Five questions to help you quickly clarify gout management strategies Clinical Q&A

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Gout, caused by excessive production or decreased excretion of uric acid, is one of the most common causes of
inflammatory arthritis.
The global prevalence and incidence of gout is gradually increasing, with a prevalence of approximately 1% to 6.
8%
as of 2020.
Although there are viable treatment options for gout, its management is not ideal
.
To better manage gout, strategies such as medication, lifestyle modification, and risk reduction should be combined to prevent recurrent gout, tophi formation, and progressive joint injury
.

How much do you know about gout management? Let's take a quiz!

1.
What is the preferred treatment for acute attack of gout?

A.
NSAIDs

B.
Aspirin

C.
Interleukin-1 receptor antagonist

D.
Urate-lowering therapy

Patients with acute attacks of gout should quickly reduce pain and relieve joint inflammation
.
Nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and colchicine are effective in treating acute attacks
of gout.
NSAIDs are most effective when used within 48 hours of symptom onset
.

Aspirin can prolong and exacerbate acute attacks of gout and should be avoided
.
However, there is no need to interrupt low-dose aspirin for the treatment of cardiovascular disease during a gout attack
.

Consider interleukin-1 receptor antagonists
only in patients with recurrent gout attacks and contraindications to NSAIDs, colchicine, and glucocorticoids.

Urate-lowering therapy is recommended to prevent gout attacks
.
Initiation of uric acid-lowering therapy without the use of anti-inflammatory drugs during an acute gout attack may lead to exacerbation
of the condition.

Answer: A

2.
According to the 2020 American College of Rheumatology (ACR) guidelines, which urate-lowering treatment statement is the most accurate in the long-term management of gout?

A.
Urate-lowering therapy should start with a high dose and taper gradually after reaching the target uric acid level

B.
Patients with blood uric acid > 6.
8mg/dL should start uric acid-lowering therapy

C.
If there is radiographic evidence of joint injury, urate-lowering therapy should be initiated

D.
HLA-B*5801 should be tested before initiating urate-lowering therapy

ACR guidelines recommend initiating urate-lowering therapy in patients with gout with any of the following features:

➤ One or more subcutaneous tophi

➤ There is evidence of any form of radiographic impairment caused by gout

➤ Frequent occurrence of gout (> 2 times/year).

For patients with moderate to severe chronic kidney disease, blood uric acid > 9 mg/dL, or urolithiasis, initiation of urate-lowering therapy is conditionally recommended to prevent renal impairment
.
However, asymptomatic hyperuricemia patients with blood uric acid < 9 mg/dL and no previous gout attacks do not need to initiate urate-lowering therapy
.

Allopurinol therapy should be started with a low dose (100 mg/day) and gradually increased until the patient reaches a target blood uric acid level
.
Rapidly reducing blood uric acid levels may increase the frequency of
gout attacks.

Allopurinol is the most commonly used urate-lowering drug and may cause allopurinol allergy syndrome, especially in patients
who are HLA-B*5801 positive.
ACR guidelines conditionally recommend HLA-B*5801 genetic testing
in Southeast Asian and African-American patients prior to initiating allopurinol therapy.

Answer: C

3.
What is the preferred first-line urate-lowering therapy?