Comorbidities and polypharmacy need to be monitored when prescribing medication for both chronic and acute gout to reduce side effects. When prescribing pegloticase, antihistamines and corticosteroids
should be administered prior to the infusion to prevent reactions and anaphylaxis (Arcangelo et al., 2017). ReferencesAbhiskek, A. (2017). Managing gout flares in the elderly: Practical considerations. Drugs & Aging, 34(12), 873-880. doi:10.1007/s40266-017-0512-4Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4thed.). Philadelphia, PA: Wolters Kluwer.Aung, T., Myung, G., & FitzGerald, J. D. (2017). Treatment approaches and adherence to urate-lowering therapy for patients with gout.Patient Preference and Adherence,11, 795-800.doi:10.2147/PPA.S97927Harrold, L. R., Etzel, C. J., Gibofsky, A., Kremer, J. M., Pillinger, M. H., Saag, K. G., …Greenberg, J. D. (2017). Sex differenced in gout characteristics: Tailoring care for women and men. BMC Musculoskeletal Disorders, 18(108), 1-6. doi:10.1186/s12891-017-1465-9Response #1Allison, Thank you for posting an informative discussion on osteoarthritis (OA). Chronic pain, restricted range of motion, and muscle weakness occurs with the progression of OA and at times remains undiagnosed due to the natural aging process (Arcangelo, Peterson, Wilbur, & Reinhold,2017). OA is characterized as either primary or secondary. Primary OA occurs as a patient ages naturally and secondary OA is caused by a traumatic injury or inherited condition (Arcangelo et
al., 2017). Before starting pharmacotherapy to control pain from OA, physical therapy, exercise, and weight loss should be tried first. Stretching, strengthening, and exercise has proven to be a more effective pain control especially with knee OA and can improve functioning (Jones, Covey,Sineath, & Sineath, 2015). Weight loss is encouraged in individuals that have a BMI greater than25 kg per m2along with aerobic and strength training (Jones et al., 2015). First-line medications to assist with OA pain control is acetaminophen for patients cannottolerate nonsteroidal anti-inflammatory drugs (NSAIDs) and extended-release acetaminophen 1,300 mg three times daily is very helpful (Jones et al., 2015). NSAIDs should not be used long-term due to adverse gastrointestinal and renal issues, but if prescribed then use the lowest effective dose (Jones et al., 2015). If acetaminophen or NSAIDs have inadequate pain control then tramadol can be added to the drug therapy (Jones et al., 2015). Hyaluronic acid injections, although controversial, have been recommended by the American College of Rheumatology and Osteoarthritis Research Society International when conservative treatments are not working and if the patient has a less advanced OA (Jones et al., 2015). Intra-articular corticosteroid injectionscan also be used; however, relief is short, and the injections should not be given more than once in a three-month period (Jones et al., 2015). If pain is still not under control, opioid managementor surgical referral is considered (Jones et al., 2015).
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