7 responses to “Gouty pitfalls”

  1. Great article.
    Please explain the significance of asymptomatic hyperuricemia. Does it ever warrant treatment beyond attempting to manage metabolic syndromes?
    Always puzzled as to why physicians rarely draw periarticular aspirates ( eg first MTP) to accurately diagnose suspected gout by direct microscopy. As you say SUA is unhelpful at that phase so often.

  2. Thanks for an excellent article, and the link back to the Gout diagnosis article.

    Is testing of HLA-B*5801 covered by provincial/territorial health plans?
    Does it require a special requisition?

  3. High serum uric acid can reflect high consumption of fructose, including the common sweetener high fructose corn syrup. People consuming large quantities of ultraprocessed foods and soft drinks are at risk.

  4. In follow up to this article, would be interested in thoughts around duration of ULT and considerations for deprescribing. Does this already exist?

  5. I wasn’t aware about the connection with HLA-B 5801. Thanks for bringing that up.

    I would still only use allopurinol for those who have frequent gout attacks or sequelae. For many people treatment with allopurinol has more side effects than 1-2 gout attacks per year.

  6. Several years ago, I started a 40 something y/o patient on uric lowering medication even though he had no history of gouty flare.
    He had significant family history (father and several uncles all died in their late 50’s of CV complications) and metabolic risks: BP, DM, Cholesterol, increase BMI.
    HIs serum uric level was close to 1000.

    I always wonder if I did the correct thing.

    I chanced to meet him a few years ago, he was still working, running a business in his mid 70’s.

  7. Any thoughts on this 2020 article? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491671/
    Re: not targeting SUA. (Ton J, Kolber MR. Targeting uric acid levels in treating gout. Can Fam Physician. 2020;66(9):671. Increasing the dosage of allopurinol to achieve a serum urate target (eg, < 360 μmol/L) does not reduce gout flares, pain, or function compared with standard allopurinol dosage. Febuxostat increases cardiovascular death and overall mortality and should not be used in most patients with gout.)

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