Clinical signs of Gout
Sunkureddi P, Karnath B, Nguyen-Oghalai T. Clinical signs of Gout. Hospital Physician. January 2006:42(1);39-42,47 (Gout.pdf)
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I was interested in your thoughts on Uloric. I know it works by blocking xanthine oxidase–although, not all patients with symptomatic gout have elevated uric acid levels. What percentage of your patients would you think might be able to benefit and afford this medication?
I don’t think Uloric is more effective than Allopurinol, especially if necessary doses of Allopurinol are used. It is good for those with allopurinol sensitivity. Also, if a patient has renal insufficiency and one is concerned about higher doses of allopurinol, then im it is a good option. Because it is new, it will likely be mmore expensive than allopurinol and coverage will d epend on individual plans. Not all patients at the time of an acute gout attack will have elevated serum uric acid levels but in general, everyone with gout has hyperuricemia.
I have a patient with a crystal-proven diagnosis of gout. She just had a flare-up in the wrist. Her uric acid has been 6.8 or 6.9 the last 3 times it was tested. She has a history of allopurinol sensitivity. What are your thoughts on checking uric acid to monitor therapy when uric acid is already low?
The goal of urate lowering therapy in gout is to reach serum uric acid level below 6mg/dl. This is the level at which it has been shown that crystallization does not occur and also the incidence of attacks diminishes substantially. I would recommend Uloric for this patient.