Long-term management with urate-lowering therapy may improve patient physical function and quality of life. According to ACR guidelines, the preferred urate-lowering agent for most patients is allopurinol, a xanthine oxidase inhibitor, owing to its efficacy, low cost, and safety. Allopurinol is safe for use in patients with kidney disease and heart disease. A study by Yen and college suggests that urate-lowering agents may lower the risk for all-cause mortality in patients with gout. Although the ACR recommends a starting dose of 100 mg daily with gradual upward titration, patients with renal insufficiency should receive a starting dose of 50 mg/dL.
Uricosurics may be a treatment option for patients with underexcretion of uric acid. Probenecid, the only FDA-approved uricosuric agent available in the United States, is recommended alone or in combination with allopurinol for patients with inadequate urate control with allopurinol alone, per Perez-Ruiz and colleagues.
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Cite this: Bruce M. Rothschild. Fast Five Quiz: Gout Management - Medscape - Aug 16, 2022.