Home Registration Module 1 Module 2 Module 3 Contact Us Best Practices in Managing Newly Presenting Gout Tuesday, December 8, 2009 or Thursday, December 10, 2009 7:00 PM - 7:40 PM EST Robert A. Terkeltaub, MD VA Rheumatology Section Chief, Professor of Medicine, University of California San Diego, San Diego, CA Program Overview Gout is the most common cause of inflammatory joint disease in men over 40 years, and both the incidence and prevalence of gout are increasing. A survey in 2002 estimated that 5 million Americans are affected by gout with ~3.9 million annual physician visits, two-thirds being to primary care physicians, who are responsible for the management of the vast majority of patients with uncomplicated gout. Moreover, patients with gout have a poorer health-related quality-of-life with greater functional limitations and higher mortality than the general population. Despite greater understanding about the pathogenesis and available therapies for gout, healthcare professionals still face challenges in the accurate diagnosis and proper treatment of this disease. The goal of therapy is to achieve a target serum urate level of <6.0 mg/dL; however, traditional therapies often do not achieve this desired result. In addition, intolerance to current treatment, undesirable side effects, hypersensitivity reactions, and incomplete treatment response can lead to patient nonadherence resulting in unmet medical needs and poor patient outcomes. This online web-workshop will provide appropriate clinical steps for managing patients presenting for the first time with an acute gouty attack. This will include both non-pharmacologic (life-style) and pharmacologic approaches for treating the acute gout flares and long-term management. The importance of counseling patients on their commitment to adhering to long-term life-style and drug treatment recommendations will be a key focus. Target Audience This activity was developed for physicians, nurses and other healthcare professionals responsible for the care of patients with gout and/or hyperuricemia. Learning Objectives Upon completion of this activity, participants should be able to: Make an in-office diagnosis of gout based on patient’s symptoms and clinical presentation, and recognize ‘red flags’ which may necessitate referral to a rheumatologist for further investigations Describe the management of acute gout flares and the appropriate use of prophylactic treatment such as NSAIDs or colchicine Identify that the long-term goal of treatment is to reduce serum urate to <6.0 mg/dL and to define the key steps in selecting and individualizing urate-lowering therapy (ULT) according to disease stage; together with recognizing the importance of monitoring serum urate levels Educate patients that successful management with ULT includes their long-term commitment to adherence with the recommended life-style and drug interventions Explain how gout management may require modification in special patient populations who have various co-morbidities Faculty Biography Robert A. Terkeltaub, MD VA Rheumatology Section Chief Professor of Medicine University of California San Diego San Diego, CA Robert A. Terkeltaub received his medical degree at McGill University in Montreal, Canada, and completed residency and training programs in clinical rheumatology and internal medicine at Montreal General Hospital. He is now Chief of Rheumatology at the Veterans Administration Medical Center in San Diego, CA, and Professor of Medicine and Associate Division Director at the University of California in San Diego. Dr. Terkeltaub’s research has concentrated principally on clinical aspects of gout, chondrocalcinosis, and osteoarthritis, and in basic research on inflammation and skeletal biology and the interfaces between the two in the skeleton and in soft tissues such as the artery. Dr. Terkeltaub has been the recipient of numerous teaching awards at the University of California in San Diego. Dr. Terkeltaub was recently appointed associate editor of Arthritis and Rheumatism and he regularly serves on NIH and Arthritis Research Foundation’s Study Sections. CME/CE Information CME/CE Evaluation Form CME/CE Evaluation Form-Module 1 To receive CME/CE credit, click on the above link and complete the form. Once completed fax to (949) 824-3037 . Certification Statement Physicians This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of University of California, Irvine School of Medicine and Strategic Consultants International. University of California, Irvine School of Medicine is accredited by the ACCME to provide continuing medical education for physicians. The University of California, Irvine School of Medicine designates the educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity. Nurses Contact hours for registered nurses are provided by the University of California, Irvine College of Health Sciences, Program in Nursing Science as approved by the California Board of Registered Nursing, Provider Number 11349 for 1.0 contact hours. Credit Designation Statement Physicians Maximum of 1.0 AMA PRA Category 1 Credit(s)TM. Nurses 1.0 Nursing Contact Hour(s) (0 contact hours are in the area of pharmacology). All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation. Method of participation There are no fees for participating in and receiving credit for this activity. The participant must 1) read the learning objectives and faculty disclosures; 2) study the educational activity; 3) complete the -pre / -mid / and -post test questions by recording the best answer to each question during the activity; 4) complete the evaluation form; and mail to: University of California Irvine Shool of Medicine, Building 802, Room 120H, Irvine, CA 92697-4089 ; or fax to (949) 824-3037 . Estimated time of completion This activity should take approximately 1.0 hour to complete. The time allocated includes the completion of reading the material and completing the post-test and evaluation. Disclosure of unlabeled use The contents of some CME activities may contain discussions of non-approved or off-label uses of some of the agents mentioned. Please consult the prescribing information for full disclosure of approved uses. IL-1 antagonists - acute gout flares Pegloticase - treatment-failure gout California Assembly Bill 1195 California Assembly Bill 1195 requires continuing medical education activities with patient care components to include curriculum in the subjects of cultural and linguistic competency. It is the intent of the bill, which went into effect on July 1, 2006, to encourage physicians and surgeons, CME providers in the state of California, and the Accreditation Council for Continuing Medical Education to meet the cultural and linguistic concerns of a diverse patient population through appropriate professional development. The planners, speakers and authors of this CME activity have been encouraged to address issues relevant in their topic area. Additional resources and information about AB1195 can be found on our website at http://www.cme.uci.edu. Disclosure Statements This activity has been peer reviewed for evidence base and fair balance. Authors Dr. Terkeltaub serves as a consultant for Anadys Pharmaceuticals, Inc., Ardea Biosciences, Inc., BioCryst, Enzyme Rx, Novartis, Pfizer Inc, Regeneron Pharmaceuticals, Inc., Savient Pharmaceuticals, Inc., Takeda Pharmaceuticals North America, Inc., UCB, Inc., and URL Pharma. Staff Alka Amin, Senior Associate Project Director, Strategic Consultants International, Hemel Hempstead, Herts, England Vicki Evans, Project Manager, Strategic Consultants International, Hemel Hempstead, Herts, England Rebecca Yamarik, MD, Peer Reviewer, UCI School of Medicine, Irvine, California Bonnie Carroll, Director of CME, UCI School of Medicine, Irvine, California The planning staffs at UCI School of Medicine and Strategic Consultants International have nothing to disclose.