From the Guidelines
The nurse would expect the provider to order urate lowering drugs (option D) for a patient who has experienced three gouty flare-ups in the past year. When a patient has multiple gout attacks within a 12-month period, long-term management with urate lowering therapy is indicated to prevent future attacks by reducing serum uric acid levels. Common urate lowering medications include allopurinol, febuxostat, and probenecid. These medications work by either decreasing uric acid production or increasing its excretion through the kidneys. The typical starting dose for allopurinol, the most commonly prescribed option, is 100 mg daily, gradually titrated upward to achieve a target serum uric acid level below 6 mg/dL, as recommended by the 2020 American College of Rheumatology guideline for the management of gout 1.
Some key points to consider when initiating urate lowering therapy include:
- Starting with a low dose and titrating upward to achieve the target serum uric acid level
- Monitoring serum uric acid levels regularly to ensure the target level is maintained
- Continuing prophylactic treatment with colchicine or NSAIDs for at least 3-6 months to prevent acute gout attacks, as recommended by the 2020 American College of Rheumatology guideline for the management of gout 1
- Discussing the benefits, harms, costs, and individual preferences with patients before initiating urate-lowering therapy, including concomitant prophylaxis, in patients with recurrent gout attacks, as recommended by the American College of Physicians 1
While colchicine, glucocorticoids, and NSAIDs are all used for acute gout attacks to reduce inflammation and pain, they don't address the underlying hyperuricemia that causes recurrent gout. Urate lowering therapy is the only option that targets the root cause of gout by normalizing uric acid levels, making it the appropriate choice for patients with frequent attacks, as supported by the 2017 updated EULAR evidence-based recommendations for the management of gout 1.
From the FDA Drug Label
An increase in acute attacks of gout has been reported during the early stages of administration of allopurinol tablets, even when normal or subnormal serum uric acid levels have been attained. The nurse will expect the provider to order Urate lowering drugs for the patient, as the patient has had 3 gouty flare ups in the past year, indicating a need to reduce serum urate levels to prevent future attacks 2.
From the Research
Gout Treatment Options
The patient has experienced 3 gouty flare-ups in the past year, indicating the need for a medication to manage and prevent future flare-ups.
- The nurse can expect the provider to order Urate lowering drugs for the patient, as they are the primary treatment for preventing future gout attacks and managing serum uric acid levels 3, 4, 5, 6, 7.
- Urate lowering drugs, such as febuxostat and allopurinol, have been shown to be effective in reducing serum uric acid levels and preventing gout flare-ups 3, 4, 6, 7.
- Febuxostat has been found to be more effective than allopurinol in achieving target serum urate levels and has a better safety profile 3, 4, 6, 7.
Rationale for Urate Lowering Drugs
- The American College of Rheumatology recommends urate lowering therapy for patients with gout who have had 2 or more flare-ups in a year 5.
- Urate lowering drugs work by reducing the production of uric acid in the body, which can help to prevent future gout flare-ups and manage serum uric acid levels 3, 4, 5, 6, 7.
- The goal of urate lowering therapy is to achieve a serum uric acid level of less than 6 mg/dL, which can help to prevent future gout flare-ups and reduce the risk of joint damage 3, 4, 5, 6, 7.