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Managing Gout in the Primary Care Setting: What You and Your Patients Need to Know
MULTIMEDIA ACTIVITY
CME MULTIMEDIA ACTIVITY Managing Gout in the Primary Care Setting: What You and Your Patients Need to Know Paul P. Doghramji, MD, FAAFP,a N. Lawrence Edwards, MD,b,c Joan McTigue, MS, PA-Cd
This CME Multimedia Activity is also available through the Website of The American Journal of Medicine (www. amjmed.com). Click on the CME Multimedia Activity button in the navigation bar for full access. © 2010 Elsevier Inc. All rights reserved. • The American Journal of Medicine (2010) 123, S2
a
Collegeville Family Practice, Medical Director of Health Services, Ursinus College, Collegeville, Penn; bDivision of Clinical Immunology, Department of Medicine, University of Florida, Gainesville, Fla; cRheumatology Section, VA Medical Center, Gainesville, Fla; dDivision of Rheumatology, University of Florida College of Medicine, Gainesville, Fla.
ABSTRACT The US prevalence of gout, a rapidly progressive inflammatory arthritic condition linked to serum uric acid levels, has grown in recent years, in part due to the increasing prevalence and incidence of predisposing factors in the population, such as metabolic syndrome, obesity, and the use of diuretics. Left untreated, gout can be debilitating and cause deformity. Although a definitive diagnosis requires joint aspiration, only ⬃11% of patients with suspected gout undergo this procedure, and a presumptive diagnosis based on patient medical history and presentation with characteristic symptoms and comorbidities is a reasonable guidelines-based approach that has utility in the primary care setting, where approximately 70% of all cases and nearly 3,000,000 visits occur. The therapeutic standard for patients with recurrent gout flares is urate-lowering therapy (ULT), including allopurinol and the recently introduced febuxostat, the first new treatment for gout in 40 years. Although ULT must be taken consistently to sustain benefits, inadequate dosing and patient nonadherence or intolerance to therapy often lead to treatment failure. It is important that primary care clinicians understand gout diagnosis and therapeutic approaches and can communicate effectively with patients to improve treatment adherence. Online Access: http://cmeaccess.com/cme/ajm_gout_program/
0002-9343/$ -see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.amjmed.2010.06.005
Statement of author disclosure: Please see the Author Disclosures section at the end of this article. Funding: Takeda Pharmaceuticals North America. Authorship: All authors had access to all data in preparation of this multimedia activity. E-mail addresses: [email protected]; Larry.Edwards@ medicine.ufl.edu; [email protected].
ACKNOWLEDGMENT This CME Multimedia Activity was peer reviewed by The American Journal of Medicine and jointly sponsored by Purdue University College of Pharmacy and Health Education Alliance, Inc.
AUTHOR DISCLOSURES The faculty who participated in this multimedia activity have disclosed the following industry relationships: Paul P. Doghramji, MD, FAAFP, is a member of the Speakers’ Bureau for Cephalon, Pfizer Inc, sanofi-aventis, and Takeda Pharmaceuticals North America. N. Lawrence Edwards, MD, is a member of the Speakers’ Bureau for Savient Pharmaceuticals and Takeda Pharmaceuticals North America. He is a member of the Advisory Board for Takeda Pharmaceuticals North America. Dr. Edwards has also received honoraria from Takeda Pharmaceuticals North America. Joan McTigue, MS, PA-C, is a member of the Advisory Board for The Gout & Uric Acid Education Society. All additional planning committee members, Health Education Alliance, Inc. staff, and Purdue University College of Pharmacy staff have no relationships to disclose.
CME MULTIMEDIA ACTIVITY Managing Gout in the Primary Care Setting: What You and Your Patients Need to Know Paul P. Doghramji, MD, FAAFP,a N. Lawrence Edwards, MD,b,c Joan McTigue, MS, PA-Cd
This CME Multimedia Activity is also available through the Website of The American Journal of Medicine (www. amjmed.com). Click on the CME Multimedia Activity button in the navigation bar for full access. © 2010 Elsevier Inc. All rights reserved. • The American Journal of Medicine (2010) 123, S2
a
Collegeville Family Practice, Medical Director of Health Services, Ursinus College, Collegeville, Penn; bDivision of Clinical Immunology, Department of Medicine, University of Florida, Gainesville, Fla; cRheumatology Section, VA Medical Center, Gainesville, Fla; dDivision of Rheumatology, University of Florida College of Medicine, Gainesville, Fla.
ABSTRACT The US prevalence of gout, a rapidly progressive inflammatory arthritic condition linked to serum uric acid levels, has grown in recent years, in part due to the increasing prevalence and incidence of predisposing factors in the population, such as metabolic syndrome, obesity, and the use of diuretics. Left untreated, gout can be debilitating and cause deformity. Although a definitive diagnosis requires joint aspiration, only ⬃11% of patients with suspected gout undergo this procedure, and a presumptive diagnosis based on patient medical history and presentation with characteristic symptoms and comorbidities is a reasonable guidelines-based approach that has utility in the primary care setting, where approximately 70% of all cases and nearly 3,000,000 visits occur. The therapeutic standard for patients with recurrent gout flares is urate-lowering therapy (ULT), including allopurinol and the recently introduced febuxostat, the first new treatment for gout in 40 years. Although ULT must be taken consistently to sustain benefits, inadequate dosing and patient nonadherence or intolerance to therapy often lead to treatment failure. It is important that primary care clinicians understand gout diagnosis and therapeutic approaches and can communicate effectively with patients to improve treatment adherence. Online Access: http://cmeaccess.com/cme/ajm_gout_program/
0002-9343/$ -see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.amjmed.2010.06.005
Statement of author disclosure: Please see the Author Disclosures section at the end of this article. Funding: Takeda Pharmaceuticals North America. Authorship: All authors had access to all data in preparation of this multimedia activity. E-mail addresses: [email protected]; Larry.Edwards@ medicine.ufl.edu; [email protected].
ACKNOWLEDGMENT This CME Multimedia Activity was peer reviewed by The American Journal of Medicine and jointly sponsored by Purdue University College of Pharmacy and Health Education Alliance, Inc.
AUTHOR DISCLOSURES The faculty who participated in this multimedia activity have disclosed the following industry relationships: Paul P. Doghramji, MD, FAAFP, is a member of the Speakers’ Bureau for Cephalon, Pfizer Inc, sanofi-aventis, and Takeda Pharmaceuticals North America. N. Lawrence Edwards, MD, is a member of the Speakers’ Bureau for Savient Pharmaceuticals and Takeda Pharmaceuticals North America. He is a member of the Advisory Board for Takeda Pharmaceuticals North America. Dr. Edwards has also received honoraria from Takeda Pharmaceuticals North America. Joan McTigue, MS, PA-C, is a member of the Advisory Board for The Gout & Uric Acid Education Society. All additional planning committee members, Health Education Alliance, Inc. staff, and Purdue University College of Pharmacy staff have no relationships to disclose.