What is the recommended treatment for a patient with gout who has a history of typhoid fever?

From the Guidelines

For a patient with gout who has a history of typhoid fever, the recommended treatment includes colchicine for acute attacks, followed by urate-lowering therapy such as allopurinol or febuxostat for long-term management, as the history of typhoid fever does not significantly alter the treatment approach for gout. During acute gout attacks, colchicine can be given at a loading dose of 1 mg followed 1 hour later by 0.5 mg on day 1, as recommended by the 2016 updated EULAR evidence-based recommendations for the management of gout 1. For long-term management, allopurinol should be started at a low dose (100 mg daily) and gradually increased to achieve a target serum uric acid level below 6 mg/dL, as supported by the 2020 American College of Rheumatology guideline for the management of gout 1.

• Key considerations in treatment include:
  • The choice of drug(s) should be based on the presence of contraindications, the patient’s previous experience with treatments, time of initiation after flare onset, and the number and type of joint(s) involved 1.
  • Caution should be exercised with NSAIDs if there is any residual gastrointestinal damage from the typhoid infection.
  • NSAIDs like naproxen or indomethacin can be used for acute attacks if colchicine is not tolerated, but with careful monitoring for GI effects.
  • Corticosteroids are another alternative for acute attacks if both colchicine and NSAIDs are contraindicated.
• Adjunctive measures include:
  • Proper hydration
  • Dietary modifications to reduce purine intake
  • Weight management
  • Avoidance of alcohol (especially beer and spirits) and sugar-sweetened drinks, heavy meals, and excessive intake of meat and seafood, as recommended by the 2016 updated EULAR evidence-based recommendations for the management of gout 1. The goal of treatment is to reduce serum uric acid levels to prevent crystal formation and recurrent attacks, with a target serum uric acid level below 6 mg/dL, as supported by the 2020 American College of Rheumatology guideline for the management of gout 1.

From the Research

Treatment for Gout

• The recommended treatment for gout includes nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or colchicine for acute gout 2, 3, 4, 5, 6.
• To reduce the likelihood of recurrent flares, patients should limit their consumption of certain purine-rich foods and avoid alcoholic drinks, especially beer, and beverages sweetened with high-fructose corn syrup 2.
• The use of loop and thiazide diuretics can increase uric acid levels, whereas the use of the angiotensin receptor blocker losartan increases urinary excretion of uric acid 2.

Considerations for Patients with a History of Typhoid Fever

• There is no specific evidence to suggest that a history of typhoid fever affects the treatment of gout 2, 3, 4, 5, 6.
• However, patients with a history of typhoid fever should be monitored for any potential interactions between their gout medication and any other medications they may be taking for their typhoid fever 2.

Urate-Lowering Therapy

• Allopurinol and febuxostat are first-line medications for the prevention of recurrent gout, and colchicine and/or probenecid are reserved for patients who cannot tolerate first-line agents or in whom first-line agents are ineffective 2, 5.
• Patients receiving urate-lowering medications should be treated concurrently with nonsteroidal anti-inflammatory drugs, colchicine, or low-dose corticosteroids to prevent flares 2.