colchicine & gout
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You have to be really organized when talking about gout, because they ask different questions that need different answers.
For acute gout, colchicine is the most effective. The most current treatment is indomethacin. The 1st line treatment before using either of these drugs is NSAIDS (UWorld Q - and they ask how does it improve symptoms -> inhibits neutrophils).
If the patient has renal failure, then you use an IV steroid injected locally. Why? Colchicine and indomethacin are short acting drugs that are renally excreted, and wouldn't work in a renal failure case.
For acute gout, colchicine is the most effective. The most current treatment is indomethacin. The 1st line treatment before using either of these drugs is NSAIDS (UWorld Q - and they ask how does it improve symptoms -> inhibits neutrophils).
If the patient has renal failure, then you use an IV steroid injected locally. Why? Colchicine and indomethacin are short acting drugs that are renally excreted, and wouldn't work in a renal failure case.
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For acute gout: first answer is always indomethacin (or an NSAID, e.g., naproxen). If that doesn't work, the next answer is steroids. If that doesn't work --> colchicine.
And Worldbeater has raised a great point that if the patient is a renal transplant recipient or has renal insufficiency of any kind, intra-articular steroid injection is correct over NSAIDs or colchicine. If the gout is polyarticular in this case, answer is PO/SC/IM/IV steroids (answer would be oral or IV).
And if the patient is on aspirin as a regular med and gets acute gout, answer is still indomethacin over steroids.
For chronic gout: allopurinol or febuxostat is the first answer. Avoid probenecid or sulfinpyrazone if the patient is an over-excreter (cuz these further increase risk of urate stones). Rasburicase or pegloticase are often never the answer unless they specifically ask for which drug is a urate oxidase analogue. Never give allopurinol or febuxostat if giving 6-MP or azathioprine (since these latter two drugs require xanthine oxidase for breakdown).
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Probably more information than you wanted. And I'm sure you knew this stuff already. But I saw this gout post and got excited.
And Worldbeater has raised a great point that if the patient is a renal transplant recipient or has renal insufficiency of any kind, intra-articular steroid injection is correct over NSAIDs or colchicine. If the gout is polyarticular in this case, answer is PO/SC/IM/IV steroids (answer would be oral or IV).
And if the patient is on aspirin as a regular med and gets acute gout, answer is still indomethacin over steroids.
For chronic gout: allopurinol or febuxostat is the first answer. Avoid probenecid or sulfinpyrazone if the patient is an over-excreter (cuz these further increase risk of urate stones). Rasburicase or pegloticase are often never the answer unless they specifically ask for which drug is a urate oxidase analogue. Never give allopurinol or febuxostat if giving 6-MP or azathioprine (since these latter two drugs require xanthine oxidase for breakdown).
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Probably more information than you wanted. And I'm sure you knew this stuff already. But I saw this gout post and got excited.
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Thank you @ phloston & worldbeater.
From your inputs we can say that for acute gout: 1st line is NSAID, 2nd line is steroids, 3rd line is colchicine.
I think pegloticase is indicated for refractory chronic gout while Rasburicase is indicated for prevention of UA stone in tumor lysis syndrome.
From your inputs we can say that for acute gout: 1st line is NSAID, 2nd line is steroids, 3rd line is colchicine.
I think pegloticase is indicated for refractory chronic gout while Rasburicase is indicated for prevention of UA stone in tumor lysis syndrome.
