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Internal Medicine

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What are the indications for starting Allopurinol in patients with gout?

N G
Mazen Kherallah

Thank you for your answers.


The primary indications for pharmacologic urate-lowering therapy in gout include frequent or disabling flares, often defined as two or more annually, with the threshold for treatment potentially lower for patients experiencing severe, prolonged, or activity-interfering flares. Additionally, the presence of tophi and structural joint damage, evidenced by clinical or radiographic signs such as gouty bone erosion, polyarticular disease, and tophaceous deposits, necessitates this therapy. Furthermore, treatment should be individualized for patients at high risk of severe gout, considering factors such as high baseline serum urate levels, early onset of symptoms, genetic predisposition, medication intolerance, and ultrasound evidence of monosodium urate deposits or inflammation.

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