View source for GOUT-CHRONIC MANAGEMENT

===== [[Summary Article|'''SUMMARY''']] =====
1. Dietary/lifestyle modifications.
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<br/>2. Urate lowering therapy: to reduce the serum uric acid to &lt; 6.0 mg/dL, which is below the saturation point of monosodium urate. Use for 6 months if tophi are present, 3 months if not. 
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<br/>3. When SUA levels are &lt; 6.0, urate crystals are reabsorbed from the joint and tophi, resulting in reduction in frequency of gout flares.
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<br/>4. Prescribe ULT to patients with tophi, recurrent gout attacks (&gt;1/year), uric acid kidney stones, radiographic appearance of gout.
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<br/>5. Rare SE of allopurinol, xanthine oxidase inhibitor: toxic epidermal necrolysis (fever, AKI &amp; blistering mucosa &amp; typical rash). assoc. with HLA-B5801.
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<br/>6. Other agents: probenecid (uricosuric agent, increases renal urate clearance), Febuxostat can be used in those who cannot tolerate allopurinol, similar SE profile. 


==Reference(s)==
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. [https://amzn.to/3YHrI6K Get it on Amazon.]
<br/>Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. [https://amzn.to/3k7WSW0 Get it on Amazon.]
<br/>Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
<br/>Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].

[[Category:Gout]]
[[Category:Rheumatology]]
[[Category:Medicine]]