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Writer's pictureMark Nguyen, PharmD, BCEMP

Acute Gouty Arthritis - #PHARMFAX

Excessive uric acid accumulation comes from an overproduction or undersecretion.

 


Excessive uric acid accumulation comes from an overproduction or undersecretion. Urate crystal deposits pool into synovial fluid. Breakdown of urate crytals leads to cell lysis subsequent inflammatory reaction. Seems like something to cause intense joint pain.


Treatment of gout consists of chronic and acute management. Uric acid lowering agents have no use in acute gouty arthritis. We need pain medications, and no, I'm not talking about opioids.


Pharmacologic agents to treat mild to moderate acute gouty arthritis include NSAIDS, glucocorticoids, and colchicine with each having unique patient considerations. Ibuprofen 400 - 800 mg TID and indomethacin 50 mg TID have excellent data for efficacy and short term use in treating gout attacks. Caution with NSAID effects on GI ulceration and renal insufficiency.


Glucocorticoids can be given orally, or intra-articular for severe cases. Prednisone is dosed as 0.5 mg/kg for 5 to 10 days with or without a taper. Glucocorticoid-induced insulin resistance makes use in diabetes less appealing.


Colchicine is extremely effective in terminating acute gout attacks. Patients receive 1.2 mg initially, then 0.6 mg in an hour if needed. Although effective, colchicine is associated with significant GI symptoms and can be toxic in the setting of renal dysfunction or CYP3A4 drug interactions.


Acute treatments don't last very long if patients are not adherence to uric acid lowering therapy. Check out another video on my page, share the #PHARMFAX with a friend, and I hope you learned something new.


Recommended Read/Watch

Acute Gouty Arthritis Infographic:

IV Opioid Metabolism: https://www.instagram.com/p/CpVi-dxJQ5-/

Ketamine for Pain: https://www.instagram.com/p/CqUfMVUgstX/


 

References

  1. FitzGerald et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res (Hoboken). 2020 Jun;72(6):744-760.

  2. Clebak K, Morrison A, Croad J. Gout: Rapid Evidence Review. Am Fam Physician. 2020 Nov 1;102(9):533-538.


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