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* MCQ : Gout treatment
 #852874  
  hgad - 07/10/18 08:03
 
  A 63-year-old gentleman is seen with a painful, swollen right first metatarsal joint. He has a past history of gout and he tells you that he uses diclofenac whenever he gets a flare-up and this clear things up within a few days. About ten months ago he was started on allopurinol due to recurrent attacks and currently takes 300mg daily. You examine him and diagnose a recurrence of gout. This is the first attack he has had since being started on the allopurinol. What do you advise him with regard to his medicines during this acute attack of gout?

A. Add aspirin to his regular medicines and treat the acute attack of gout with NSAID.
B. Increase the allopurinol dose and treat the acute attack with NSAID.
C. Stop the allopurinol and start an alternative prophylactic agent such as sulfinpyrazone.
D. Stop the allopurinol whilst treating the acute attack of gout and restart it when things have fully settled.
E. Treat the acute flare of gout and continue the allopurinol at the same dose wihlst doing so.


It is quite confusing, i know that allopurinol exacerbates acute atks of gout, yet this happens only when you are not already on allopurinol. According to AAFP, allopurinol shouldnt be stopped if already on when acute atks develop.

I am wondering what the correct answer would be ....
 
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* Re:MCQ : Gout treatment
#3369058
  captan - 07/10/18 09:19
 
  I am not sure but B ) is more likely the answer
B. Increase the allopurinol dose and treat the acute attack with NSAID
 
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* Re:MCQ : Gout treatment
#3369121
  hgad - 07/11/18 05:26
 
  I was thinking the same, hopefully we are correct ^_^

Thanks alot mate !
 
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* Re:MCQ : Gout treatment
#3369135
  captan - 07/11/18 12:07
 
  do you know the correct answer?  
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* Re:MCQ : Gout treatment
#3369182
  hgad - 07/12/18 06:05
 
  nope thats why im asking T_T but here is the thing .... its either B or E, yet if im going to increase the dose i should first assess the serum urate level or GFR. E umm quite looks good too because i havent done the tests i have mentioned so i just have to continue the same dose then after that i will do proper tests and titrate the dose. ppl would choose B cuz he hasnt reached max dose of allopurinol which is ranging from 600mg-900mg.


---- In case the patient was already on Allopurinol and presented with an acute attack of gout, Allopurinol should be “continued in the same dose”

reference: https://www.sciencedirect.com/science/article/pii/S2090506814000372
 
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* Re:MCQ : Gout treatment
#3369187
  jazpreet2000 - 07/12/18 09:23
 
  honestly i would of guessed B as well  
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