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  #1  
Old 05-26-2012
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Default chronic treatment of gout...what is the best initial regimen?

A 68-year-old man is evaluated for hyperuricemia. He has had multiple attacks of acute gout
typically affecting the great toe, but 2 weeks ago he had an attack involving his right great
toe and both ankles. Arthrocentesis confirmed the presence of monosodium urate crystals. He
was successfully treated with ibuprofen.
Physical examination is normal except for a tophaceous deposit on the right forefoot.
Laboratory studies are normal except for a serum uric acid level of 11.2 mg/dL (0.7 mmol/L).
Which of the following is the most appropriate therapy for this patient?
(A) Allopurinol
(B) Low-dose colchicine
(C) Low-dose colchicine and allopurinol
(D) Low-dose indomethacin
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Old 05-26-2012
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A, Allopurinol
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Old 05-26-2012
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i think it wud be C.
cos MTB says that colchicine is given in low doses initally, to control the inital fluctuations in allopurinol levels once u start it.

although pt has had multiple attacks of gout the question stem DOESNT SAY that hes already on allopurinol.
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Old 05-26-2012
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(B) Low-dose colchicine
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Old 05-26-2012
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A) Allopurinol
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Old 05-26-2012
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C, Never Start Allopurinol or Uricosuric agent without concomitant prophylaxis with colchcine, cuz this will cuz fluctuation of serum UA --> gout attack
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Old 05-26-2012
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(C) Low-dose colchicine and allopurinol

His gout seems to be progressing so needs both.

He has high serum Uric acid >>>>>>>> allopurinol to inhibit formation.

He has tophi >>>>>>>>>>>>> colchicine
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  #8  
Old 05-26-2012
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yup
ans is C
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Old 05-28-2012
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Quote:
Originally Posted by tyagee View Post
A 68-year-old man is evaluated for hyperuricemia. He has had multiple attacks of acute gout
typically affecting the great toe, but 2 weeks ago he had an attack involving his right great
toe and both ankles. Arthrocentesis confirmed the presence of monosodium urate crystals. He
was successfully treated with ibuprofen.
Physical examination is normal except for a tophaceous deposit on the right forefoot.
Laboratory studies are normal except for a serum uric acid level of 11.2 mg/dL (0.7 mmol/L).
Which of the following is the most appropriate therapy for this patient?
(A) Allopurinol
(B) Low-dose colchicine
(C) Low-dose colchicine and allopurinol
(D) Low-dose indomethacin
answer is C........
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