Gout treatment : a classic question for step 3 !! - triplehelix

[ArchivalUser]

c....bring it below 6

[ArchivalUser]

dddddddd

[ArchivalUser]

C......cant discontinue colchicine abruptly can bring an attack

[ArchivalUser]

correct answer is C.

This patient's allopurinol dose should be increased to 400 mg/d. In addition, repeat urate measurement is indicated to assure that this value is decreased to an appropriate level. This patient has tophaceous gout with infrequent but persistent attacks. His total body stores of urate are elevated, and the presence of tophi demonstrates that he has abnormal urate deposition.

Even if this patient did not have attacks of gout, treatment to dissolve his tophi would be reasonable. Although this patient's urate level is within the reference range, it is not biologically normal. Reference values describe the distribution of urate levels in the population, which are two standard deviations around the population mean value. However, in patients with urate levels >6.8 mg/dL (0.4 mmol/L), urate will continue to deposit in tissues. Therefore, the target of hypouricemic therapy is to obtain a urate level of approximately 6 mg/dL (0.36 mmol/L) to dissolve detected tophi and other urate deposits in the tissues. If allopurinol is discontinued, urate levels will increase to the pretreatment levels and the tophi and gouty attacks will return.

Because decreasing a patient's urate level may induce a gouty attack, continuation of colchicine therapy is indicated while the allopurinol level is increased. Allopurinol therapy also should be continued lifelong even after the tophi have resolved to maintain a low urate level, which will prevent tophi and gout attacks from returning. In some patients, however, colchicine may be discontinued once the urate level is decreased and stabilized and the patient has been free of gouty attack for approximately 6 months. Measuring the 24-hour urine urate excretion is not needed before adjusting the allopurinol dose. The target urate level is approximately 6 mg/dL (0.36 mmol/L), regardless of the level of urate excretion.