How the risk of Gout flares due to ULT be minimized

How the risk of Gout flares due to ULT be minimized

Gout flares can be precipitated with the initiation of ULT. How can this risk be minimized?

Antiinflammatory prophylaxis is recommended to mitigate the risk of gout flares precipitated by initiation of ULT and should be initiated concomitantly or prior to ULT. Agents most commonly used in prophylaxis include low-dose NSAIDs (e.g., naproxen 250 mg twice daily) or oral colchicine (0.6 mg once or twice daily). In elderly patients or those with a GFR of 30 to 50 mL/minute, colchicine doses may need to be reduced (0.6 mg/day or every other day) and avoided all together with more advanced CKD (particularly as colchicine cannot be removed by dialysis). Low-dose glucocorticoid treatment (e.g., prednisone 5–10 mg/day) can be used for prophylaxis in those intolerant to or unable to take NSAIDs or colchicine. Although shown to be efficacious in prophylaxis with ULT initiation, the role of IL-1 inhibition is uncertain, given the poorly defined risk/benefit ratios.

Prophylaxis should be continued for the first 3-6 months of ULT, as shorter periods have been associated with rapid increases in flare rates following discontinuation of prophylaxis. Patients suffering from recurrent gout flares may require continued prophylaxis for more prolonged periods. It is important to note that while initiation of ULT can precipitate gout flares, such therapy should be neither stopped nor reduced in patients presenting with a flare.

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