गाउट: जब तीव्र फ्लेयर प्रबंधन पूर्ण समाधान प्राप्त न करे तो क्या करें

References

DOI: 10.1136/annrheumdis-2016-209707

• In patients with normal kidney function, allopurinol is recommended for first-line ULT, starting at a low dose and increasing by 100 mg increments every 2–4 weeks if required, to reach the uricaemia target.
• Prophylaxis is recommended during the first 6 months of ULT.
• Recommended prophylactic treatment is colchicine; a dose that should be reduced in patients with renal impairment.
• If colchicine is not tolerated or is contraindicated, prophylaxis with NSAIDs at low dosage, if not contraindicated, should be considered.
• 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.
• SUA level <3 mg/dL is not recommended in the long term.