Sunday, June 23, 2013

Capsaicin for osteoarthritis

Let’s begin with a patient case.  An elderly patient is being treated with acetaminophen 650 mg po q6hr prn osteoarthritis pain of the hands.  She takes all four doses on most days and does not feel this relieves her symptoms adequately.  She has multiple comorbidities and is looking for some therapy with improved efficacy.  She wants to know if Capzasin® over-the-counter would be a good choice.

Sunday, June 9, 2013

Dosing colchicine in acute gouty arthritis

Let’s start with a patient case.  An elderly patient with multiple comorbidities is being treated in the hospital for heart failure when he develops an acute gouty attack.  His past medical history, among other things, includes CKD (Stage 4).  Should colchicine be used in this patient and if so, what dose would be indicated?

The American College of Rheumatology guidelines for the treatment of acute gout consider colchicine, NSAIDs, and corticosteroids all first line monotherapy (Evidence A) for moderate severity pain in 1-2 joints.  A combination of these is appropriate to consider in severe pain (Evidence C).  Since all have the same grade evidence for first line therapy, agent selection should be based on prior response, comorbidities, and patient preference while also considering each agent’s drug interactions. 

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