Gout: Allopurinol adjustment for renal function.
IF a gout patient is receiving an initial prescription for allopurinol and has significant renal impairment (defined as a serum creatinine level > 2 mg/dl or measured/estimated creatinine clearance < 50 ml/min), THEN the initial daily allopurinol dose should be < 300 mg/day.
Gout: Anti-inflammatory agents with Initiation of urate lowering agents.
IF a patient with tophaceous gout is given an initial prescription for a urate-lowering medication and lacks both 1) significant renal impairment (a serum creatinine level > 2 mg/dl or measured/ estimated creatinine clearance < 50 ml/min and 2) peptic ulcer disease, THEN a prophylactic agent (colchicine or NSAID) should be given concomitantly.
Gout: Appropriate urate lowering agent.
IF a gout patient has either 1) a history of nephrolithiasis or 2) significant renal insufficiency (defined as a serum creatinine level > 2 mg/dl or measured/estimated creatinine clearance < 50 ml/min) THEN a xanthine oxidase inhibitor should be started as the initial urate-lowering medication rather than a uricosuric agent.
Gout: Initiation of urate lowering therapy.
IF a patient has hyperuricemia and gouty arthritis characterized by any of the following clinical characteristics 1) tophaceous deposits, 2) gouty erosive changes on radiographs, or 3) gout attack of twice or more per year, THEN the patient should be offered therapy with a urate lowering drug unless contraindicated.
Reference
Centers for Education and Research on Therapeutics at the University of Alabama, Birmingham
Mikuls TR, MacLean CH, Olivieri J, Patino F, Allison JJ, Farrar JT, Bilker WB, Saag KG. Quality of care indicators for gout management. Arthritis Rheum 2004;50:937-43.
