It is important to estimate the glomerular filtration rate for dosing many prescription drugs. Here is a link to the MDRD GFR Eqaution Calculator from MDCalc.
For example, Dr. Neogi states, in #113 Gout: Uric acid targets, urate lowering therapy, and random questions:
- Who needs urate lowering therapy (ULT): Patients with two or more flares in a year (Grade A); tophus or tophi on exam or imaging (Grade A); CKD stage 2 or worse (Grade C); past urolithiasis (Grade C) – [Khanna et al. ACR 2012 Gout Guidelines]
- ULT with allopurinol: Start at 100 mg daily (50 mg daily if CKD 4) and titrate up by 100 mg every two weeks up to 300 mg. Monitor serum uric acid level after 4-8 weeks on therapy.
Dr. Neogi, rheumatology, and The Curbsiders give us an outstanding mini-course in the diagnosis and treatment of gout in:
- #112 Gout Flares: Bathtubs and Firefighting [Link is to the show notes and podcast] SEPTEMBER 3, 2018 By MATTHEW WATTO, MD
- #113 Gout: Uric acid targets, urate lowering therapy, and random questions [Link is to the show notes and podcast] SEPTEMBER 10, 2018 By MATTHEW WATTO, MD
[Note to myself: The show notes are outstanding and brief so there is no point in making excerpts. Just review the show notes.]
The new American College Of Rheumatology guidelines on gout will be coming out next year in 2019. Here are links to the 2012 ACR Guidelines On Gout: Part 1, and Part 2.
Because they are more current, I’ve included a link to the EULAR 2016 guidelines on gout [Resource (3) below].
In one of the podcasts, Dr. Neogi talks briefly about the use of ultrasound in the diagnosis of gout. I’ve included articles on that topic [Resources (4) and (5) below] for my later review.
Additional Resources:
(1) ACR-EULAR Gout Classification Criteria Calculator
(2) ACR-EULAR GOUT CLASSIFICATION CRITERIA Form [PDF].
(3) 2016 updated EULAR evidence-based recommendations for the management of gout [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Ann Rheum Dis. 2017 Jan;76(1):29-42. doi: 10.1136/annrheumdis-2016-209707. Epub 2016 Jul 25.
(4) Musculoskeletal ultrasonography in gout [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Med Ultrason. 2015 Dec;17(4):535-40. doi: 10.11152/mu.2013.2066.174.msk.
Musculoskeletal ultrasonography in gout.
(5) An optimal ultrasonographic diagnostic test for early gout: A prospective controlled study [PubMed Abstract] [Full Text HTML] [Full Text PDF]. J Int Med Res. 2017 Aug;45(4):1417-1429. doi: 10.1177/0300060517706800. Epub 2017 Jun 15.
