GOTA - EAD - Sociedade de Reumatologia de Brasília

Summary

This video discusses the management and treatment of gout, focusing on medication options, prophylaxis during treatment, and lifestyle changes. Key points include using allopurinol as a first-line treatment, with anti-inflammatory medications to prevent acute attacks. Prophylaxis is recommended for the first few months, and lifestyle adjustments like diet and weight loss are vital for managing gout. The video also covers the importance of monitoring uric acid levels and making medication adjustments based on patient response, particularly for those with comorbid conditions like hypertension. Overall, the aim is to prevent joint damage and improve long-term quality of life.

Takeaways

• 😀 Uricosurics are not considered first-line therapy for gout; allopurinol is the preferred treatment.
• 😀 When starting allopurinol therapy, prophylactic treatment should be used to prevent acute gout attacks.
• 😀 During acute gout attacks, anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids (like prednisone) are recommended depending on the patient's condition.
• 😀 Prophylactic anti-inflammatory therapy should be continued for 3-4 months to prevent further gout attacks.
• 😀 Starting uric acid-lowering therapy during an acute gout attack does not significantly worsen the attack, and may improve patient adherence to treatment.
• 😀 The treatment goal is to reduce serum uric acid levels to below 6 mg/dL. For chronic gout arthritis, lifelong treatment may be necessary.
• 😀 If uric acid levels are not controlled with maximum doses of allopurinol, other medications like uricosurics may be added.
• 😀 Patients who experience acute gout attacks despite maximum dose treatment should consider switching to combination therapy or changing their medication.
• 😀 Lifestyle changes, such as reducing alcohol consumption, limiting purine-rich foods, and losing weight, are essential in managing gout.
• 😀 Medications for co-existing conditions like hypertension and dyslipidemia should be carefully chosen to avoid increasing uric acid levels, e.g., switching from hydrochlorothiazide to losartan.

Q & A

What is the first-line treatment for an acute gout flare?

The first-line treatment for an acute gout flare typically involves non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. These help manage the pain and inflammation associated with the flare.

Why is colchicine not recommended as first-line therapy for acute gout flares?

Colchicine is no longer considered a first-line therapy due to its side effects, difficult administration, and the availability of more effective treatments like NSAIDs and corticosteroids.

What is the role of prophylaxis during the initiation of urate-lowering therapy (ULT) for gout?

When initiating ULT, prophylaxis with medications such as colchicine or NSAIDs is essential to prevent acute gout flares. This helps reduce the risk of triggering a flare when lowering uric acid levels.

What is the target serum uric acid level in gout treatment?

The goal of gout treatment is to lower serum uric acid levels to below 6 mg/dL. This helps prevent the formation of uric acid crystals in the joints and reduces the frequency of gout attacks.

What should be done if a patient does not reach the target uric acid level with alopurinol alone?

If a patient does not reach the target uric acid level with alopurinol, a uricosuric medication can be added. Uricosurics help increase the excretion of uric acid in urine, further lowering its levels in the blood.

How long should prophylactic therapy be continued when starting ULT?

Prophylactic therapy should be continued for 3 to 4 months after starting ULT, depending on the patient's response. The therapy is gradually tapered off once the patient has not had any acute gout flares.

What is the recommended approach for treating patients with chronic gout?

Patients with chronic gout may require lifelong ULT to prevent flare-ups and preserve joint function. Continuous therapy is particularly important in cases of tophaceous gout, which involves the accumulation of uric acid crystals in the joints.

When should a change in medication be considered for patients with gout?

A change in medication should be considered if a patient has not reached the target uric acid level despite using the maximum tolerated dose of their current medication, or if they continue to experience acute gout flares.

What non-pharmacological treatments are recommended for gout management?

Non-pharmacological treatments include lifestyle modifications such as weight loss, limiting alcohol intake, and reducing purine-rich foods. These changes can significantly help in managing gout and preventing flare-ups.

What medication adjustments are recommended for patients with both gout and comorbid conditions like hypertension?

For patients with both gout and comorbidities such as hypertension, it may be necessary to adjust medications that contribute to elevated uric acid levels. For example, thiazide diuretics should be replaced with alternatives like losartan, which does not increase uric acid levels.