Question 1

A postmenopausal female patient has a blood test that reveals hyperuricemia, although the patient has no symptoms of gout. What will the provider do initially?&#10;A) Ask the patient about medications and medical history&#10;B) Begin therapy with colchicine and an NSAID&#10;C) Recommend a low-purine, alcohol-restricted diet&#10;D) Treat for gout prophylactically to prevent a flare

Accepted Answer

The provider should first ask the patient about any medications she is taking (such as diuretics or low-dose aspirin) and any medical history that may be contributing to the hyperuricemia. It is important to rule out any underlying conditions that may be causing the high uric acid level before initiating treatment for gout.

Question 2

A patient experiences a second gouty flare and the provider decides to begin urate-lowering therapy (ULT). How should this be prescribed?&#10;A) Begin with a high-loading dose and gradually decrease.&#10;B) Start ULT during the current flare for best results.&#10;C) Start ULT in 5 weeks along with an anti-inflammatory drug.&#10;D) ULT should be suspended during future gouty flares.

Accepted Answer

ULT should not be initiated during a gouty flare as it can worsen symptoms. Instead, it should be started 1-2 weeks after the flare resolves. Starting ULT along with an anti-inflammatory drug can help prevent future flares during the early period of ULT initiation. A high-loading dose is not recommended as it can increase the risk of flares and adverse effects. ULT should not be suspended during future flares as it is a lifelong treatment for gout.

Question 3

A patient with gout and impaired renal function who uses urate-lowering therapy (ULT) is experiencing an acute gout flare involving one joint. What is the recommended treatment?&#10;A) Administration of intraarticular corticosteroid&#10;B) Discontinuing ULT while treating the flare&#10;C) Oral colchicine for 5 days&#10;D) Therapy with NSAIDs begun within 24 hours

Accepted Answer

In a patient with impaired renal function, discontinuing ULT during an acute gout flare can cause a rebound increase in serum uric acid levels, leading to more frequent flares. NSAIDs can potentially worsen renal function and colchicine can be toxic in patients with renal impairment. Thus, the recommended treatment is administration of intraarticular corticosteroid, as it provides rapid relief of pain without exacerbating renal dysfunction or serum urate levels.

Deck 158: Gout