Improving Outcomes for Patients With Gout

Faculty

Michael H. Pillinger, MD
Professor
Department of Medicine
Department of Biochemistry and Molecular Pharmacology
New York University School of Medicine
Director of Rheumatology
VA New York Harbor Healthcare System
New York, New York

Paul P. Doghramji, MD, FAAFP Family Physician
Collegeville Family Practice
Medical Director of Health Services
Ursinus College
Collegeville, Pennsylvania

N. Lawrence Edwards, MD, MACP, FACR
Professor of Medicine
Division of Rheumatology and Clinical Immunology
Program Director, Internal Medicine Residency
Vice Chairman, Department of Medicine
University of Florida
Gainesville, Florida

Target Audience

The educational design of this activity addresses the needs of family physicians and other primary care providers involved in managing patients with hyperuricemia and gout.

Statement of Need/Program Overview

Gout is a chronic arthropathy caused by hyperuricemia, which is abnormally high uric acid levels in the blood that can lead to monosodium urate crystal deposition in tissues and joints.¹ The overall prevalence has been estimated at 4%—or approximately 8.3 million Americans—and may reach 12% to 13% in certain subpopulations.² Gout is expected to become more common, owing in part to an aging population and increased rates of comorbidities that predispose individuals to hyperuricemia (eg, metabolic syndrome, type 2 diabetes mellitus, chronic kidney disease).³ Despite the availability of effective therapies, including inhibitors of the urate-producing enzyme xanthine oxidase, gout management is often inadequate.^3,4 Patients commonly suffer from short- and long-term disability, may develop permanent joint damage, and often land in the emergency room.^5,6 Moreover, a gout diagnosis has been independently linked to total and cardiovascular mortality, with higher risks observed with rising urate levels.⁷ Thus, there is a significant need for greater clinician awareness of best practices for diagnosis as well as new agents that target various processes in urate homeostasis, such as uric acid reabsorption in the kidney.^4,8 During this enduring Interactive Exchange™ program, expert faculty will highlight the pathophysiology, diagnosis, and treatment of gout, with an emphasis on multimodal treatment regimens, urate-lowering therapies, and strategies for therapeutic tailoring.

References

1. Neogi T. Clinical practice. Gout. N Engl J Med. 2011;364(5):443-452.
2. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011;63(10):3136-3141.
3. Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res. 2012;64(10):1431-1446.
4. Doherty M, Jansen TL, Nuki G, et al. Gout: why is this curable disease so seldom cured? Ann Rheum Dis. 2012;71(11):1765-1770.
5. Garg R, Sayles HR, Yu F, et al. Gout-related health care utilization in US emergency departments, 2006 through 2008. Arthritis Care Res. 2013;65(4):571-577.
6. Wertheimer A, Morlock R, Becker MA. A revised estimate of the burden of illness of gout. Curr Ther Res Clin Exp. 2013;75:1-4.
7. Stack AG, Hanley A, Casserly LF, et al. Independent and conjoint associations of gout and hyperuricaemia with total and cardiovascular mortality. QJM. 2013;106(7):647-658.
8. Edwards NL, So A. Emerging therapies for gout. Rheum Dis Clin North Am. 2014;40(2):375-387.

Educational Objectives

After completing this activity, the participant should be better able to:

• Discuss the pathophysiologic mechanisms that contribute to the development of gout
• Identify patients with gout based on hyperuricemia, joint assessment, podagra, and relevant risk factors
• Compare current and emerging gout therapies that can reduce hyperuricemia and prevent acute gout attacks
• Individualize treatment regimens for patients with gout over time
• Educate patients about gout as a chronic disease, therapeutic goals and options, and the need for treatment adherence

Physician Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas Communications. Global is accredited by the ACCME to provide continuing medical education for physicians.

Global Education Group designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioner Continuing Education

Global Education Group is approved as a provider of nurse practitioner continuing education by the American Association of Nurse Practitioners: AANP Provider Number 110121. This program has been approved for 1.0 contact hour of continuing education. (0.5 hour has been identified)

Global Contact Information

For information about the accreditation of this program, please contact Global at 303-395-1782 or inquire@globaleducationgroup.com.

Instructions to Receive Credit

In order to receive credit, participants must complete the preactivity questionnaire, posttest, and program evaluation. Participants must also score at least 70% on the posttest. Certificates will be distributed online at the conclusion of the activity.

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.

Disclosure of Conflicts of Interest

Global Education Group (Global) requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

Michael H. Pillinger, MD Grant/Research Support: Takeda Pharmaceutical Company Ltd. Honoraria: AstraZeneca; Crealta Pharmaceuticals, Inc.

Paul P. Doghramji, MD, FAAFP Consultant: AstraZeneca; Iroko Pharmaceuticals, LLC; Takeda Pharmaceutical Company Ltd. Speakers Bureau: AstraZeneca; Takeda Pharmaceutical Company Ltd.

N. Lawrence Edwards, MD, MACP, FACR Consultant/Independent Contractor: AstraZeneca; Crealta Pharmaceuticals, Inc.; CymaBay Therapeutics Inc.; Takeda Pharmaceutical Company Ltd.

Kristen Delisi      Nothing to disclose
Amanda Glazar, PhD     Nothing to disclose
Andrea Funk      Nothing to disclose
Jim Kappler, PhD     Nothing to disclose

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) and Integritas Communications do not recommend the use of any agent outside of the labeled indications.  

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.