Urate-lowering Therapy: Acute Gout Attack Management (Nursing)

00:00 While our focus in this series is on urate-lowering therapies, it's important to briefly review acute attack management since these medications are often used alongside ULT or urate-lowering therapies.

00:14 Colchicine works by stopping white blood cells, the neutrophils, from moving to and consuming the urate crystals, which reduces inflammation during gout attacks.

00:22 Now the modern low-dose treatment plan is more effective and causes fewer digestive side effects than the older approaches which used higher doses.

00:30 Now, if you have an acute gout attack, you're going to take 1.2 mg at the first sign of an attack, followed by 0.6 mg an hour later.

00:39 Now this specific dosing helps the medication be more effective while we're trying to minimize the stomach and intentional discomfort that can come along with this medication.

00:48 Colchicine is really most effective if it started within 12 to 24 hours of the attack onset, so it's really important that the patient understand that they recognize the appropriate symptoms and when they should take this medication.

01:01 The earlier you catch the symptoms and the patient recognizes it, the more effective the treatment is going to be.

01:08 NSAIDs provide anti-inflammatory effects and pain relief during an acute attack.

01:12 Now options that are used commonly include things like naproxen, endomethacin, and Sulindac.

01:19 Now these are all used at anti-inflammatory doses.

01:23 These should be absolutely avoided in patients with renal impairment, heart failure, or even peptic ulcer disease.

01:30 In an acute gout attack, Corticosteroids can be administered one of three ways.

01:36 Orally, intra-articular injection, or parenterally.

01:40 Just depends on the clinical situation.

01:42 Typically, this is just a short course, maybe 7 to 10 days, and remember that you're going to taper at the end to prevent rebound.

01:49 Now the blood glucose level has to be monitored particularly closely in diabetic patients.

01:54 Now let's look at prophylactic therapy.

01:56 We're trying to prevent future gout attacks.

01:59 Now, when you start medication to lower uric acid levels, here's some bad news.

02:03 Patients often experience more gout attacks initially rather than fewer.

02:07 Now the good news is this is a temporary effect and it occurs during the early treatment phase.

02:13 But this seems kind of contradictory, doesn't it, to what we're wanting? This reaction happens because of the changes that are caused in the uric acid levels in the bloodstream.

02:23 That's because we're giving them the medication, we're changing the uric acid levels, but it disturbs those crystals.

02:29 It can disturb the existing crystal deposits in the joints.

02:32 So as these crystals shift and move, they trigger the body's inflammatory response and that's what results in a painful gout flare.

02:40 Now in order to prevent these flares, that's why we need the prophylactic therapy.

02:44 That's why it's recommended during the first three to six months of ULT initiation.

02:49 So you've got roughly three options.

02:51 You can have low-dose colchicine and do 0.6 milligrams daily or twice daily, low-dose NSAIDs with gastric protection, or low-dose corticosteroids if other options are contraindicated.

03:04 Prophylaxis really should continue for approximately three to six months or until target uric levels are achieved and stable.