Few gout experts would suggest stopping a patient’s antihypertensive medication—regardless of class—as a means to treating his gout (Item 145-1). According to the most relevant information for treating this on-the-rise disease: (1) Treat the acute pain of gout aggressively and early on in the flare. Be sure the patient has such medication as a methylprednisolone (Medrol Dosepak), colchicine, or a high-dose nonsteroidal anti-inflammatory drug (NSAID) on hand should another flare arise. Stress the necessity of aborting flares as soon as possible. The longer a flare goes on before medication is started, the harder it is to cool. (2) Continue the patient on b.i.d. colchicine dosing and standard NSAID dosing after the flare fully subsides. Follow up two to three weeks postflare to assess creatinine, glucose, lipids, and urate levels. Be prepared to initiate urea-lowering therapy (ULT). (3) Be aware that two flares of gout make a patient a very likely candidate for ULT and lifestyle changes. (4) Continue b.i.d. colchicine or standard-dose NSAID while ULT is initiated and for six to eight months after urate level reaches the target of <6.0 mg/dL. This will reduce the incidence of flare while the uric acid is dropping due to therapy.—JOAN McTIGUE, PA-C, Gainesville, Fla. (146-23)
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