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Hyperuricemia -• Males - Serum uric acid levels above 8mg/dl• Females - Serum uric acid levels above 6.1mg/dl• The risk of Gout is 5X greater if the serum uric acid is > 9mg/dl compared
to levels between 7-8.9mg/dl.• Gout occurs when serum uric acid levels are greater than 6mg/dl.• Result of the overproduction and/or under-excretion of uric acid• Serum uric acid levels drop during acute attacks.
For example, 66 y.o. male with acute onset great toe pain and swelling with an unremarkable xray has a serum uric acid level of 5.3mg/dL. Could he be experiencing Gout?
1st Line Urate Lowering Therapy (ULT)Xanthine Oxidase Inhibitor
allopurinol • allopurinol
• Starting dose –• 100mg/day• CKD - 50mg/day
• Titrate every 2-5 weeks.• Dose can exceed 300mg daily even in renal impairment.• Monitor for AE: pruritis, rash, elevated LFTs• Maximum dose 800mg/day
• Educate regarding acute hypersensitivity syndrome (AHS)• Highest risk in first few months of therapy & RI• Consider genetic testing in high risk populations
• Koreans with CKD• Han Chinese and Thai irrespective of renal function
Mr. M. presents with acute onset pain, swelling, erythema, and warmth affecting his right 1st MTP joint. His serum uric acid level is 10.2mg/dL. He has never had a joint aspirated. Is this enough information to conclude the patient has Gout?
A. Yes. If it looks like a duck, quacks like a duck, and waddles like a duck, then it is a duck.
B. No. Hyperuricemia and a painful swollen joint is not synonymous with a diagnosis of Gout.
Microscopic evaluation of synovial fluid aspirated from Mr. M’s Great toe MTP joint confirms the diagnosis of Gout. The pain and swelling started 2 days ago. He has no contraindications for NSAIDs, colchicine, prednisone, or allopurinol.
According to ACR guidelines, choose treatment options to be started immediately.
Mrs. G. has recently been diagnosed with Gout. Her PMHX includes diabetes mellitus, nephrolithiasis, and moderate chronic kidney disease. The starting dose of allopurinol for her should not exceed:
A. 50mg daily
B. 100mg daily
C. 300mg daily
D. None of the above. She should not start allopurinol.
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