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  • Image not available. In the absence of a history of gout, asymptomatic hyperuricemia does not require treatment.
  • Image not available. Acute gouty arthritis may be treated effectively with short courses of high-dose nonacetylated nonsteroidal antiinflammatory drugs (NSAIDs), corticosteroids, or colchicine.
  • Image not available. Colchicine is highly effective at relieving acute attacks of gout but has the lowest benefit-to-toxicity ratio of the available pharmacotherapy for gout.
  • Image not available. Uric acid nephrolithiasis should be treated with adequate hydration (2 to 3 L/day), a daytime urine-alkalinizing agent, and 60 to 80 mEq/day (60 to 80 mmol/L) of potassium bicarbonate or potassium citrate.
  • Image not available. Treatment with urate-lowering drugs to reduce risk of recurrent attacks of gouty arthritis is considered cost-effective for patients having two or more attacks of gout per year.
  • Image not available. Xanthine oxidase inhibitors are efficacious for the prophylaxis of recurrent gout attacks in both underexcreters and overproducers of uric acid. Allopurinol should be started with a low dose (100 mg/day) after the acute attack has resolved and increased by 100 mg/day at 1-week intervals until the goal serum urate concentration of <6 mg/dL (<357 μmol/L) is achieved. Febuxostat 40 to 80 mg/day can be used for patients intolerant to allopurinol or who have mild to moderate renal insufficiency. Colchicine (0.6 mg once daily) or an NSAID should be administered for at least the first 8 weeks of therapy to minimize the risk of acute attacks that may occur during initiation of uric acid–lowering therapy.
  • Image not available. Uricosuric agents should be avoided for patients with renal impairment [a creatinine clearance below 50 mL/min (0.84 mL/s)], a history of renal calculi, or overproduction of uric acid.
  • Image not available. Patients with hyperuricemia or gout should undergo comprehensive evaluation for signs and symptoms of cardiovascular disease, and aggressive management of cardiovascular risk factors (i.e., weight loss, reduction of alcohol intake, control of blood pressure, glucose, and lipids) should be undertaken as indicated.

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After reviewing this chapter the reader should be able to:

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  • 1. Describe the four clinical manifestations of hyperuricemia.
  • 2. Explain the pathophysiology of gout and hyperuricemia.
  • 3. Describe comorbidities that are commonly associated with gout.
  • 4. Differentiate the clinical presentation of the various forms of gout.
  • 5. Identify the most common anatomic sites affected in acute gouty arthritis.
  • 6. Determine the likelihood of nephrolithiasis for patients with hyperuricemia based on urinary pH and uric acid excretion rates.
  • 7. Differentiate the two types of gouty nephropathy based on pathophysiologic mechanisms.
  • 8. Identify the most common sites of tophaceous gout.
  • 9. Formulate a plan for treating acute gouty arthritis for a patient who has been symptomatic for more than 48 hours.
  • 10. Formulate a plan for treating acute gouty arthritis for a patient with recent (<24 hours) onset.
  • 11. Recommend a treatment for acute gouty arthritis for a patient who is unresponsive to colchicine or nonsteroidal antiinflammatory therapy.
  • 12. Develop a treatment plan for uric acid nephrolithiasis.
  • 13. Identify patients with gout in whom prophylactic therapy should be implemented.
  • 14. Recommend appropriate indications for antihyperuricemic therapy.
  • 15. Evaluate both the safety ...

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