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GOUT-CHRONIC MANAGEMENT

Rheumatology

GOUT-CHRONIC MANAGEMENT

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 & blisterin mucosa & typical rash). A/W 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.


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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