From the Research
Gout and thrombocytosis can be related conditions, and treatment should prioritize managing gout with urate-lowering therapy and controlling thrombocytosis based on its underlying cause. For patients with gout, initial management includes colchicine (1.2mg initially, followed by 0.6mg one hour later, then 0.6mg once or twice daily until flare resolves) or low-dose colchicine (0.6mg daily) as shown to be effective in preventing gout flares with fewer adverse events compared to regular-dose colchicine 1. Corticosteroids are alternatives when these medications are contraindicated. Long-term management may require urate-lowering therapy such as allopurinol (starting at 100mg daily and titrating up) or febuxostat (40-80mg daily), with allopurinol being the preferred first-line treatment due to its safety and potential for reducing cardiovascular outcomes 2, 3. For thrombocytosis, treatment depends on whether it's reactive (secondary to inflammation) or primary (due to bone marrow disorders). Reactive thrombocytosis from gout typically resolves when the underlying inflammation is controlled. However, if thrombocytosis is primary or persistent, additional evaluation by a hematologist is necessary, as it may require specific treatments like hydroxyurea or aspirin to prevent thrombotic complications. Patients should maintain adequate hydration, follow a low-purine diet, and avoid alcohol to help manage gout symptoms while their platelet levels are being monitored. It's also important to note that gout has been associated with an increased risk of venous thromboembolism, particularly when the patient is not in hospital and regardless of exposure to urate-lowering therapy 4. Therefore, clinical vigilance may be required when caring for these patients. The most recent and highest quality study 3 supports the use of colchicine and urate-lowering therapy as the cornerstone of gout management, while also considering the potential risks and benefits of these treatments in patients with thrombocytosis. Key considerations in managing gout and thrombocytosis include:
- Controlling gout inflammation to reduce the risk of reactive thrombocytosis
- Monitoring platelet levels and adjusting treatment as needed
- Using urate-lowering therapy to prevent gout flares and reduce the risk of cardiovascular outcomes
- Considering the potential risks and benefits of treatments in patients with thrombocytosis.