Hi!
Long time..
Urate-lowering therapy indications and important guidelines for management of gout, as updated by ACR in 2020:
- recommended in patients with >1 s/c tophi, evidence of damage on radiology, and frequent gout flares (>2 annually).
- comorbid moderate-to-severe (stage >3) CKD with serum urate concentration of >9 mg/dl, or urolithiasis.
- start ULT in patients currently experiencing a gout flare instead of waiting for it to resolve.
- set a target serum uric acid level of <6 mg/dl
- start with low-dose (<100 mg/dl) allopurinol and febuxostat (<40 mg/dl) -- even lower doses in patients with comorbid CKD; probenecid is the third choice.
- Concomitant anti-inflammatory therapy for 3-6 months (low-dose colchicine, NSAIDs, prednisone), instead of <3 months previously
- Second-line: IL-1 inhibitors or ACTH or I.V. glucocorticoids
- Adjuvant treatment with topical ice.
Source - American College of Rheumatology
That's all
- Jaskunwar Singh
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