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., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
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].