#113 Gout: Uric acid targets, urate lowering therapy, and random questions from social media

The Curbsiders Internal Medicine Podcast

Health & Fitness, Medicine, Science, Higher Education, Education

4.8 • 3.1K Ratings

🗓️ 10 September 2018

⏱️ 38 minutes

🔗️ Recording | iTunes | RSS

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Summary

Master the management of gout with tips from expert, Tuhina Neogi MD, PhD, Professor of Medicine at Boston University School of Medicine. Topics include: how to initiate and titrate urate lowering therapy, guidelines controversy over uric acid targets, colchicine & NSAIDS for anti-inflammatory prophylaxis, uricosuric agents, febuxostat, HLA B5801, use of uric acid levels in the acute setting and more random gout facts.

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Credits:

Written and produced by: Matthew Watto MD
Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD
Guest: Tuhina Neogi MD, PhD

Time Stamps

00:00 Intro and guest bio
01:30 Allopurinol initiation and titration
07:10 Uricosuric therapy
09:10 Controversy over uric acid targets for gout
17:40 Parachutes and randomized controlled trials
19:15 Colchicine or NSAIDS for prophylaxis
23:20 Who needs febuxostat?
26:20 When to refer for gout, HLA B5801, and checking uric acid levels in the acute setting
33:29 Take home points
36:15 Outro

Tags: allopurinol, uric, urate, acid, level, therapy, management, gout, flare, crystal, arthritis, titration, probenecid, febuxostat, target, acr, acp, guidelines, nsaids, colchicine, hla b5801, septic, rheumatology, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Transcript

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0:00.0	The first time I've got this is for entertainment education and information purposes only.
0:09.2	And the topics discussed should not be used only by industry, your ordinance, and these
0:11.5	are more than used in the same expressed on the spot, as far as I know those, should not be
0:14.1	interpreted perfectly for official policy or position of agency, the psychro-possibly,
0:16.0	cash-like morons will end affiliate outreach programs, and indeed there are any in fact
0:18.4	there are none. Pretty much we are responsible for this throughout, but we should always do
0:20.2	our homework and let's know when we're ready.
0:30.3	Welcome back to the Curb Siders. This is going to be a very quick introduction. Back again,
0:40.9	this week is Dr. Tahina Nioji. She is a rheumatologist and epidemiologist with a specialization
0:47.1	in Gout and osteoarthritis. She is currently leading updates of the American College of
0:53.3	Rheumatology Treatment Guidelines for both osteoarthritis and in Gout. Of course, on this episode we'll
0:59.2	be talking about Gout. This one, as I said prior, focuses more on urate lowering therapy.
1:06.0	What's the controversy about there? Should we be targeting urate levels? And then at the end of
1:11.1	the episode, the last 10, 15 minutes or so, we get into all your random questions from social media.
1:17.4	This episode is filled with great pearls. So without further delay, here is the rest of our
1:23.2	discussion with Dr. Tahina Nioji. So a question that had come up is, can you ever use alopeurinol
1:33.5	during this acute flare? Let's say this is not Mr. T's first acute flare. Let's say it's his
1:40.6	third one in a one-year period. When would you initiate alopeurinol? And so now we're sort of,
1:49.9	and how does that factor in, how does this factor into your analogy? So we just talked about the
1:53.4	stuff to put out the fire, right? Now we're talking about the bathtub analogy. So can you kind of
1:59.0	walk us through? Yeah, so this is a really great question, very clinically important. And I think if
2:07.0	you ask different people, it'll get different opinions because we don't actually have great data
	...

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