 Last Review Date: December 8, 2017 Duzallo Description Duzallo (lesinurad
More informationCopyright 2016 Wolters Kluwer Health, Inc. All rights reserved.
14 The Nurse Practitioner Vol. 41, No. 14 www.tnpj.com 2.5 CONTACT HOURS 2.5 CONTACT HOURS Gout An update on for primary care providers Abstract: This article discusses the current beliefs regarding the
More informationGout. Clinical features Most commonly affects middle-aged males. It is an acute and usually relapsing selflimiting
Gout Gout is a syndrome caused by an inflammatory response to the formation of monosodium urate monohydrate crystals which develop secondary to hyperuricemia. Acute and chronic forms are recognized. Hyperuricemia
More informationRheumatologic Emergencies It s not just swollen joints. Joanne Homik Rheumatologist University of Alberta
Rheumatologic Emergencies It s not just swollen joints Joanne Homik Rheumatologist University of Alberta Or is it? Disclosures No relevant conflicts of interest regarding the content of this presentation
More informationTherapy for Gout: The Past
Advances in Therapy for Gout: 2011 The Past, Present, and Future Therapy for Gout: The Past May 22, 1997 Pity a Tyrannosaur? Sue Had Gout By MALCOLM W. BROWNE Jonathan Graf, M.D. Associate Professor of
More informationFebuxostat now subsidised on Special Authority
Gout update: Febuxostat now subsidised on Special Authority 38 Febuxostat was added to the New Zealand Pharmaceutical Schedule on 1 June, 2014. It is now available as a third-line preventive treatment
More informationAcute hot swollen joint. Dr Edward Roddy Senior Lecturer in Rheumatology and Consultant Rheumatologist
Acute hot swollen joint Dr Edward Roddy Senior Lecturer in Rheumatology and Consultant Rheumatologist Acute monoarthritis: differential diagnosis Septic arthritis Crystal arthritis (gout, pseudogout) Haemarthrosis
More informationClass Update: Drugs for Gout
Copyright 2012 Oregon State University. ll Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationNew Drug Evaluation: lesinurad tablet, oral
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationCHAPTER:2 GOUT. BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY
CHAPTER:2 GOUT BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY DEFINITION Gout is defined as a peripheral arthritis, resulting from the deposition of MSU crystals
More informationRHEUMATOLOGY OVERVIEW. Carmelita J. Colbert, MD Assistant Professor of Medicine Division of Rheumatology Loyola University Medical Center
RHEUMATOLOGY OVERVIEW Carmelita J. Colbert, MD Assistant Professor of Medicine Division of Rheumatology Loyola University Medical Center What is Rheumatology? Medical science devoted to the rheumatic diseases
More informationClinical Practice Guideline. Gout. Version
Clinical Practice Guideline Gout Version 1.1.2017 August 2017 Table of Contents Introduction...5 Stages of Gout...7 Asymptomatic Hyperuricemia... 7 Acute Intermittent Gout... 7 Advanced Gout... 8 Diagnosis...8
More informationUloric Step Therapy Program
Uloric Step Therapy Program Policy Number: 5.01.584 Last Review: 7/2017 Origination: 7/2014 Next Review: 7/2018 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage for brand
More informationMRCP(UK) PACES. INFORMATION FOR THE CANDIDATE Training Scenario N 003 SAMPLE HOST CENTRE Station 5: BRIEF CLINICAL CONSULTATION
INFORMATION FOR THE CANDIDATE MRCP(UK) PACES Station 5: BRIEF CLINICAL CONSULTATION Patient details: Mr JS aged 70. Your role: You are the doctor in the medical assessment unit. You have 10 minutes with
More informationClinical Policy: Colchicine (Colcrys) Reference Number: CP.PMN.123 Effective Date: Last Review Date: 05.18
Clinical Policy: (Colcrys) Reference Number: CP.PMN.123 Effective Date: 05.01.11 Last Review Date: 05.18 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important
More informationCost-effectiveness of lesinurad (Zurampic ) for the treatment of adult patients with gout
Cost-effectiveness of lesinurad (Zurampic ) for the treatment of adult patients with gout The NCPE has issued a recommendation regarding the cost-effectiveness of Lesinurad (Zurampic ) in combination with
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Krystexxa) Reference Number: CP.CPA.57 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Medicaid Medi-Cal Revision Log See Important Reminder at the end of this policy
More informationGout: A Clinical Update. Why talk about Gout? Why talk about Gout? Populations at risk: Why is Gout Less Common in Women? US Gout Population: 2009
Gout: A Clinical Update Peng Thim Fan, MD, FACP Clinical Professor of Medicine Division of Rheumatology David Geffen School of Medicine at UCLA Why talk about Gout? Large increase in gout in the last 20
More informationAnalgesics. Munir Gharaibeh, MD, PhD, MHPE Faculty of Medicine The University of Jordan March, 2014
Analgesics Munir Gharaibeh, MD, PhD, MHPE Faculty of Medicine The University of Jordan March, 2014 Mar-14 Munir Gharaibeh, MD, PhD, MHPE 2 Feature Comparison of Analgesics Narcotic (Opioids) Nonnarcotic
More informationLong-term Treatment of Gout: New Opportunities for Improved Outcomes
Long-term Treatment of Gout: New Opportunities for Improved Outcomes Paul P. Doghramji, MD, FAAFP CONTINUING MEDICAL EDUCATION LEARNING OBJECTIVES Make a presumptive diagnosis of gout based on history
More informationTherapy for Gout: The Past
Advances in Therapy for Gout: 2015 The Past, Present, and Future Therapy for Gout: The Past Jonathan Graf, M.D. Professor of Clinical Medicine UCSF Division of Rheumatology, SFGH May 22, 1997 Pity a Tyrannosaur?
More informationFor more information about how to cite these materials visit
Author(s): Seetha Monrad, M.D., 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Noncommercial Share Alike 3.0 License: http://creativecommons.org/licenses/by-nc-sa/3.0/
More informationCurrent treatment options for acute and chronic gout
DRUG REVIEW n Current treatment options for acute and chronic gout Kelsey Jordan FRCP and Andrew Jeffries PGDip, MRCP Gout is the only curable form of arthritis, yet only a third of patients with chronic
More informationTherapy for Gout: The Past
Advances in Therapy for Gout: 2014 The Past, Present, and Future Therapy for Gout: The Past May 22, 1997 Pity a Tyrannosaur? Sue Had Gout By MALCOLM W. BROWNE Jonathan Graf, M.D. Associate Professor of
More informationKrystexxa (pegloticase) Document Number: IC-0158
Krystexxa (pegloticase) Document Number: IC-0158 Last Review Date: 06/27/2017 Date of Origin: 02/07/20103 Dates Reviewed: 11/2013, 08/2014, 07/2015, 07/2016, 09/2016, 12/2016, 03/2017, 06/2017 I. Length
More informationSubject: Krystexxa (pegloticase) Original Effective Date: 06/26/13. Policy Number: MCP-138. Revision Date(s):
Subject: Krystexxa (pegloticase) Original Effective Date: 06/26/13 Policy Number: MCP-138 Revision Date(s): Review Date(s): 12/16/15; 6/15/2016; 3/21/2017 DISCLAIMER This Molina Clinical Policy (MCP) is
More informationCOMPARATIVE EVALUATION OF EFFICACY AND SAFETY PROFILE OF FEBUXOSTAT WITH ALLOPURINOL IN PATIENTS WITH HYPERURICEMIA AND GOUT
Int. J. Pharm. Med. & Bio. Sc. 2013 P K Agarwal and Bijay Kumar, 2013 Research Paper ISSN 2278 5221 www.ijpmbs.com Vol. 2, No. 4, October 2013 2013 IJPMBS. All Rights Reserved COMPARATIVE EVALUATION OF
More informationMUSCULOSKELETAL PHARMACOLOGY. A story of the inflamed
MUSCULOSKELETAL PHARMACOLOGY A story of the inflamed 1 INFLAMMATION Pathophysiology Inflammation Reaction to tissue injury Caused by release of chemical mediators Leads to a vascular response Fluid and
More informationVI.2 Elements for a Public Summary. VI.2.1 Overview of disease epidemiology
VI.2 Elements for a Public Summary VI.2.1 Overview of disease epidemiology Febuxostat is a medicine used in adults with gout to reduce high levels of uric acid in the blood. Gout results from a build up
More informationGout Goals Are Not Being Achieved!! Strengthening The Provider/Patient Alliance Featuring PEPtools TM JointsAflame
Gout Goals Are ot Being Achieved!! Strengthening The Provider/Patient Alliance QS Priorities Gout Goals Are ot Being Achieved!! Strengthening The Provider/Patient Alliance Paul P. Doghramji, MD, FAAFP
More informationThe CKD patient in the office or ER. Dr. Vincent Cheung Nephrologist Peterborough Regional Renal Program November 9 th, 2016
The CKD patient in the office or ER Dr. Vincent Cheung Nephrologist Peterborough Regional Renal Program November 9 th, 2016 Presenter Disclosure Dr. Vincent Cheung Relationships with commercial interests
More informationImplementing AHRQ Effective Health Care Reviews Helping Clinicians Make Better Treatment Choices
Implementing AHRQ Effective Health Care Reviews Helping Clinicians Make Better Treatment Choices Gout: Diagnosis and Management Practice Pointers by MATTHEW R. NOSS, DO, MSEd, U.S. Army Health Clinic,
More informationGout Goals Are Not Being Achieved!! Strengthening The Provider/Patient Alliance Featuring PEPtools JointsAflame
Gout Goals Are ot Being Achieved!! Strengthening The Provider/Patient Alliance QS Priorities Gout Goals Are ot Being Achieved!! Strengthening The Provider/Patient Alliance Featuring PEPtools TM JointsAflame
More informationCrystal-Induced Arthritis. Rajesh Kataria, D.O. Southern Ohio Rheumatology
Crystal-Induced Arthritis Rajesh Kataria, D.O. Southern Ohio Rheumatology Disclosures Speaker: Rajesh Kataria, D.O. Relationships with commercial interests: Speakers Bureau - Horizon Presentation will
More informationGout Goals Are Not Being Achieved!! Strengthening The Provider/Patient Alliance Featuring PEPtools JointsAflame
Gout Goals Are ot Being Achieved!! Strengthening The Provider/Patient Alliance QS Priorities Gout Goals Are ot Being Achieved!! Strengthening The Provider/Patient Alliance Featuring PEPtools TM JointsAflame
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A ABCG2 gene, in gout, 283 285 Acetaminophen, for CPP crystal deposition, 347 ACTH (corticotropin), for gout, 335 336, 383 ADAMTS proteins,
More informationThe 2010 Competency Standards addressed by this activity include (but may not be limited to): 4.2.2, 4.2.3, 6.1.2, 6.2.1, 7.1.2, 7.1.3,
UPDATE ON GOUT Learning objectives: After completing this activity, pharmacists should be able to: 1. describe the mechanisms underlying hyperuricaemia 2. state the risk factors for development of gout
More informationNovel uricosurics RHEUMATOLOGY. Thomas Bardin 1,2 and Pascal Richette 1,2. Abstract. Introduction REVIEW
RHEUMATOLOGY Rheumatology 2018;57:i42 i46 doi:10.1093/rheumatology/kex433 Novel uricosurics Thomas Bardin 1,2 and Pascal Richette 1,2 REVIEW Abstract Objective. According to recent guidelines, the mainstay
More informationLiterature Scan: Analgesics for Gout. Month/Year of Review: April 2015 Date of Last Review: January 2014
Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301 1079 Phone 503 947 5220 Fax 503 947 1119 Copyright 2012 Oregon State University. All Rights
More informationRheumatology Review Update in Internal Medicine COPYRIGHT. Robert H. Shmerling, M.D. Beth Israel Deaconess Medical Center.
Rheumatology Review Update in Internal Medicine Robert H. Shmerling, M.D. Beth Israel Deaconess Medical Center Boston MA Case #1 True statement(s) regarding etanercept and leflunomide, for the treatment
More informationThe legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 24 June 2009
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 24 June 2009 ADENURIC 80 mg, film-coated tablets B/28 (CIP code: 385 724-4) B/84 (CIP code: 572 820-3) ADENURIC 120
More informationLESSON ASSIGNMENT. Analgesic, Anti-Inflammatory, and Antigout Agents.
LESSON ASSIGNMENT LESSON 4 Analgesic, Anti-Inflammatory, and Antigout Agents. TEXT ASSIGNMENT Paragraphs 4-1 through 4-8. LESSON OBJECTIVES 4-1. Given one of the following terms: analgesic, antipyretic,
More informationGout Prevention Project. Simplifying Gout Prevention Management for GPs and Patients
Gout Prevention Project Simplifying Gout Prevention Management for GPs and Patients Gout Prevalance 2 Gout Management primary care level 52.8% of PCP provided optimal medication treatment for acute attack
More informationEssence of the Revised Guideline for the Management of Hyperuricemia and Gout
Research and Reviews Essence of the Revised Guideline for the Management of Hyperuricemia and Gout JMAJ 55(4): 324 329, 2012 Hisashi YAMANAKA,* 1 The Guideline Revising Committee of Japanese Society of
More informationGout. Edward Roddy, 1 Christian D Mallen, 1 Michael Doherty 2 CLINICAL REVIEW
Gout Edward Roddy, 1 Christian D Mallen, 1 Michael Doherty 2 1 Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele ST5 5BG, UK 2 Academic Rheumatology, University
More informationClinical Policy: Colchicine (Colcrys) Reference Number: CP.PPA.11. Line of Business: Medicaid
Clinical Policy: (Colcrys) Reference Number: CP.PPA.11 Effective Date: 05/11 Last Review Date: 05/176 Line of Business: Medicaid Coding Implications Revision Log See Important Reminder at the end of this
More informationHARVARD PILGRIM HEALTH CARE RECOMMENDED MEDICATION REQUEST GUIDELINES
Generic Brand HICL GCN Exception/Other PEGLOTICASE KRYSTEXXA 37154 GUIDELINES FOR USE 1. Does the patient have a diagnosis of symptomatic chronic gout (prior to initiating Krystexxa therapy) with clinical
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Zurampic) Reference Number: CP.CPA.174 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Medicaid Medi-Cal Revision Log See Important Reminder at the end of this policy
More information2.0. Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved. 24 The Nurse Practitioner Vol. 40, No. 8
2.0 CONTACT HOURS 24 The Nurse Practitioner Vol. 40, No. 8 www.tnpj.com Treatment and gout prevention of o leva Abstract: Gout is a disorder of purine metabolism that primarily occurs in adult males. Elevated
More informationG O U T. New Medications For New/Established Mechanisms AND. Old Medications With Novel Benefits
G O U T New Medications For New/Established Mechanisms AND Old Medications With Novel Benefits Tawatchai (Kee) Paisansinsup, MD. Health Partners-Park Nicollet Health Services Twin Cities, Minnesota May
More informationUric acid and CKD. Sunil Badve Conjoint Associate Professor, UNSW Staff Specialist, St George
Uric acid and CKD Sunil Badve Conjoint Associate Professor, UNSW Staff Specialist, St George Hospital @Badves Case Mr J, 52 Male, referred in June 2015 DM type 2 (4 years), HTN, diabetic retinopathy, diabetic
More informationHypertension in 2015: SPRINT-ing ahead of JNC-8. MAJ Charles Magee, MD MPH FACP Director, WRNMMC Hypertension Clinic
Hypertension in 2015: SPRINT-ing ahead of JNC-8 MAJ Charles Magee, MD MPH FACP Director, WRNMMC Hypertension Clinic Conflits of interest? None Disclaimer The opinions contained herein are not to be considered
More information