نوبات النقرس المتكررة: الخطوة التالية بعد عدم نجاح علاج مثبطات IL-1 في حل النوبة الحادة

References

DOI: 10.1136/annrheumdis-2016-209707

• In patients with frequent flares and contraindications to colchicine, NSAIDs and corticosteroid (oral and injectable), IL-1 blockers should be considered for treating flares.
• Current infection is a contraindication to the use of IL-1 blockers.
• ULT should be adjusted to achieve the uricaemia target following an IL-1 blocker treatment for flare.
• In patients with normal kidney function, allopurinol is recommended for first-line ULT, starting at a low dose (100 mg/day) and increasing by 100 mg increments every 2-4 weeks if required, to reach the uricaemia target.
• Every person with gout should receive advice regarding lifestyle: weight loss if appropriate and avoidance of alcohol (especially beer and spirits) and sugar-sweetened drinks, heavy meals and excessive intake of meat and seafood.
• Low-fat dairy products should be encouraged.
• Regular exercise should be advised.
• For patients on ULT, SUA level should be monitored and maintained to <6 mg/dL (360 mmol/L).
• A lower SUA target (<5 mg/dL; 300 mmol/L) to facilitate faster dissolution of crystals is recommended for patients with severe gout (tophi, chronic arthropathy, frequent attacks) until total crystal dissolution and resolution of gout.
• SUA <6 mg/dL (360 mmol/L) should be maintained lifelong.