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Understanding Gout: Prevalence, Treatment, and Management Strategies

Gout prevalence has doubled over the last 20 years, largely due to factors like prolonged diuretic use, obesity, and metabolic syndrome. Effective management involves both non-pharmacologic and pharmacologic strategies, emphasizing patient education on weight loss and diet to lower serum uric acid (SUA) levels. Treatment goals focus on terminating acute attacks, providing pain relief, and preventing complications such as tophi and renal stones. Medications like NSAIDs and colchicine are crucial during acute gout episodes, while urate-lowering therapies are key in chronic management.

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Understanding Gout: Prevalence, Treatment, and Management Strategies

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  1. GOUT Dr. K. Declerck • prevalence doubled over the last 20 years • due to longevity use of diuretics and ASA obesity – metabolic syndrome end stage disease – hypertension • treatment should be non pharmacologic and pharmacologic

  2. Patient education • weight loss • diet can reduce SUA with 1 à 2 mg/dl • treatment of comorbid conditions • evaluation of concomitant medications

  3. Goals of treatment • 1. terminate acute attack • 2. provide rapid, safe pain and anti- inflammatory relief • 3. prevent complications * destructive arthropathy * tophi * renal stones

  4. Acute gout treatment • NSAIDs • Colchicine • Corticosteroids

  5. IF ON A URATE LOWERING DRUG, DO NOT STOP OR ADJUST DOSE DO NOT START A URATE LOWERING DRUG DURING AN ACUTE ATTACK

  6. Gout urate lowering treatment • 1. never start a urine acid lowering agent during an acute attack • 2. hyperuricemia with an acute inflammatory arthritis is not necessarily gout • 3. asymptomatic hyperuricemia is not a disease and is not always an indication for treatment • 4. maintain SAU level below 6 mg/dl i.e. below the tissue saturation for MSU

  7. Who to treat ? • 1. tophi • 2. gouty arthropathy • 3. radiographic changes of gout • 4. multiple joint involvement • 5. nephrolithiasis > Controversy when to treat in early disease?

  8. Urate lowering drugs = inhibitor of xanthine oxidase > Allopurinol * start low dose untill average dose of 300 mg daily * associate prophylactic colchicine * adjust dose in renal insufficiency * cave: adverse events > Oxypurinol

  9. Urate lowering drugs = uricosurica • 1. Probenecid • 2. Sulfinpyrazone • 3. Benzbromarone • 4. Fenofibrate • 5. Losartan • 6. Vitamine C • 7. ASA

  10. Uratelowering drugs = the future • 1. Febuxastat • 2. Natural uricase • 3. Uricase with HMW poly ethylenen glycol PEG • 4. URAT 1 anion exchange targeting

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