Home Registration Module 1 Module 2 Module 3 Contact Us Best Practices in Managing Complex Gout Thursday, February 4, 2010 or Tuesday, February 9, 2010 7:00 PM - 7:40 PM EST Kenneth G. Saag, MD, MSc Jane Knight Lowe Professor of Medicine, Director, Center for Education and Research on Therapeutics (CERTs) of Musculoskeletal Disorders and Center for Outcomes Effectiveness Research and Education (COERE), University of Alabama at Birmingham, Birmingham, AL Program Overview A variety of comorbidities are associated with gout, including cardiovascular disease, hypertension, type 2 diabetes mellitus, obesity, hyperlipidemia, metabolic syndrome, chronic kidney disease, and kidney stones. A 2-year retrospective study of patients with gout found they had a mean of five different comorbid conditions. Patients with comorbid illness are likely to be taking multiple medications, increasing the potential for interactions with urate-lowering medications. For instance, allopurinol undergoes interactions with several drugs (mercaptopurine, azathioprine), and also prolongs the half life of the anticoagulant dicumarol and increases levels of warfarin. Aspirin blocks the uricosuric effect of probenecid, though it is not clear whether the low doses of aspirin commonly used for prevention of stroke and MI have a significant effect. Probenecid blocks tubular excretion of penicillins, increases serum concentrations and diuretic effects of frusemide, and prolongs the metabolism of warfarin. This on-line web-workshop highlights the complexities of managing hyperuricemia in patients with comorbid illness, underscoring that the management approach needs to be suitably tailored to the needs of the individual, with appropriate choices of medication for reduction of hyperuricemia and the particular balance of comorbid conditions. Target Audience This activity was developed for physicians, physicians assistants, 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 Kenneth G. Saag, MD, MSc Jane Knight Lowe Professor of Medicine, Director, Center for Education and Research on Therapeutics (CERTs) of Musculoskeletal Disorders and Center for Outcomes Effectiveness Research and Education (COERE) University of Alabama at Birmingham, Birmingham, AL Kenneth G. Saag is a Professor of Medicine in the Division of Clinical Immunology and Rheumatology at the University of Alabama at Birmingham (UAB) School of Medicine, and Professor of Epidemiology at the UAB School of Public Health. He is director of the Deep South Musculoskeletal (DSM) CERTs since its inception in 2000, Associate Director of the Multidisciplinary Clinical Research Center (NIAMS P60), and Director of the Center for Outcomes, Effectiveness Research and Education (COERE). Dr. Saag is a rheumatologist and outcomes researcher with expertise in musculoskeletal disorders (MSD) pharmacoepidemiology and his clinical focus is in bone health. He is the only rheumatologist on the Board of Directors of the National Osteoporosis Foundation (NOF). He is experienced in population-based investigations, working with large databases, and quality indicator development. He serves on the editorial board of Archives of Internal Medicine, Arthritis Care and Research, and Arthritis Research and Therapy. Dr. Saag serves on the FDA Arthritis Advisory Committee and recently co-chaired the American Medical Association (AMA) Physician Consortium for Performance Improvement on Osteoporosis. He has previously chaired the Arthritis Foundation Clinical, Therapeutics, and Outcomes Study Section, has served on several NIH study sections, IOM Committees, National Committees to develop both arthritis and osteoporosis guidelines, the Musculoskeletal Workgroup of the Cochrane Collaboration, and the NCQA workgroup on Arthritis Quality Indicators. He also chairs the American College of Rheumatology (ACR) Quality of Care Committee. CME/CE Information CME/CE Evaluation Form CME/CE Evaluation Form-Module 3 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 Saag serves as a consultant for Novartis, Savient Pharmaceuticals, Inc., Takeda Pharmaceuticals North America, Inc., and URL Pharma and receives grant/research support from Novartis and Regeneron Pharmaceuticals, Inc; and is on the speaker’s bureau for Novartis. 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.