Chapter 59. Gout and Hyperuricemia
A 45-year-old woman presents to clinic for routine follow-up after an acute gout attack. She has experienced three flares within the past 8 months treated successfully with NSAIDs. Her past medical history includes mild renal impairment and allopurinol hypersensitivity syndrome. Based on her past medical history, what agent would be the most appropriate to initiate for chronic urate lowering?
Option A: Incorrect. Although lesinurad can lower uric acid, it is never recommended as monotherapy and must always be combined with either allopurinol or febuxostat.
Option B: Correct. Febuxostat is a xanthine oxidase inhibitor and considered first-line for urate lowering. It can also be used safely in mild renal impairment.
Option C: Incorrect. While naproxen is successful in treating acute gout flares due to its anti-inflammatory properties, it is not effective in lowering the uric acid level.
Option D: Incorrect. Allopurinol is considered first-line for urate lowering; however, given the patient's history of allopurinol hypersensitivity syndrome, it is not the safest option.
An adult man with normal renal function has been maintained on allopurinol 200 mg daily for chronic urate lowering for the past three years; however, his serum uric acid (SUA) remains consistently above target with occasional acute gout attacks. What change in therapy is most appropriate to improve hyperuricemia and long-term disease control?
C. Increase the allopurinol dose
Option A: Incorrect. The combination of allopurinol and febuxostat would be considered duplicate therapy since both are xanthine oxidase inhibitors.
Option B: Incorrect. The addition of lesinurad to allopurinol in patients with normal renal function who have failed to achieve their uric acid target is only appropriate with doses of 300 mg or greater.
Option C: Correct. The allopurinol dose should be gradually increased (to a maximum of 800 mg/day) to achieve the target SUA level.
Option D: Incorrect. While prednisone is successful in treating acute gout flares due to its anti-inflammatory properties, it is not effective for chronic urate lowering.
Which one of the following statements concerning indomethacin use in acute gout is correct?
A. Studies have determined that indomethacin ...