Gout - Prophylactic treatment

9 important questions on Gout - Prophylactic treatment

Who should be started on gout prophylaxis?

All patients with gout who experienced multiple or frequent attacks, have evidence of joint damage or have tophi

1st line for gout prophylaxis

Allopurinol- xanthine oxidase inhibitor (XOI)

How do XOIs work?

Block the xanthine oxidase enzyme -> stops production of UA
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Patients at high risk for severe allopurinol hypersensitivity reaction, need screened for what before starting?

HLA-B*5801 allele

What is the alternative xanthine oxidase inhibitor?

Febuxostat (Uloric)

Gout prophylaxis 2nd line or adjuvant when UA is not at goal despite max dose XOI

Probenecid - inhibits reabsorption of UA in proximal tubule of nephron -> increases UA excretion.
It requires adequate renal function in order to work.

What drug is reserved for severe, refractory gout?

Pegloticase (Krystexxa) 8mg IV q2 weeks - recombinant uricase enzyme (converts uric acid to allantoin)

Allopurinol (Zyloprim, Aloprim) warnings and side effects

Hypersensitivity reactions- severe rash; hepatotoxicity, nephrotoxicity; do not use if positive HLA-B*5801
Rash, gout flare, nausea, diarrhea, increased LFTs  

Due to the high rate of gout attacks when starting ULT, what should be done?

Use with colchicine 0.6 mg once or BID, OR an NSAID
for the first 3-6 months

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