strategies to reduce the likelihood and impact of gout flare following initiation of urate lowering therapy

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Strategies to reduce the likelihood and impact of gout flare following initiation of urate-lowering therapy (ULT)

  • advise the patient that an attack of gout may occur following initiation of ULT and reassure them that this is a sign that ULT is working
  • ULT should not be stopped if an acute attack of gout occurs. If started during an attack of gout, ULT can exacerbate that attack and hence it is customary to wait for 1-2 weeks after an acute attack has resolved before commencing ULT
  • ULT should be started in low dose (e.g. allopurinol 100 mg daily) and escalated gradually, titrated to serum urate levels and renal function
  • NSAID or low-dose colchicine should be co-prescribed with ULT to prevent ULT-induced gout flare and continued until the target serum urate level has been achieved.

Reference:

  1. Arthritis Research UK (2011). Hands On (9) - gout: presentation and management in primary care.

Last reviewed 01/2018

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