Gout

Which enzyme is responsible for the conversion of hypoxanthine to xanthine?

What is the principle cause of gouty arthritis?

Which of the following is NOT a risk factor for gout?

What is the gold standard for diagnosing gout?

Which medication is the cheapest option for IL-1 antagonists?

What is the FDA approved dosing for colchicine in prophylaxis of acute gout flares?

Which medication inhibits IL-1 from binding to its receptor?

Which medication is a decoy receptor that binds to IL-1B?

Which of the following is a strongly recommended condition for initiating urate-lowering therapy (ULT)?

Which of the following is a conditionally recommended against initiating urate-lowering therapy (ULT)?

Which medication is NOT studied for prophylactic therapy for mobilization flares when initiating urate-lowering therapy (ULT)?

Which drug is a Xanthine Oxidase inhibitor (XOI) used for initiating Urate Lowering Therapy in gout?

What is the maximum dose of Allopurinol?

Which drug has a black box warning for increased cardiovascular death risk in patients with CV disease?

Which drug is a pegylated recombinant modified mammalian urate oxidase used for refractory gout?

Treatment Options for Gout: Allopurinol, Febuxostat, Probenecid, and Pegloticase

Allopurinol and Febuxostat are Xanthine Oxidase inhibitors (XOI) used for initiating Urate Lowering Therapy in gout.
Allopurinol initial dose is 50-100 mg daily, titrated every 2-5 weeks until uric acid levels are less than 6. Maximum dose is 800 mg.
Febuxostat initial dose is 40 mg daily, increased to 80 mg daily if no response. Maximum dose is 40 mg in severe renal impairment.
Both Allopurinol and Febuxostat require renal dose adjustments. Allopurinol also requires lower initial dose in CKD Stage 4 or greater.
Allopurinol can cause agranulocytosis, aplastic anemia, myelosuppression, thrombocytopenia, renal failure, diarrhea, nausea, acute gout flares, rash, and allopurinol hypersensitivity syndrome.
Allopurinol hypersensitivity syndrome (AHS) can be severe and fatal. Prevention includes HLA-B*5801 screening.
Febuxostat can cause abnormal LFTs, nausea, mobilization flares, arthralgia, and rash. It has a black box warning for increased cardiovascular death risk in patients with CV disease.
Probenecid is a uricosuric drug that competitively inhibits post-secretory renal proximal tubular reabsorption of uric acid.
Probenecid initial dose is 500 mg daily or twice daily, titrated up to 500-2000 mg/day. It should be avoided in patients with CrCl < 50.
Probenecid can cause flushing, dizziness, fever, headache, alopecia, dermatitis, pruritus, rash, anorexia, dyspepsia, nausea, anemia, gouty arthritis, and hypersensitivity.
Pegloticase is a pegylated recombinant modified mammalian urate oxidase used for refractory gout.
Pegloticase dosing is 8 mg infusion over 2 hours every 2 weeks, premedicated with corticosteroids and antihistamines. It can cause gout flares, infusion reactions, nausea, vomiting, bruising, nasopharyngitis, constipation, chest pain, and anaphylaxis.

Test your knowledge on the treatment options for gout. Learn about medications such as Allopurinol, Febuxostat, Probenecid, and Pegloticase, their dosing, side effects, and precautions.