Gout: Recent Issues
Several issues were raised and discussed at the recent ARA 2008 meeting.
1. Issues about treating asymptomatic hyperuricemia. Debate remains as to whether we should be treating hyperuricemia to prevent gout. As of now, we do not treat patients who have asymptomatic hyperuricemia
2. The panel discussion in Medscape did highlight the fact that the regular dose of 300mg daily may be a rather conservative dose when the permitted level was up to 800 mg daily. There were concerns about allopurinol hypersensitivity. Nevertheless they still recommended increasing the dose from 300 mg if the hyperuricemia is uncontrolled. In my experience, I have seen several cases of severe allergic reactions from allopurinol itself. There was also little concern about increasing the dose in renal impairment.
3. It was agreed that the main cause of hyperuricemia is iatrogenic especially after the ALLHAT trial advocated the use of thiazide diuretics. In such instances, removing the cause would be the logical choice. Other rarer genetical causes were discussed but will remain a much less common cause.
4. Many of treat allopurinol with colchicine. There was concern about colchicine and its drug interactions. It remains a drug that is usually poorly tolerated.
5. One interesting find is that pegylated uricase had significant results in removing tophi. As of now, it is usually a permanent feature and can only be solved through a plastic surgeon's intervention.
The activity on medscape.
ACR 2008: Treating Chronic Gout: The Challenges of Lowering Serum Urate Levels
1. Issues about treating asymptomatic hyperuricemia. Debate remains as to whether we should be treating hyperuricemia to prevent gout. As of now, we do not treat patients who have asymptomatic hyperuricemia
2. The panel discussion in Medscape did highlight the fact that the regular dose of 300mg daily may be a rather conservative dose when the permitted level was up to 800 mg daily. There were concerns about allopurinol hypersensitivity. Nevertheless they still recommended increasing the dose from 300 mg if the hyperuricemia is uncontrolled. In my experience, I have seen several cases of severe allergic reactions from allopurinol itself. There was also little concern about increasing the dose in renal impairment.
3. It was agreed that the main cause of hyperuricemia is iatrogenic especially after the ALLHAT trial advocated the use of thiazide diuretics. In such instances, removing the cause would be the logical choice. Other rarer genetical causes were discussed but will remain a much less common cause.
4. Many of treat allopurinol with colchicine. There was concern about colchicine and its drug interactions. It remains a drug that is usually poorly tolerated.
5. One interesting find is that pegylated uricase had significant results in removing tophi. As of now, it is usually a permanent feature and can only be solved through a plastic surgeon's intervention.
The activity on medscape.
ACR 2008: Treating Chronic Gout: The Challenges of Lowering Serum Urate Levels
Labels: Rheumatology