What is the patient information for a patient with gout (gouty arthritis)?

From the Guidelines

Gout patients should be treated with allopurinol as the first-line urate-lowering therapy, starting at a low dose of 100mg daily and increasing by 100mg increments every 2-4 weeks if required, to reach the uricaemic target of <6 mg/dL, as recommended by the 2016 updated EULAR evidence-based recommendations for the management of gout 1.

Key Recommendations for Gout Management

• For acute gout attacks, take an anti-inflammatory medication like colchicine (0.6mg twice daily), naproxen (500mg twice daily), or prednisone (20-40mg daily, tapering over 5-10 days) at the first sign of pain, as recommended by the American College of Physicians 1.
• Rest the affected joint, apply ice for 20 minutes several times daily, and elevate it when possible.
• To prevent future attacks, maintain a healthy weight, stay hydrated with 8-10 glasses of water daily, and limit purine-rich foods like red meat, seafood, and alcohol (especially beer).
• If you experience frequent attacks, your doctor may prescribe preventive medications such as allopurinol (starting at 100mg daily) or febuxostat (40mg daily) to lower uric acid levels long-term.
• Regular uric acid level monitoring is important to ensure your treatment is effective, with a target level below 6 mg/dL.
• Contact your doctor if your pain is severe, doesn't improve with medication, or if you develop fever, as these may indicate infection or other complications.

Important Considerations

• The treatment goal is to maintain a uric acid level below 6 mg/dL to prevent the formation of urate crystals and reduce the risk of future attacks.
• Allopurinol is the recommended first-line urate-lowering therapy due to its efficacy, low cost, and safety profile, as stated in the 2016 updated EULAR evidence-based recommendations for the management of gout 1.
• Febuxostat is an alternative option for patients who cannot tolerate allopurinol or have a contraindication to its use.
• Uric acid level monitoring is crucial to ensure that the treatment is effective and to adjust the dose of urate-lowering therapy as needed.

From the FDA Drug Label

The dosage of allopurinol tablets to accomplish full control of gout and to lower serum uric acid to normal or near-normal levels varies with the severity of the disease. The minimal effective dosage is 100 to 200 mg daily and the maximal recommended dosage is 800 mg daily To reduce the possibility of flare-up of acute gouty attacks, it is recommended that the patient start with a low dose of allopurinol tablets (100 mg daily) and increase at weekly intervals by 100 mg until a serum uric acid level of 6 mg/dL or less is attained but without exceeding the maximal recommended dosage. A fluid intake sufficient to yield a daily urinary output of at least 2 liters and the maintenance of a neutral or, preferably, slightly alkaline urine are desirable.

Key Points for Gout Patient Info:

• The recommended dosage of allopurinol varies with the severity of the disease.
• The minimal effective dosage is 100 to 200 mg daily and the maximal recommended dosage is 800 mg daily.
• It is recommended to start with a low dose of 100 mg daily and increase at weekly intervals by 100 mg until a serum uric acid level of 6 mg/dL or less is attained.
• A daily urinary output of at least 2 liters and a neutral or slightly alkaline urine are desirable.
• Patients should be monitored closely during the early stages of administration of allopurinol tablets 2.
• The use of colchicine or anti-inflammatory agents may be required to suppress gouty attacks in some cases 2.
• Dosage requirements in excess of 300 mg should be administered in divided doses 2.

From the Research

Gout Patient Information

• Gout is a condition caused by monosodium urate crystal deposition in joints and tissues, with risk factors including male sex, obesity, hypertension, and alcohol intake 3.
• The condition is characterized by swelling, pain, or tenderness in a peripheral joint or bursa, including the development of a tophus 3.
• Diagnosis of gout can be made using several validated clinical prediction rules, with arthrocentesis and synovial fluid or tophus analysis performed when the diagnosis is uncertain 3.

Treatment Options

• Colchicine, nonsteroidal anti-inflammatory drugs, and corticosteroids are used to relieve pain in adults with acute gout episodes 3, 4.
• Indications for long-term urate-lowering therapy include chronic kidney disease, two or more flare-ups per year, urolithiasis, the presence of tophus, chronic gouty arthritis, and joint damage 3.
• Allopurinol and febuxostat are used to prevent flare-ups, although febuxostat is associated with an increase in all-cause and cardiovascular mortality 3, 5.

Management Recommendations

• Clinical practice guidelines consistently recommend education, commencement of non-steroidal anti-inflammatories, colchicine or corticosteroids, and assessment of cardiovascular risk factors, renal function, and co-morbid conditions for acute gout management 6.
• Consistent recommendations for chronic gout management include urate lowering therapy and continued prophylaxis based on individual patient characteristics 6.
• Management of acute gout is consistent across clinical practice guidelines, while management of chronic gout is mostly consistent with some inconsistent recommendations regarding urate lowering therapy and other pharmacological therapies 6.