Gout — structured viva

Structured oral on gout: defending the crystal standard versus clinical criteria, the low-dose colchicine evidence, steroid equivalence, treat-to-target allopurinol titration, prophylaxis duration, febuxostat cardiovascular caution after CARES, and lifestyle advice with honest numbers.

Prompt

The examiner opens: 'Gout is easy — colchicine for the flare, allopurinol forever. Why do you make it complicated?' The viva branches through diagnosis standards, acute therapy evidence, ULT indications and titration, prophylaxis, febuxostat safety and lifestyle.

Stem

A colleague describes gout management as two prescriptions. The examiner asks you to defend a more structured approach. ^[1]

References17Show

[1]FitzGerald JD, Dalbeth N, Mikuls T, Brignardello-Petersen R, Guyatt G, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Rheumatol, 2020.PMID 32390306
[2]McKenzie BJ, Wechalekar MD, Johnston RV, Schlesinger N, Buchbinder R Colchicine for acute gout. Cochrane Database Syst Rev, 2021.PMID 34438469
[3]Terkeltaub RA, Furst DE, Bennett K, Kook KA, Crockett RS, Davis MW High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum, 2010.PMID 20131255
[4]White WB, Saag KG, Becker MA, Borer JS, Gorelick PB, et al. Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout. N Engl J Med, 2018.PMID 29527974
[5]Rainer TH, Cheng CH, Janssens HJ, Man CY, Tam LS, et al. Oral Prednisolone in the Treatment of Acute Gout: A Pragmatic, Multicenter, Double-Blind, Randomized Trial. Ann Intern Med, 2016.PMID 26903390
[6]Wortmann RL, Macdonald PA, Hunt B, Jackson RL Effect of prophylaxis on gout flares after the initiation of urate-lowering therapy: analysis of data from three phase III trials. Clin Ther, 2010.PMID 21353107
[7]Jennings CG, Mackenzie IS, Flynn R, Ford I, Nuki G, et al. Up-titration of allopurinol in patients with gout. Semin Arthritis Rheum, 2014.PMID 24560169
[8]Zhang Q, Gao F, Sun W, Ma J, Cheng L, Li Z The diagnostic performance of musculoskeletal ultrasound in gout: A systematic review and meta-analysis. PLoS One, 2018.PMID 29979706
[9]Gamala M, Jacobs JWG, van Laar JM The diagnostic performance of dual energy CT for diagnosing gout: a systematic literature review and meta-analysis. Rheumatology (Oxford), 2019.PMID 31089688
[10]Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med, 2004.PMID 15014182
[11]Choi HK, Curhan G Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ, 2008.PMID 18244959
[12]Lyu JQ, Miao MY, Wang JM, Qian YW, Han WW, et al. Consumption of Total and Specific Alcoholic Beverages and Long-Term Risk of Gout Among Men and Women. JAMA Netw Open, 2024.PMID 39196557
[13]GBD 2021 Gout Collaborators Global, regional, and national burden of gout, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol, 2024.PMID 38996590
[14]Kannangara DRW, Graham GG, Wright DFB, Stocker SL, Portek I, et al. Individualising the dose of allopurinol in patients with gout. Br J Clin Pharmacol, 2017.PMID 28417592
[16]van Durme CM, Wechalekar MD, Landewé RB, Pardo Pardo J, Cyril S, et al. Non-steroidal anti-inflammatory drugs for acute gout. Cochrane Database Syst Rev, 2021.PMID 34882311
[18]Park DJ, Kang JH, Lee JW, Lee KE, Wen L, et al. Cost-effectiveness analysis of HLA-B5801 genotyping in the treatment of gout patients with chronic renal insufficiency in Korea. Arthritis Care Res (Hoboken), 2015.PMID 25047754
[20]Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis, 2015.PMID 26359487

Gout — structured viva

Stem

A colleague describes gout management as two prescriptions. The examiner asks you to defend a more structured approach. ^[1]

References17Show

[1]FitzGerald JD, Dalbeth N, Mikuls T, Brignardello-Petersen R, Guyatt G, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Rheumatol, 2020.PMID 32390306
[2]McKenzie BJ, Wechalekar MD, Johnston RV, Schlesinger N, Buchbinder R Colchicine for acute gout. Cochrane Database Syst Rev, 2021.PMID 34438469
[3]Terkeltaub RA, Furst DE, Bennett K, Kook KA, Crockett RS, Davis MW High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum, 2010.PMID 20131255
[4]White WB, Saag KG, Becker MA, Borer JS, Gorelick PB, et al. Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout. N Engl J Med, 2018.PMID 29527974
[5]Rainer TH, Cheng CH, Janssens HJ, Man CY, Tam LS, et al. Oral Prednisolone in the Treatment of Acute Gout: A Pragmatic, Multicenter, Double-Blind, Randomized Trial. Ann Intern Med, 2016.PMID 26903390
[6]Wortmann RL, Macdonald PA, Hunt B, Jackson RL Effect of prophylaxis on gout flares after the initiation of urate-lowering therapy: analysis of data from three phase III trials. Clin Ther, 2010.PMID 21353107
[7]Jennings CG, Mackenzie IS, Flynn R, Ford I, Nuki G, et al. Up-titration of allopurinol in patients with gout. Semin Arthritis Rheum, 2014.PMID 24560169
[8]Zhang Q, Gao F, Sun W, Ma J, Cheng L, Li Z The diagnostic performance of musculoskeletal ultrasound in gout: A systematic review and meta-analysis. PLoS One, 2018.PMID 29979706
[9]Gamala M, Jacobs JWG, van Laar JM The diagnostic performance of dual energy CT for diagnosing gout: a systematic literature review and meta-analysis. Rheumatology (Oxford), 2019.PMID 31089688
[10]Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med, 2004.PMID 15014182
[11]Choi HK, Curhan G Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ, 2008.PMID 18244959
[12]Lyu JQ, Miao MY, Wang JM, Qian YW, Han WW, et al. Consumption of Total and Specific Alcoholic Beverages and Long-Term Risk of Gout Among Men and Women. JAMA Netw Open, 2024.PMID 39196557
[13]GBD 2021 Gout Collaborators Global, regional, and national burden of gout, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol, 2024.PMID 38996590
[14]Kannangara DRW, Graham GG, Wright DFB, Stocker SL, Portek I, et al. Individualising the dose of allopurinol in patients with gout. Br J Clin Pharmacol, 2017.PMID 28417592
[16]van Durme CM, Wechalekar MD, Landewé RB, Pardo Pardo J, Cyril S, et al. Non-steroidal anti-inflammatory drugs for acute gout. Cochrane Database Syst Rev, 2021.PMID 34882311
[18]Park DJ, Kang JH, Lee JW, Lee KE, Wen L, et al. Cost-effectiveness analysis of HLA-B5801 genotyping in the treatment of gout patients with chronic renal insufficiency in Korea. Arthritis Care Res (Hoboken), 2015.PMID 25047754
[20]Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis, 2015.PMID 26359487