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Patient counseling
Gout Treat-to-Target Counseling
How to get patients to stay on urate-lowering therapy.
Video lesson
Key points
Indications include two or more flares a year, tophi, radiographic damage, and consider after the first flare with CKD stage 3 or higher, uric acid over 9 mg/dL or urolithiasis. Target uric acid below 6 mg/dL.
Practical approach
Start allopurinol 100 mg daily (50 mg in CKD 4 or worse) and titrate every 2 to 5 weeks to target. Give flare prophylaxis with colchicine or low-dose NSAID for 3 to 6 months. Do not stop urate-lowering therapy during a flare.
Pearls
Explain that early flares mean crystals are dissolving, not that the drug is failing. Under-dosed allopurinol is the most common reason for treatment failure.
At a glance
Category
Patient counseling
Reviewed by Farhan Tahir, MD, FACR
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For education only. Don’t start, stop or change a medicine without talking to your care team.