GOUT-CHRONIC MANAGEMENT

SUMMARY

1. Dietary/lifestyle modifications.
2. Urate lowering therapy: to reduce the serum uric acid to < 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.

3. When SUA levels are < 6.0, urate crystals are reabsorbed from the joint and tophi, resulting in reduction in frequency of gout flares.

4. Prescribe ULT to patients with tophi, recurrent gout attacks (>1/year), uric acid kidney stones, radiographic appearance of gout.

5. Rare SE of allopurinol, xanthine oxidase inhibitor: toxic epidermal necrolysis (fever, AKI & blistering mucosa & typical rash). assoc. with HLA-B5801.

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. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].